Acta Medica Okayama volume74 issue4
2020-08 発行

Comparison of Two Different Intensive Care Unit Systems for Severely Ill Children in Japan: Data from the JaRPAC Registry

Tsukahara, Kohei Department of Emergency, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Naitou, Hiromichi Department of Emergency, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kaken ID
Yorifuji, Takashi Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kaken ID researchmap
Nosaka, Nobuyuki Department of Pediatrics, Cedars-Sinai Medical Center
Yamamoto, Hirotsugu Department of Emergency, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Osako, Takaaki Department of Emergency, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Nakao, Atsunori Department of Emergency, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kaken ID
the JaRPAC Study Group
Publication Date
2020-08
Abstract
The importance of centralizing treatment services for severely ill children has been well established, but such entralization remains difficult in Japan. We aimed to compare the trauma and illness severity and mortality of children admitted to two common types of ICUs for children. According to the type of management and disposition of the medical provider, we classified ICUs as pediatric ICUs [PICUs] or general ICUs, and analyzed differences in endogenous and exogenous illness settings between them. Overall, 1,333 pediatric patients were included, with 1,143 patients admitted to PICUs and 190 patients to general ICUs. The Pediatric Cerebral Performance Category score (PCPC) at discharge was significantly lower in the PICU group (adjusted OR: 0.45; 95%CI: 0.23-0.88). Death and unfavorable neurological outcomes occurred less often in the PICU group (adjusted OR: 0.29; 95%CI: 0.14-0.60). However, when limited to exogenous illness, PCPC scores (adjusted OR: 0.38; 95%CI: 0.07-1.99) or death/unfavorable outcomes (adjusted OR: 0.72; 95%CI: 0.08-6.34) did not differ between the groups. PCPC deterioration and overall sequelae/death rates were lower in PICUs for children with endogenous illnesses, although the outcomes of exogenous illness were similar between the 2 unit types. Further studies on the necessity of centralization are warranted.
Document Type
Original Article
Keywords
kids
critical care
mortality
morbidity
centralization
Link to PubMed
Thumnail 74_4_285.pdf 1.96 MB