Pediatric Critical Care Medicine最新文献

{"title":"The Phoenix Sepsis Score Criteria in Critically Ill Children: Evaluation Using a Retrospective, Single-Center PICU Cohort in China, 2019-2024.","authors":"Jiaqian Fan, Haoran Shen, Lvchang Zhu, Zehua Wu, Sheng Ye, Qiang Shu, Qixing Chen","doi":"10.1097/PCC.0000000000003833","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003833","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the Phoenix Sepsis Score (PSS) and criteria in PICU children with suspected or confirmed infection. Additionally, to assess PSS performance in relation to in-hospital mortality.</p><p><strong>Design: </strong>Retrospective data from a 2019-2024 cohort.</p><p><strong>Setting: </strong>Single-center, multidisciplinary, tertiary PICU in China.</p><p><strong>Patients: </strong>In 2584 patient encounters, 0-18 years old, there were 2396 separate encounters with suspected or confirmed infection.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The PSS was calculated as the sum of four organ subscores (respiratory, cardiovascular, neurologic, and coagulation) using the worst post-admission data from the first 24 hours. Sepsis was defined as a PSS greater than or equal to 2 points and septic shock as sepsis with greater than or equal to 1 point in the cardiovascular subscore. In 2396 patient encounters with suspected or confirmed infection, 1261 (52.6%) with sepsis had a 19.9% (251/1261) mortality rate, and 573/1261 (45.4%) with septic shock had a 34.9% (200/573) mortality rate. Nonsurvival vs. survival was associated with higher median (interquartile range [IQR]) PSS (5 points [IQR, 3-7 points] vs. 2 points [IQR, 2-3 points]; p < 0.001). Also, in-hospital mortality rate increased with progressively higher PSS points. A PSS greater than or equal to 2 points had an area under the receiver operating characteristic curve of 0.81 (95% CI, 0.78-0.84) for in-hospital mortality. Comparison with the International Pediatric Sepsis Consensus Conference (IPSCC) criteria or the pediatric Sequential Organ Failure Assessment (pSOFA) score showed that the PSS had better performance in identifying death rate for those patients with sepsis and for those with septic shock.</p><p><strong>Conclusions: </strong>In our single-center PICU cohort (2019-2024) from China, among patient encounters with suspected or confirmed infection, the PSS showed good discriminatory ability in identifying sepsis or septic shock. It also outperformed the IPSCC criteria and the pSOFA score in classifying in-hospital mortality. These analyses support the potential utility of the PSS for risk stratification in our international PICU setting.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Body Size on Stroke Volume Response to Passive Leg Raising in Spontaneously Breathing Children.","authors":"Carlos Ocaña-Alcober, Ignacio Oulego-Erroz, Daniel Palanca-Arias, Almudena Alonso-Ojembarrena, Juan José Menéndez-Suso, José Luis Vázquez-Martínez","doi":"10.1097/PCC.0000000000003828","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003828","url":null,"abstract":"<p><strong>Objectives: </strong>To test whether indexing stroke volume change (ΔSV%) to body size during the passive leg raising (PLR) test in spontanoeusly breathing children improves accuracy to detect fluid responsiveness (FR).</p><p><strong>Design: </strong>Observational study.</p><p><strong>Setting: </strong>Two pediatric hospitals.</p><p><strong>Patients: </strong>Children 2-16 years old.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In study phase 1, we measured ΔSV% by echocardiography during PLR in healthy children. A positive PLR test was defined as a mean ΔSV% greater than or equal to 10%. The correlation between ΔSV% with body size parameters was assessed, and optimal body size indexation was generated. In study phase 2, the PLR was performed in acutely ill children before a fluid challenge of 20 mL/kg of normal saline. ΔSV% was measured at 10 and 20 mL/kg and FR was defined as ΔSV% greater than or equal to 10% or greater than or equal to 15% (four possible definitions of FR). The diagnostic performance of the PLR using nonindexed and indexed ΔSV% to identify FR was assessed using the area under the receiver operating characteristic curve (AUC) analyses. We recruited 133 and 87 children in phase 1 and 2, respectively. Mean ΔSV% and the proportion of positive PLR test increased with age tertiles both in healthy children and children receiving a fluid challenge (p ≤ 0.01). ΔSV% positively correlated with body size. Indexing by height (i.e., [ΔSV%/0.0006] × height2.493) removed the effect of body size. The AUC of the PLR for FR ranged from 0.745 to 0.802, depending on the FR definition applied. The use of height-indexed ΔSV% improved diagnostic performance (AUC range, 0.852-0.894) compared to non-indexed ΔSV%, although the result was significant only when FR was defined as ΔSV% greater than 15% after 20 mL/kg (DeLong test < 0.05).</p><p><strong>Conclusions: </strong>The response in ΔSV% to a PLR is greatly influenced by body size. Indexing the value by height may improve the diagnostic performance of the PLR in children.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return-to-Care After Discharge Directly Home From the PICU: A Propensity-Matched Cohort Study.","authors":"Leslie A Dervan, Julia A Heneghan, Matt Hall, Daniel H Choi, Adam C Dziorny, Denise M Goodman, Jason M Kane, Joseph G Kohne, Colin M Rogerson, Vanessa Toomey, Daniel Garros, Nadia Roumeliotis","doi":"10.1097/PCC.0000000000003830","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003830","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the proportion of PICU patients returning to the emergency department (ED) or readmitted within 14 days of hospital discharge, between those discharged directly home from the PICU and those transferred to acute care before discharge home; we hypothesized that rates of return-to-care would be similar.</p><p><strong>Design: </strong>Propensity-matched multicenter cohort study.</p><p><strong>Setting: </strong>Forty-five U.S. hospitals participating in Pediatric Health Information Systems.</p><p><strong>Patients: </strong>Children admitted to a non-neonatal cardiac or PICU from 2016 to 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 560,815 PICU discharges, 150,126 (26.8%) were discharged directly home, although this proportion varied by center (9.8-55.6%). We matched 94,048 children (62.6%) discharged directly home to 153,887 ward-transferred children at admission year, admission type, principal diagnosis, and a propensity score estimating the likelihood of being discharged directly home. Compared with ward-transferred peers, children discharged directly home had similar rates of return-to-ED care (2.9% vs. 3.0%; odds ratio [OR], 0.94 [0.89-0.99]) and hospital readmission (4.8% vs. 4.9%; OR, 0.97 [0.94-1.01]) within 14 days. Once readmitted, however, children discharged directly home were more likely to be readmitted to a PICU (2.4% vs. 1.6%; OR, 1.58 [1.49-1.67]). Costs for the index hospitalization were lower for children discharged directly home compared with ward-transferred peers, leading to lower inpatient healthcare costs over 14 days (median, 15,023 [7,614.5-34,294.6] vs. 30,750 [14,558.3-68,830.6]; p ≤ 0.001).</p><p><strong>Conclusions: </strong>Discharge directly home from the PICU is common; children discharged directly home have comparable likelihood of return-to-ED or inpatient care as matched, ward-discharged peers. Discharge directly home for appropriate patients may provide increased efficiency for healthcare systems.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Mechanical Ventilation for Children With Medical Complexity Undergoing Spinal Fusion: A Pediatric Health Information System Database, 2016-2021 Cohort.","authors":"Jennifer M Perez, Matt Hall, Robert J Graham, Jay G Berry","doi":"10.1097/PCC.0000000000003827","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003827","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the prevalence and factors associated with duration of postoperative invasive mechanical ventilation (IMV) in children with medical complexity undergoing spinal fusion.</p><p><strong>Design: </strong>Retrospective cohort study of the Pediatric Health Information System database.</p><p><strong>Setting: </strong>Forty-seven tertiary referral U.S. children's hospitals.</p><p><strong>Patients: </strong>Patients 5-18 years old with an underlying neuromuscular or genetic disorder admitted to the ICU following thoracic-lumbar spinal fusion for scoliosis, with hospital discharge between January 1, 2016, and December 31, 2021.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 6511 patients who met inclusion criteria, of which 438 (6.7%) had established preoperative tracheostomy and ventilator dependence. Three hundred seventy-two (5.7%) and 458 (7%) patients underwent postoperative IMV for 4-6 days and greater than or equal to 7 days, respectively. Chronic conditions associated with greater odds of greater than or equal to 4 days of postoperative IMV (as shown by adjusted odds ratio [aOR, 95% CI]), included diseases affecting the following systems: neurologic (aOR, 3.5; 95% CI, 2.5-5.0), respiratory (aOR, 2.8; 95% CI, 2.3-3.5), skin/subcutaneous tissue (aOR, 1.5; 95% CI, 1.2-2.1), hematologic (aOR, 1.4; 95% CI, 1.1-1.7), endocrine/metabolic (aOR, 1.3; 95% CI, 1.1-1.6), genitourinary (aOR, 1.3; 95% CI, 1.1-1.7), and cardiac (aOR, 1.3; 95% CI, 1.0-1.7). Established preoperative tracheostomy was associated with lower odds of greater than or equal to 4 days of postoperative IMV (aOR, 0.1; 95% CI, 0.02-0.3). New tracheostomy procedures were uncommon (n = 43, 0.7%). Finally, there was substantial regional variation in postoperative IMV after spinal fusion, with patients in the Northeast vs. Midwest region having greater odds of greater than or equal to 4 days of postoperative IMV (aOR, 3.1; 95% CI, 1.9-5.0).</p><p><strong>Conclusions: </strong>One-in-eight children required greater than or equal to 4 days of IMV after spinal fusion. Chronic conditions affecting the neurologic, respiratory, skin/subcutaneous tissue, hematologic, endocrine/metabolic, genitourinary, and cardiac systems were associated with postoperative IMV. Further understanding of chronic conditions, clinical characteristics, and regional factors associated with duration of IMV may identify opportunities for improvements in care delivery.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Cohort Study of Emergency Department to PICU Transfers: Emergency Department Factors Associated With Delirium Development Within 24 Hours of Hospitalization.","authors":"Tomas Leng, Hanin H Ali, Justin E McKone, Georgia Sullivan, Travis R Kirkpatrick, James L Homme, Yu Kawai","doi":"10.1097/PCC.0000000000003824","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003824","url":null,"abstract":"<p><strong>Objectives: </strong>Many PICU admissions start with presentation in the emergency department (ED). However, we do not know whether there are any ED-related factors associated with the subsequent development of pediatric delirium (PD) within 24 hours of PICU admission.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single-center ED and PICU serving a quaternary referral center in the United States.</p><p><strong>Patients: </strong>Children younger than 18 years old presenting to the ED between January 2022 and December 2023 who required direct admission to the PICU, and who had at least one positive delirium screening within 24 hours of the admission.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The presence of delirium in the PICU was defined as a Cornell Assessment of Pediatric Delirium (CAPD) score of 9 and higher. We identified 138 patients for the final analysis. Overall, 51 of 138 patients (37%) developed PD within 24 hours of admission. The majority of delirium cases were classified as hypoactive (53%, 27/51) and mixed (31%, 16/51) subtypes, while only 16% (8/51) were identified as hyperactive delirium. Factors associated with greater odds (95% CI) of delirium in the PICU in multivariable analysis were use of mechanical ventilation (odds ratio [OR], 3.42 [95% CI, 1.09-10.78]; p = 0.04) and intermittent urinary catheterization (OR, 3.7 [95% CI, 1.21-11.30]; p = 0.02). Initial CAPD score positively correlated with PICU length of stay (LOS; r = 0.32; p < 0.01), Pediatric Index of Mortality 3 (PIM 3) score (r = 0.26; p < 0.01), and negatively correlated with emergency severity index (ESI) in the ED (r = -0.35; p < 0.01).</p><p><strong>Conclusions: </strong>Mechanical ventilation and intermittent urinary catheterization in the ED are associated with greater odds of PD within 24 hours of PICU admission. CAPD at admission positively correlates with PICU LOS, PIM 3 scores, and negatively correlates with ESI in the ED.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Let-Down Reflex: New Motherhood, One Drop at a Time.","authors":"Lauren Rissman, Rachel Ashworth","doi":"10.1097/PCC.0000000000003829","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003829","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of Death in Children Referred for Intensive Care With Sepsis: Comparison of Two Cohorts in the United Kingdom, 2005-2011 vs. 2018-2023.","authors":"Maile Wedgwood, Elise Randle, Maik Honsel, Padmanabhan Ramnarayan, Mark J Peters","doi":"10.1097/PCC.0000000000003825","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003825","url":null,"abstract":"<p><strong>Objective: </strong>To review the timing of death in children with sepsis referred for intensive care, 2018-2023, and compare with our previous 2005-2011 practice. We hypothesized that most deaths occur within 24 hours of referral to the PICU, with many before PICU admission.</p><p><strong>Design, setting, and patients: </strong>We reviewed referrals to the Children's Acute Transport Service (CATS), North Thames regional pediatric intensive care transport service in the United Kingdom, between January 2018 and March 2023. We included referrals of children (younger than 16 yr) with a working diagnosis of \"sepsis,\" \"severe sepsis,\" \"septicemia,\" or \"septic shock.\" The primary outcome measure was time to death up to a year after referral.</p><p><strong>Measurements and main results: </strong>Over the 62-month study period, 11,231 referrals were made to CATS, and 330 (3%) met the study inclusion criteria. Outcome data were available on 272, of whom 29 (11%) died in the first year after referral, which compares favorably with our 2005-2011 cohort from the same service in which the 1-year mortality was 21% (130/627): mean difference 10% (95% CI, 4.8-14.6%), p value equals 0.0003. Eighteen of the 29 deaths occurred in the first 24 hours after referral. Amongst children with comorbidities 12 of 139 (9%) died compared to 6 of 133 (5%) previously healthy children (p = 0.22 Fisher exact test, odds ratio [OR] 2.0 with 95% CI, 0.73-5.5). By 1 year, mortality in children with comorbidities was 19 of 139 (13.9%) vs. mortality in previously healthy children of 10 of 133 (7.5%) (p = 0.12; OR 1.8 [95% CI, 0.82-4.1]).</p><p><strong>Conclusions: </strong>In 2018-2023, the proportion of referrals for PICU retrieval with a clinical diagnosis of \"sepsis\" was low at 3%. As with our 2005-2011 cohort, most deaths occurred within 24 hours of first referral. Therefore, early recognition and resuscitation still have the greatest potential for improving sepsis outcomes, which has implications for clinical trials.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of Intracranial Hypertension and Patterns of Brain Injury on MRI: Secondary Analysis of the 2014-2017 \"Approaches and Decisions for Acute Pediatric TBI\" Study.","authors":"Anna M Janas, Aimee T Broman, Tellen D Bennett, Susan Rebsamen, Aaron S Field, Bedda L Rosario, Michael J Bell, Andrew L Alexander, Peter A Ferrazzano","doi":"10.1097/PCC.0000000000003823","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003823","url":null,"abstract":"<p><strong>Objectives: </strong>Elevated intracranial pressure (ICP) is a complication of severe traumatic brain injury (TBI) that carries a risk of secondary brain injury. This study investigated the association between ICP burden and brain injury patterns on MRI in children with severe TBI.</p><p><strong>Design, setting, and patients: </strong>Secondary analysis of the Approaches and Decisions in Acute Pediatric TBI (ADAPT) study, which included children with severe TBI (Glasgow Coma Scale score < 9) who received a clinical MRI within 30 days of injury. We excluded patients who had ICP monitoring less than 24 hours, were missing ICP data for greater than 40% of monitoring time, or who underwent craniectomy.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>ICP burden was defined as the trapezoidal area under the curve of hourly ICP greater than 20 mm Hg. ICP was standardized to total monitoring time, and patients were categorized to four levels of ICP burden. MRI was evaluated for number of diffuse axonal injury (DAI) microhemorrhages, intracerebral hemorrhage (ICH) volume, contusion volume, and number of regions with ischemia. Fisher exact or chi-square tests were used to test the independence between ICP burden and MRI injury amount. Of the 220 patients, 156 (71%) had DAI, 31 (14%) had ICH, 161 (73%) had contusions, and 70 (32%) had ischemia on MRI. Most patients (180, 82%) experienced episodes of ICP greater than 20 mm Hg. Contusion volume (p = 0.02) and number of regions with ischemia (p = 0.007) were associated with ICP burden, but we failed to identify such an association for DAI or ICH. Severe (but not mild or moderate) ICP burden was associated with presence of ischemia (odds ratio, 4.64 [95% CI, 1.30-19.5]; p = 0.02).</p><p><strong>Conclusions: </strong>Elevated ICP was prevalent in the ADAPT cohort. Ischemia and contusion were associated with the burden of ICP. Further research is needed to determine temporal relationships between elevated ICP and ischemia.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurocritical Care Entrustable Professional Activities for Pediatric Critical Care Medicine Education and Professional Development: Standardizing Curriculum, Training, and Assessment.","authors":"Andrew E Becker, Nicholas S Abend, Giulia M Benedetti, Sandra D W Buttram, Melissa G Chung, Jennifer C Erklauer, Stuart H Friess, Sue J Hong, Jimmy Huh, Matthew P Kirschen, Kerri L LaRovere, Marlina E Lovett, Michelle E Schober, Kristen A Smith, Katie Wolfe, Adrian D Zurca, Alexis A Topjian, Donald L Boyer","doi":"10.1097/PCC.0000000000003818","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003818","url":null,"abstract":"<p><strong>Objective: </strong>To develop a set of pediatric neurocritical care (PNCC) entrustable professional activities (EPAs) for pediatric critical care medicine (PCCM).</p><p><strong>Design: </strong>Survey and Delphi methodology in a panel of experts from the Pediatric Neurocritical Care Research Group (PNCRG) and the Education in Pediatric Intensive Care (EPIC) Research Collaborative.</p><p><strong>Setting: </strong>Interprofessional local focus group, national focus group, and subsequent national multi-institutional, multidisciplinary expert panel in the United States.</p><p><strong>Subjects: </strong>The interprofessional local group of 23 members carried out work March 2022 to June 2022 and the national group of 19 members October 2022 to November 2022. Subsequently, 38 physicians from the PNCRG and EPIC networks carried out work December 2022 to August 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>First, a preliminary set of 15 PNCC EPAs was developed by two local and national interprofessional groups. The EPAs were based on the American Board of Pediatrics (ABP) practice analysis for PCCM, the ABP PCCM content outline, and stakeholder opinion. Next, a panel of critical care, neurology, and education experts used Delphi methodology to generate consensus, edit, and finalize the EPAs, with content validity. All EPAs were edited; two were deemed non-essential and not included in the final set of 13 EPAs. The EPAs fit three categories: general management and principles; disease-specific management; and neuroprognostication and end-of-life care. Consensus was reached after three Delphi rounds, with response rates of 31 of 38, 29 of 31, and 29 of 31, respectively. The final set of EPAs was approved by 30 respondents (response rate 30/31), with content validity indices 0.81-1.00.</p><p><strong>Conclusions: </strong>The 2024 set of 13 EPAs are intended to be a valuable framework for competency-based curriculum and assessment to ensure consistent PCCM proficiency in the provision of neurocritical care while also promoting standardization in curriculum development for PCCM fellowship trainees.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urine Output Trajectories and Dialysis Independence in Critically Ill Children With Acute Kidney Injury: A Single-Center Retrospective Cohort Study, 2014-2023.","authors":"Yusuke Tokuda, Kentaro Ide, Junichiro Morota, Eisaku Nashiki, Kentaro Nishi, Mai Miyaji, Masanori Tani, Shotaro Matsumoto, Satoshi Nakagawa","doi":"10.1097/PCC.0000000000003826","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003826","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether the urine output trajectory is associated with dialysis independence in critically ill children with acute kidney injury (AKI).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>A PICU in Japan.</p><p><strong>Patients: </strong>Children younger than 16 years old who received continuous kidney replacement therapy (CKRT) for AKI between July 1, 2014, and June 30, 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 61 eligible patients, including 16 patients who remained dialysis-dependent 30 days after CKRT initiation. Compared with dialysis-independent patients, dialysis dependence was associated with lower urine output on days 3, 7, 14, and 21 after CKRT initiation. Dialysis independence, when compared with dialysis dependence, was associated with higher median (interquartile range) urine output (mL/kg/hr) at each timepoint (day 3: 0.3 [0.1-1.6] vs. 0.0 [0-0.2]; p = 0.001; day 7: 1.3 [0.4-2.0] vs. 0.0 [0-0.1]; p < 0.001; day 14: 1.8 [1.0-3.5] vs. 0.0 [0-0; p < 0.001]; and day 21: 2.1 [1.1-3.0] vs. 0.0 [0-0]; p < 0.001). The area under the receiver operating characteristic curve (AUROC with 95% CI) for identifying dialysis independence at day 30 after CKRT initiation, based on urine output on day 14, was 0.96 (95% CI, 0.88-1.00). Using the DeLong test, this AUROC was higher than that on day 7 (0.88 [95% CI, 0.77-0.99]; p = 0.009). Also, on day 14, with a pre-test probability of dialysis independence of 71%, the post-test probability increases to 97% when using a test urine output greater than or equal to 0.41 mL/kg/hr. The sensitivity analysis with the exclusion of neonates yielded similar results.</p><p><strong>Conclusions: </strong>In this 2014-2023 cohort of critically ill children with AKI supported with CKRT, using a urine output greater than or equal to 0.41 mL/kg/hr on day 14, CKRT may be an effective diagnostic test of dialysis independence on day 30. Further validation studies are needed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}