COMPARATIVE-ASSESSMENT OF PEDIATRIC INTENSIVE-CARE IN MOSCOW, THE RUSSIAN-FEDERATION - A PROSPECTIVE, MULTICENTER STUDY

Objective: Comparative assessment of pediatric intensive care, Design: Prospective multicenter study. Setting: Four pediatric intensive care units in Moscow, the Russian Federation. Patients: Consecutive unsele cted admissions (n = 583), less than or equal to 14 yrs of age, in a 6 -month period. Interventions: None. Measurements and Main Results: Eff ectiveness was defined as the ratio of observed to predicted mortality , based on prediction by Pediatric Risk of Mortality (PRISM) severity of illness scoring, Efficiency (on the day of admission only) depended on either a mortality risk of >1% or the administration of intensive care unit-dependent therapies. In all four hospitals, observed mortali ty rates were higher than expected, with a range of standardized morta lity ratios between 1.10 and 1.83 (mean 1.32), The excess mortality wa s found in the low- and medium-risk strata (risk of mortality of <1% t o 15%), Admission efficiency ratings did not fluctuate greatly between institutions (mean 60.4%, range 55.7 to 65.9). Conclusions: We provid ed a quantitative description and assessment of pediatric intensive ca re in Moscow, Moderate efficiency may reflect a low threshold for ICU admission due to poor nurse/patient ratios on the wards, Effectiveness in the low- and medium-risk strata is below standard, as compared wit h a Western reference population, Excess mortality was concentrated in the low- and medium-risk strata, and can only partially be explained by the inclusion of co morbidity. Future analysis should focus on spec ific treatment protocols, protocol adherence, and the determination of infectious and therapeutic complications.