COMPARATIVE-ASSESSMENT OF PEDIATRIC INTENSIVE-CARE - A NATIONAL MULTICENTER STUDY

Objective: Comparative assessment of performance of pediatric intensiv e care, Design: Open, prospective multicenter study, Setting: All pedi atric intensive care units (n = 10; six tertiary and four nontertiary) in the Netherlands, Patients: 1063 consecutive unselected admissions, less than or equal to 18 yrs old, during a 4-month period, Interventi ons: None, Measurements and Main Results: Effectiveness was defined as the ratio of observed to expected (Pediatric Risk of Mortality-score- derived) mortality, Efficiency was determined by two objective criteri a: mortality risk of >1%, or administration of at least one intensive care unit (ICU)-dependent therapy. In the total population, observed a nd expected mortality rates were similar, Between hospitals, crude mor tality showed wide variations (mean 7.1%, range 1% to 10%), However, i n each center, observed and expected mortality rates were similar (mea n ratio of observed/expected mortality 0.99, range 0.8 to 1.5), In ter tiary care centers, severity of illness-corrected mortality rates in h igh-risk patients were less than in a United States reference populati on, Paradoxically, in low-risk tertiary care patients, the observed mo rtality rate was higher than expected, The relatively high mortality r ate in this group is probably the result of the large number of low-ri sk tertiary care patients suffering from severe, incurable chronic dis ease, The average number of efficient ICU days was 72%, although large fluctuations between units were found (range 22% to 95%), suggesting that in several centers efficiency rates might be improved by a better selection of high-risk patients requiring ICU-dependent therapies, Co nclusions: Differences in mortality rates among pediatric ICUs were la rgely explained by differences in severity of illness, High efficiency rates combined with adequate effectiveness were found in several cent ers, indicating that admission and discharge decisions might be improv ed in less efficient centers.