Pediatric Critical Care Medicine最新文献

{"title":"Physical Activity Monitoring in Children in the 1-Year After 3 or More Days of Invasive Ventilation: Feasibility of Using Accelerometers.","authors":"Aline B Maddux, Kristen R Miller, Yamila L Sierra, Tellen D Bennett, R Scott Watson, Matthew Spear, Laura L Pyle, Peter M Mourani","doi":"10.1097/PCC.0000000000003657","DOIUrl":"10.1097/PCC.0000000000003657","url":null,"abstract":"<p><strong>Objectives: </strong>To measure physical activity in a cohort of children who survived greater than or equal to 3 days of invasive ventilation.</p><p><strong>Design: </strong>Prospective cohort study (2018-2021).</p><p><strong>Setting: </strong>Quaternary children's hospital PICU.</p><p><strong>Patients: </strong>Children (2-17 yr old) without a preexisting tracheostomy who were ambulatory pre-illness and received greater than or equal to 3 days of invasive ventilation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We measured duration and intensity of physical activity using hip- (< 6 yr old) or wrist- (≥ 6 yr old) worn ActiGraph GT3XP-BTLE accelerometers (ActiGraph, Pensacola, FL) for 7 days at three timepoints: hospital discharge, 3 months, and 12 months post-discharge. We measured duration of moderate or vigorous physical activity (MVPA) and nonsedentary activity, both characterized as percent of total awake wear time and total minutes per day. We categorized participants based on when they first attained a \"high activity\" day defined as greater than or equal to 60 minutes of MVPA or a day with percent of MVPA in the top quartile of all days measured. We evaluated 55 children of whom 43 (78%) had data from greater than or equal to 1 timepoint including 19 (35%) with data from all timepoints. Maximum daily MVPA increased across the three post-discharge timepoints (median, 16.0 min [interquartile range (IQR), 8.0-42.8 min], 48.3 min [27.8-94.3 min], and 68.4 min [34.7-111.0 min], respectively) as did maximum daily percent of awake wear time in MVPA (median, 4.3% [IQR, 2.8-9.0%], 10.1% [5.7-14.4%], and 11.1% [7.1-17.5%], respectively). Of the 43 participants, 27 achieved a high activity day: nine of 43 during the hospital discharge period, 14 of 43 during the 3 months post-discharge period, and four of 43 during the 12 months post-discharge period; 16 of 43 did not demonstrate high activity during the post-discharge year.</p><p><strong>Conclusions: </strong>In the 1-year after PICU discharge measuring physical activity with accelerometers in children 2-17 years old is feasible. Furthermore, demonstration of variable recovery trajectories in our pilot cohort suggests it has potential to be an outcome measure in clinical trials.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 3","pages":"e324-e333"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Sepsis Phenotype in a Single-Center Cohort Covering 2010-2020: Evolution in Day 1-Day 3 Trajectory and Potential Prognostic Value.","authors":"Zachary Aldewereld, Christopher Horvat, Gilles Clermont","doi":"10.1097/PCC.0000000000003708","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003708","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the utility of day 3 sepsis phenotype classifications compared with day 1 and whether these could be reliably identified using routine clinical data on day 1.</p><p><strong>Design: </strong>Retrospective cohort study of pediatric patients managed 2010-2014 and 2018-2020.</p><p><strong>Setting: </strong>Academic children's hospital.</p><p><strong>Patients: </strong>One thousand eight hundred twenty-eight children (1 mo to 18 yr old) admitted to the PICU with suspected infection who received a minimum of 7 days of systemic antibiotics.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Subjects showed significant evolution of phenotype from day 1 to day 3, with 31.7-60.9% remaining the same type. Outcomes were worst in those classifying as type D on day 3, with mortality as high as 16.6% in those that were classified as type D on both days 1 and 3, as well as 11.3% in those initially classified as type C (a lower mortality type) on day 1 but type D on day 3. Accurate statistical prediction of day 3 types using multinomial logistic regression and random forest and day 1 data was poor, despite attempts to improve performance.</p><p><strong>Conclusions: </strong>In our retrospective cohort of patients with sepsis, we identified significant evolution in phenotype over the first 3 days of illness. Day 3 phenotypes may provide more accurate statistical prediction of outcomes, but identification of day 3 phenotypes using data available early in the course of illness is challenging. New methods will likely be required to improve performance in this area.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524091","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":"Outcomes of Pediatric Venovenous Extracorporeal Membrane Oxygenation Using Dual-Lumen or Multisite Cannulation: Extracorporeal Life Support Database Study, 2000-2019.","authors":"Jessica A Barreto, Pingping Qu, Ravi R Thiagarajan, John K McGuire, Thomas V Brogan","doi":"10.1097/PCC.0000000000003713","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003713","url":null,"abstract":"<p><strong>Objectives: </strong>In children reported to the Extracorporeal Life Support Organization (ELSO) registry, to compare mortality, the need for additional cannulas, and complications associated with dual-lumen (DL) or multisite cannulation for venovenous extracorporeal membrane oxygenation (ECMO).</p><p><strong>Design: </strong>Multicenter retrospective study using the ELSO registry.</p><p><strong>Setting: </strong>Centers reporting to ELSO between January 1, 2000, and December 31, 2019.</p><p><strong>Patients: </strong>Children 28 days to 18 years old supported with venovenous ECMO.</p><p><strong>Interventions: </strong>We performed univariate and multivariable regression analyses to determine the association between venovenous ECMO cannulation strategy and in-hospital mortality, ECMO duration, and need for additional cannulas. We also compared the frequency of venovenous ECMO complications using univariate analysis.</p><p><strong>Measurements and main results: </strong>We identified a cohort of 2034 patients, of whom 1441 (71%) were supported with DL. Support with DL, as opposed to multisite cannulation, was associated with median (interquartile range) of younger age (23 mo [6-89 mo] vs. 147 mo [64-189 mo]; p < 0.001). We failed to identify an association between in-hospital mortality and whether DL or multisite cannulation had been used (393/1441 [27%] vs. 184/593 [31%]); unadjusted and adjusted risk ratio (aRR) of death using DL as the reference group of 1.1 (95% CI, 0.7-1.9; p = 0.70). The other analyses failed to identify an association between cannulation type, ECMO duration, and the use of additional cannulas. ECMO complications were similar except for more frequent neurologic determination of death in the multisite group.</p><p><strong>Conclusions: </strong>In the 2000-2019 ELSO pediatric dataset, we failed to identify an association between venovenous ECMO cannulation type-DL or multisite-and greater aRR of ECMO outcomes.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524089","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":"Extubation Practices and Outcomes During Pediatric Respiratory Extracorporeal Membrane Oxygenation: Analysis of the Extracorporeal Life Support Organization Registry, 2018-2022.","authors":"Christina R Rufener, Zaineb Boulil, Denise M Suttner, David K Werho, Helen A Harvey, Erica I Bak, Nicole O'Brien, Sapna R Kudchadkar, Nicole G Coufal","doi":"10.1097/PCC.0000000000003711","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003711","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the outcomes associated with extubation during extracorporeal membrane oxygenation (ECMO) in pediatric patients.</p><p><strong>Design: </strong>Retrospective cohort study using the Extracorporeal Life Support Organization (ELSO) registry, 2018-2022.</p><p><strong>Setting: </strong>Multicenter and international database of all ECMO centers in the ELSO registry.</p><p><strong>Patients: </strong>Patients between 30 days and 18 years old receiving pulmonary ECMO support.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Overall, 2178 patients were included, of which 105 were extubated during ECMO support (4.8%). Analysis of pre-ECMO data failed to identify an association between extubation strategy and severity using the Pediatric Pulmonary Rescue with ECMO Prediction (P-PREP) score. Use of extubation, vs. not, was associated with older age (median, 6.1 vs. 2.5 yr; p = 0.006), and longer ECMO duration (median 12.9 vs. 7.1 d; p < 0.0001). We failed to identify an association between the use of extubation, vs. not, and ECMO complications. In a propensity matching analysis with 3:1 matching of nonextubated to extubated cases, mortality was 34.3% and 43.8%, respectively (p = 0.08). In the matched subset, extubation, vs. not, was associated with shorter median PICU length of stay (LOS) after decannulation (6.6 vs. 12.2 d; p = 0.001) and higher use of mobilization (28.6% vs. 9.8%; p < 0.0001). In a multivariable analysis, we failed to identify an association between using the extubation strategy, vs. not, and greater odds of mortality (odds ratio, 1.74; 95% CI, 0.94-3.27; p = 0.08). However, we cannot exclude the possibility that the use of an extubation strategy is associated with greater odds of mortality.</p><p><strong>Conclusions: </strong>In the 2018-2022 ELSO registry data, extubating pediatric patients on ECMO for pulmonary cause was an uncommon practice, associated with improved mobility and decreased ICU LOS after ECMO decannulation. However, given the concerns about mortality, careful consideration of patient candidacy and further studies are needed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458811","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":"Sepsis in Critically Ill Children in Bolivia: Multicenter Retrospective Evaluation of the Phoenix Criteria for Sepsis in a 2023 Cohort.","authors":"Raul Copana-Olmos, Nils Casson-Rodriguez, Willmer Diaz-Villalobos, Victor Urquieta-Clavel, Mary Tejerina-Ortiz, Carol Mendoza-Montoya, Maricruz Fernandez-Vidal, Mariel Forest-Yepez, Danny Blanco-Espejo, Ibeth Rivera-Murguia, Claudia Castro-Auza, Milenka Gamboa-Lanza, Jhovana E Paco-Barral, Gustavo Choque-Osco, Betzhi Vera-Dorado, Magbely Cuellar-Gutierrez, Alan J Sarmiento-Zurita, Michelle G Carrillo-Vargas, Brisa W Ledezma-Hurtado, L Nelson Sanchez-Pinto","doi":"10.1097/PCC.0000000000003714","DOIUrl":"10.1097/PCC.0000000000003714","url":null,"abstract":"<p><strong>Objectives: </strong>We evaluated the Phoenix criteria and the Phoenix Sepsis Score in a multicenter retrospective cohort of critically ill children with a clinical diagnosis of sepsis or septic shock in Bolivia. In addition, we aimed to assess whether management in a PICU at high altitude in the Bolivian Andes was associated with the performance of the respiratory dysfunction component in the Phoenix Sepsis Score.</p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Fourteen PICUs in Bolivia.</p><p><strong>Patients: </strong>Children admitted to the PICU with a clinical diagnosis of sepsis or septic shock from January 2023 to December 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 273 patients with a diagnosis of sepsis in 2023, of which 257 (94.1%) met the 2024 Phoenix criteria for sepsis, and 166 (60.8%) met the systemic inflammatory response syndrome (SIRS)-based criteria for sepsis. Among the 257 patients meeting Phoenix sepsis criteria, 86 died (33.5%). Of the patients with Phoenix-based sepsis, there were 100 of 257 (38.9%) who were SIRS-negative, and 27 of 100 died (27.0%). After correcting the oxygenation indices for altitude, 149 of 273 patients (54.6%) had a lower Phoenix respiratory score and an associated mortality more consistent with the expected mortality of the newly derived subscore. Patients at higher altitudes had higher hemoglobin levels and higher estimated oxygen carrying capacity, and these data were independently associated with lower odds of mortality after controlling for altitude-corrected Phoenix score.</p><p><strong>Conclusions: </strong>In this 2023, retrospective cohort of PICU patients with sepsis in Bolivia, we have found that the majority met the 2024 Phoenix sepsis criteria, but less than two-thirds met the SIRS-based criteria for diagnosis. However, the respiratory score in the Phoenix criteria overestimated the severity of respiratory dysfunction in more than half of the cohort, likely because the score does not take account of the Andean adaptation to high altitude, with higher oxygen carrying capacity.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458841","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":"A Music Producer's Perspective on the ICU: It Is All About Dynamic Range Compression.","authors":"Otto F Bem, Reinout A Bem","doi":"10.1097/PCC.0000000000003710","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003710","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458810","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":"Temporary Femoral Central Venous Catheters in the PICU: Two-Center, Retrospective Cohort Study of Catheter Tip Position and Symptomatic Venous Thromboembolism, 2016-2021.","authors":"Ryan J Good, Emily Ahern, Mark D Weber, Kristen R Miller, Mackenzie DeVine, Sanjiv D Mehta, Thomas W Conlon, Adam S Himebauch","doi":"10.1097/PCC.0000000000003700","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003700","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to determine the frequency and variables associated with low femoral central venous catheter (fCVC) tip position. We also examined the association between tip position and symptomatic venous thromboembolism (VTE).</p><p><strong>Design: </strong>Retrospective cohort from two PICUs.</p><p><strong>Setting: </strong>Quaternary academic children's hospitals, 2016-2021.</p><p><strong>Patients: </strong>Children (age <18 yr) in the PICU who underwent temporary fCVC placement.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Low fCVC tip position occurs when the tip is inferior to the fifth lumbar vertebra (L5) on a postprocedural abdominal radiograph. Of 936 patients: 56.3% were 1-12 years old, and 80.0% had normal weight-for-age z score. fCVC tip position was low in 67.3% of patients. In the multivariable model, older age, earlier years of placement, and higher weight-for-age were associated with low fCVC tip position. Symptomatic fCVC-associated VTE occurred in 8.8% of patients, with a rate of 16.5 per 1000 CVC days (interquartile range, 13.1-20.5 per 1000 CVC days). The percentage of VTE in low vs. recommended fCVC tip position and VTE (8.6% vs. 9.2%) were equivalent (two one-sided z-tests; p < 0.001). Furthermore, in the multivariable model, we failed to identify an association between low fCVC tip position, relative to the recommended tip position, and greater odds of VTE (OR, 1.58 [95% CI, 0.92-2.69). However, we cannot exclude the possibility of low fCVC tip position being associated with up to 2.6-fold greater odds of symptomatic VTE.</p><p><strong>Conclusions: </strong>In our two PICUs, 2016-2021, low fCVC tip position occurred in two-thirds of placements and was associated with older age and higher weight-for-age patients. fCVC-associated VTE occurred in one-in-11-catheter placements, with the raw percentage of fCVCs and subsequent VTE in low and recommended tip position being equivalent. However, the multivariable modeling indicates that future research into the relationship between tip position and VTE requires ongoing surveillance and work.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391329","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":"Extubation Failure in Neonates Following Congenital Cardiac Surgery: Multicenter Retrospective Cohort, 2017-2020.","authors":"Daniel L Hames, Qalab Abbas, Ahmed Asfari, Santiago Borasino, J Wesley Diddle, Avihu Z Gazit, Stuart Lipsitz, Amanda Marshall, Katherine Reise, Luciana Rodriguez Guerineau, Joshua S Wolovits, Joshua W Salvin","doi":"10.1097/PCC.0000000000003703","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003703","url":null,"abstract":"<p><strong>Objectives: </strong>Extubation failure (EF) in neonates recovering from congenital cardiac surgery is associated with morbidity and mortality. Adding continuous physiologic monitoring data and risk analytics algorithms to clinical factors has the potential to assist clinicians in identifying those neonates at high risk for EF. We aimed to evaluate the association of two physiologic risk analytics algorithms evaluating the probability of inadequate delivery of oxygen index (IDo2) and inadequate ventilation of carbon dioxide index (IVco2) with EF in neonates receiving mechanical ventilation (MV) after cardiac surgery. A secondary aim was to evaluate the clinical factors associated with EF.</p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Eight international pediatric cardiac ICUs.</p><p><strong>Patients: </strong>Neonates (age < 1 mo at the time of surgery) receiving MV for longer than 48 hours following cardiac surgery between January 1, 2017, and December 31, 2020.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Data from 736 neonates were analyzed with 102 (13.9%) having EF (defined as reintubation within 48 hr of extubation). In multivariable analysis (odds ratio [OR] and 95% CI), preoperative respiratory support (OR, 1.72 [95% CI, 1.11-2.67]) was associated with greater odds of EF. In all, 611 neonates had pre-extubation IDo2 data and 478 neonates had both pre-extubation IDo2 and IVco2 data. In multivariable analysis of patients with both pre-extubation IDo2 and IVco2 data, single ventricle anatomy (OR, 2.50 [95% CI, 1.27-4.92]) and high IDo2 (≥ 25) or high IVco2 (≥ 50) in the 2 hours preceding extubation (OR, 1.77 [95% CI, 1.01-3.12]) were associated with greater odds of EF.</p><p><strong>Conclusions: </strong>In this 2017-2020 cohort, EF is high in post-cardiac surgery neonates receiving at least 48 hours of MV. The IDo2 and IVco2 algorithms may be useful in assessing risk of EF in such neonates.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382898","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":"Interfacility Transfer and Admission to PICUs in the United States: Survey of Referral Communications in 2023.","authors":"Christina L Cifra, Olivia Lin, Celestine L Gonzales, Irene Pantekidis, Madhuradhar Chegondi, Ana Lia Graciano, Eleanor Gradidge, Matthew P Malone, Matthew H M Marx, Nehal R Parikh, Charlotte Z Woods-Hill, Christopher P Landrigan","doi":"10.1097/PCC.0000000000003702","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003702","url":null,"abstract":"<p><strong>Objectives: </strong>Poor communication during interfacility transfer to the PICU can harm critically ill children. Structured handoff communication can prevent harm; however, the landscape of interfacility referral communication practices across PICUs is unknown. Our objective was to describe interfacility referral communication practices among U.S. PICUs to begin identifying potential improvement opportunities.</p><p><strong>Design: </strong>Mixed methods study including a cross-sectional survey and semi-structured interviews.</p><p><strong>Setting: </strong>U.S. PICUs with greater than or equal to 10 beds in 2023.</p><p><strong>Participants: </strong>Clinical/administrative PICU leaders.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Sixty surveys with greater than 70% completed questions were returned from 170 invited participants (35% response rate). Respondents were mainly pediatric critical care medicine division chiefs (48%) or PICU medical directors (32%). PICUs in all U.S. continental regions were represented, which had a median of 1200 (interquartile range [IQR], 1000-1500) admissions per year, of which 29.5% (IQR, 15-39%) were patients directly transferred from other institutions. In 93% of PICUs, a verbal interfacility handoff occurs between the referring clinician and a PICU physician; however, only 24% were always guided by a standard communication tool. In 72% of PICUs, medical records were only sometimes available before patient arrival. Semi-structured interviews with seven volunteer respondents revealed the following themes: 1) standardizing communication can result in organized and efficient handoffs but may also result in inefficiencies, 2) trained staff dedicated to interfacility referrals will improve communication quality, 3) integration of handoff information into the electronic health record will improve dissemination and decrease PICU physicians' workload, and 4) implementing a structured process will require staff support to change current workflows.</p><p><strong>Conclusions: </strong>Referral communication for interfacility patient transfers to the PICU occurred mainly through unstructured verbal handoffs between referring clinicians and PICU physicians. PICU leaders identified several potential benefits and challenges of standardizing interfacility referral communication.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365516","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":"Machine Learning-Based Pediatric Early Warning Score: Patient Outcomes in a Pre- Versus Post-Implementation Study, 2019-2023.","authors":"Anoop Mayampurath, Kyle Carey, Brett Palama, Monica Gonzalez, Joe Reid, Allison H Bartlett, Matthew Churpek, Dana Edelson, Priti Jani","doi":"10.1097/PCC.0000000000003656","DOIUrl":"10.1097/PCC.0000000000003656","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the deployment of pediatric Calculated Assessment of Risk and Triage (pCART), a machine learning (ML) model to predict the risk of the direct ward to the ICU transfer within 12 hours, and the associated improved outcomes among hospitalized children.</p><p><strong>Design: </strong>Pre- vs. post-implementation study.</p><p><strong>Setting: </strong>An urban, tertiary-care, academic hospital.</p><p><strong>Patients: </strong>Pediatric (age < 18 yr) admissions from May 1, 2019, to April 30, 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Patients were divided into baseline, pre-pCART implementation (May 1, 2019, to April 30 2021), and post-pCART implementation (May 1, 2021, to April 30, 2023) cohorts. First-ward admissions with a high-risk score (pCART score ≥ 92) were considered as the main cohort. The primary outcome was the occurrence of critical events, defined as invasive mechanical ventilation, vasoactive drug administration, or death within 12 hours of the first high-risk pCART score. There were 2763 and 3943 patients in the baseline and implementation cohorts, respectively. pCART implementation was associated with a decrease in the percentage of the primary outcome from baseline 1.4% to 0.4% (p < 0.001), which converted to more than two-thirds lower adjusted odds of the primary outcome (odds ratio, 0.22 [95% CI, 0.11-0.40]; p < 0.001). pCART implementation was also associated with a decreased prevalence of critical events at 24 and 48 hours after a first high-risk score. We failed to identify any association between cohort period and overall hospital and ICU length-of-stay, number of ICU transfers, and time to ICU transfer. However, there was a difference in hospital length-of-stay among a subpopulation of patients transferred to the ICU (median 6 vs. 7 d; p < 0.001). Analysis of compliance metrics indicates sustained compliance achievements over time.</p><p><strong>Conclusions: </strong>The deployment of pCART, a ML-based pediatric risk stratification tool, for clinical decision support for pediatric ward patients, was associated with lower odds of critical events among high-risk patients.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e146-e154"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}