Case fatality of critically ill children treated in pediatric versus adult intensive care units in Germany: a nationwide cohort study
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Purpose
Outcome consequences of critically ill children treated outside of pediatric intensive care units (PICU) are unknown. We assessed case fatality of children receiving complex intensive care treatment (CICT) by treating department in Germany and explored reasons for admission to adult intensive care units (AICU).
Methods
Retrospective study using the German nationwide hospital discharge dataset 2016 to 2023. Cases aged ≥ 28 days and < 18 years receiving CICT were classified as PICU, AICU, or interdisciplinary by department codes. Odds ratios (OR) for in-hospital case fatality were estimated in generalized linear mixed models with the hospital as random effect, adjusted for age, acute organ dysfunction, and chronic conditions. Excess deaths were estimated and a survey among pediatric and adult intensivists was analyzed qualitatively.
Results
Of 143,034 cases, 67.8 % were treated in PICUs, 14.0 % in AICUs, and 18.2 % were interdisciplinary. The crude OR for death in PICUs versus AICUs was 1.14 (95 % CI 1.03 to 1.26), reversing to 0.73 (0.63 to 0.84) after adjustment. For PICU and interdisciplinary cases combined versus AICU, the fully adjusted OR was 0.61 (0.54 to 0.70). Estimated excess deaths across the study period were 100, rising to 191 when interdisciplinary cases counted as pediatric. Capacity constraints, organizational factors, and clinical expertise were the main domains underlying AICU admissions.
Conclusions
Children treated outside of PICUs had higher risk-adjusted case fatality, while crude figures pointed in the opposite direction. The findings support treating critically ill children in settings with routine pediatric intensive care experience.
Take-home message
In a nationwide analysis of 143,034 children receiving complex intensive care treatment in Germany, risk-adjusted case fatality was higher for children treated in adult intensive care units, while the unadjusted comparison pointed in the opposite direction. Admission to adult units was driven by capacity, organizational factors, and available expertise, indicating that the place where critically ill children are treated is a modifiable determinant of outcome.
Tweet
Nationwide German data: children treated in adult ICUs had higher risk-adjusted case fatality than in PICUs.
