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Contact details: sam.jones@sheffield.ac.uk

UK PICOS United Kingdom Paediatric Intensive Care Outcome Study Outcomes at 6 months post-admission to paediatric intensive care: report of a national study of paediatric intensive care units in the United Kingdom . Contact details: sam.jones@sheffield.ac.uk.

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Contact details: sam.jones@sheffield.ac.uk

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  1. UK PICOSUnited Kingdom Paediatric Intensive Care Outcome StudyOutcomes at 6 months post-admission to paediatric intensive care: report of a national study of paediatric intensive care units in the United Kingdom Contact details: sam.jones@sheffield.ac.uk

  2. S Jones*, K Rantell*, K Stevens*, K Rowan#, C McCabe*, GJ Parry* *University of Sheffield, #ICNARC

  3. What is UK PICOS? • A nationwide multi-centre study funded by the MRC in 2001 to undertake a comprehensive study of the outcomes (mortality and morbidity) of children receiving paediatric intensive care in the United Kingdom • The aim was to measure the health status of children using the Health Utilities Index (HUI2), 6 months after admission to a paediatric intensive care unit (PICU) and to assess the relationship between this and measures of illness severity at admission

  4. Study participants • Twenty nine PICUs identified in the UK • Twenty three PICUs participated • One year data collection period • Over 12,000 admissions

  5. Data collected • Admission data, including medical history, reason for admission and illness severity as measured by PIM, PRISM & PRISM III • PICU outcome (died/survived) • Hospital outcome (died/survived) • Health status at 6 months as measured by HUI2 PIM: Paediatric Index of Mortality PRISM: Paediatric Risk of Mortality

  6. Health Utilities Index (HUI2) • A parent/guardian completed 15 item questionnaire providing measures on six dimensions of health: • Sensation (sight, hearing and speech) • Mobility(ability to move around without help) • Emotion(anxious or suffering from nightmares) • Cognition(ability to learn and remember) • Self-care(ability to wash, dress and bathe) • Pain(extent to which pain interferes with usual activities)

  7. Children included • All children who survived to PICU discharge were eligible (n = 10,533, 6% unit mortality) • Consent was obtained from 3842 admissions, of which 3042 survived to 6 months • HUI2 questionnaires sent to 2895 and returned from 2044 • Uncertainty of the validity of HUI2 in children <1 year of age led to their exclusion from this analysis • Final sample included 1246 children

  8. Characteristics of children with HUI2 data • 54% male • 54% unplanned admissions • 61% received mechanical ventilation • Median (quartiles) age at admission was 5.4 (2.1, 10.3) years • Median (quartiles) length of stay was 1.2 (0.8, 3.0) days Characteristics were similar for those who survived PICU, those who consented, those who returned a HUI2 and those who did not return a HUI2, e.g. the probability of mortality as measured using PIM was 0.026, 0.027, 0.025 & 0.026 respectively.

  9. Risk adjustment models • Used ordinal logistic regression models with a proportional odds assumption • Each dimension of the HUI2 was used as an outcome • Explanatory variables: probability of mortality as calculated using PIM, PRISM and PRISM III • Used the index of concordance (c-index) to assess model discriminatory power (analogous to the ROC area in binary outcomes)

  10. 80 60 % 40 20 0 1 2 3 4 Sensation level HUI2 Sensation

  11. HUI2 Mobility

  12. HUI2 Emotion

  13. HUI2 Cognition

  14. HUI2 Self-care

  15. HUI2 Pain

  16. Summary of results • Overall, 28% of children were in full health 6 months post admission to paediatric intensive care • PIM is associated with all HUI2 dimensions but has limited discriminatory power • PRISM and PRISM III are associated with some dimensions but also have limited discriminatory power • Additional potential explanatory variables are needed to develop adequate risk adjustments models

  17. Conclusions • Mortality following paediatric intensive care is currently around 6% in the UK • In determining the quality and performance of PICUs, it is important to take into account variations in the health status of survivors post discharge • Morbidity appears to be related to initial illness severity, however this information alone is insufficient to predict long term outcomes

  18. Conclusions • In attempting to develop policies to improve longer-term outcomes of children post paediatric intensive care, it may be important to also take into account factors such as co-morbidities, socioeconomic status and the quality of care received by children following discharge from intensive care

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