Browsing by Subject "Critical care outcomes"

Now showing 1 - 5 of 5
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    Development of a population‐level prediction model for intensive care unit (ICU) survivorship and mortality in older adults: A population‐based cohort study
    (Wiley, 2023-10-19) Khan, Sikandar H.; Perkins, Anthony J.; Fuchita, Mikita; Holler, Emma; Ortiz, Damaris; Boustani, Malaz; Khan, Babar A.; Gao, Sujuan; Medicine, School of Medicine
    Background and aims: Given the growing utilization of critical care services by an aging population, development of population-level risk models which predict intensive care unit (ICU) survivorship and mortality may offer advantages for researchers and health systems. Our objective was to develop a risk model for ICU survivorship and mortality among community dwelling older adults. Methods: This was a population-based cohort study of 48,127 patients who were 50 years and older with at least one primary care visit between January 1, 2017, and December 31, 2017. We used electronic health record (EHR) data to identify variables predictive of ICU survivorship. Results: ICU admission and mortality within 2 years after index primary care visit date were used to divide patients into three groups of "alive without ICU admission", "ICU survivors," and "death." Multinomial logistic regression was used to identify EHR predictive variables for the three patient outcomes. Cross-validation by randomly splitting the data into derivation and validation data sets (60:40 split) was used to identify predictor variables and validate model performance using area under the receiver operating characteristics (AUC) curve. In our overall sample, 92.2% of patients were alive without ICU admission, 6.2% were admitted to the ICU at least once and survived, and 1.6% died. Greater deciles of age over 50 years, diagnoses of chronic obstructive pulmonary disorder or chronic heart failure, and laboratory abnormalities in alkaline phosphatase, hematocrit, and albumin contributed highest risk score weights for mortality. Risk scores derived from the model discriminated between patients that died versus remained alive without ICU admission (AUC = 0.858), and between ICU survivors versus alive without ICU admission (AUC = 0.765). Conclusion: Our risk scores provide a feasible and scalable tool for researchers and health systems to identify patient cohorts at increased risk for ICU admission and survivorship. Further studies are needed to prospectively validate the risk scores in other patient populations.
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    Group Concept Mapping Conceptualizes High-Quality Care for Long-Stay Pediatric Intensive Care Unit Patients and Families
    (Elsevier, 2023) Leland, Brian D.; Wocial, Lucia D.; Madrigal, Vanessa N.; Moon, Michelle M.; Ramey-Hunt, Cheryl; Walter, Jennifer K.; Baird, Jennifer D.; Edwards, Jeffrey D.; Pediatrics, School of Medicine
    Objective: To describe and conceptualize high-quality care for long-stay pediatric intensive care unit (PICU) patients using group concept mapping (GCM). Study design: We convened an expert panel to elucidate domains of high-quality care for this growing patient population for which transitory care models fail to meet their needs. Thirty-one healthcare professionals and 7 parents of patients with previous prolonged PICU hospitalizations comprised a diverse, interprofessional multidisciplinary panel. Participants completed the prompt "For PICU patients and families experiencing prolonged lengths of stay, high quality care from the medical team includes ______", with unlimited free text responses. Responses were synthesized into individual statements, then panelists sorted them by idea similarity and rated them by perceived importance. Statement analysis using GCM software through GroupWisdom generated nonoverlapping clusters representing domains of high-quality care. Results: Participants submitted 265 prompt responses representing 313 unique ideas, resulting in 78 final statements for sorting and rating. The resultant cluster map best representing the data contained 8 domains: (1) Family-Centered Care and Shared Decision Making, (2) Humanizing the Patient, (3) Clinician Supports and Resources, (4) Multidisciplinary Coordination of Care, (5) Family Well-Being, (6) Anticipatory Guidance and Care Planning, (7) Communication, and (8) Continuity of Care. Conclusions: GCM empowered a panel of healthcare professionals and parents to explicitly describe and conceptualize high-quality care for patients and families experiencing prolonged PICU stays. This information will aid the effort to address shortcomings of transitory PICU care models.
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    Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C
    (American Academy of Pediatrics, 2022) Maddux, Aline B.; Berbert, Laura; Young, Cameron C.; Feldstein, Leora R.; Zambrano, Laura D.; Kucukak, Suden; Newhams, Margaret M.; Miller, Kristen; FitzGerald, Madyson M.; He, Jie; Halasa, Natasha B.; Cvijanovich, Natalie Z.; Loftis, Laura L.; Walker, Tracie C.; Schwartz, Stephanie P.; Gertz, Shira J.; Tarquinio, Keiko M.; Fitzgerald, Julie C.; Kong, Michele; Schuster, Jennifer E.; Mack, Elizabeth H.; Hobbs, Charlotte V.; Rowan, Courtney M.; Staat, Mary A.; Zinter, Matt S.; Irby, Katherine; Crandall, Hillary; Flori, Heidi; Cullimore, Melissa L.; Nofziger, Ryan A.; Shein, Steven L.; Glas Gaspers, Mary; Hume, Janet R.; Levy, Emily R.; Chen, Sabrina R.; Patel, Manish M.; Tenforde, Mark W.; Weller, Edie; Campbell, Angela P.; Randolph, Adrienne G.; Overcoming COVID-19 Investigators; Pediatrics, School of Medicine
    Objectives: To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C). Methods: Multicenter prospective cohort study conducted in 25 United States pediatric hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or MIS-C with follow-up 2 to 4 months after admission. We assessed readmissions, persistent symptoms or activity impairment, and new morbidities. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results: Of 358 eligible patients, 2 to 4 month survey data were available for 119 of 155 (76.8%) with acute COVID-19 and 160 of 203 (78.8%) with MIS-C. Thirteen (11%) patients with acute COVID-19 and 12 (8%) with MIS-C had a readmission. Thirty-two (26.9%) patients with acute COVID-19 had persistent symptoms (22.7%) or activity impairment (14.3%) and 48 (30.0%) with MIS-C had persistent symptoms (20.0%) or activity impairment (21.3%). For patients with acute COVID-19, persistent symptoms (aRR, 1.29 [95% CI, 1.04-1.59]) and activity impairment (aRR, 1.37 [95% CI, 1.06-1.78]) were associated with more organ systems involved. Patients with MIS-C and pre-existing respiratory conditions more frequently had persistent symptoms (aRR, 3.09 [95% CI, 1.55-6.14]) and those with obesity more frequently had activity impairment (aRR, 2.52 [95% CI, 1.35-4.69]). New morbidities were infrequent (9% COVID-19, 1% MIS-C). Conclusions: Over 1 in 4 children hospitalized with acute COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Patients with MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery.
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    Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C
    (Frontiers Media, 2023-10-18) Maddux, Aline B.; Young, Cameron C.; Kucukak, Suden; Zambrano, Laura D.; Newhams, Margaret M.; Rollins, Caitlin K.; Halasa, Natasha B.; Gertz, Shira J.; Mack, Elizabeth H.; Schwartz, Stephanie; Kong, Michele; Loftis, Laura L.; Irby, Katherine; Rowan, Courtney M.; Tarquinio, Keiko M.; Zinter, Matt S.; Crandall, Hillary; Cvijanovich, Natalie Z.; Schuster, Jennifer E.; Fitzgerald, Julie C.; Staat, Mary A.; Hobbs, Charlotte V.; Nofziger, Ryan A.; Shein, Steven; Flori, Heidi; Cullimore, Melissa L.; Chatani, Brandon M.; Levy, Emily R.; Typpo, Katri V.; Hume, Janet R.; Campbell, Angela P.; Randolph, Adrienne G.; Overcoming COVID-19 Investigators; Pediatrics, School of Medicine
    Objective: To identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic. Methods: Across 25 U.S. Overcoming COVID-19 Network hospitals, we conducted a prospective cohort study of patients <21-years-old hospitalized for acute COVID-19 or MIS-C (May 2020 to March 2022) surveyed 2- to 4-months post-admission. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results: Of 232 children with acute COVID-19, 71 (30.6%) had persistent symptoms and 50 (21.6%) had activity impairments at follow-up; for MIS-C (n = 241), 56 (23.2%) had persistent symptoms and 58 (24.1%) had activity impairments. In adjusted analyses of patients with acute COVID-19, receipt of mechanical ventilation was associated with persistent symptoms [aRR 1.83 (95% CI: 1.07, 3.13)] whereas obesity [aRR 2.18 (95% CI: 1.05, 4.51)] and greater organ system involvement [aRR 1.35 (95% CI: 1.13, 1.61)] were associated with activity impairment. For patients with MIS-C, having a pre-existing respiratory condition was associated with persistent symptoms [aRR 3.04 (95% CI: 1.70, 5.41)] whereas obesity [aRR 1.86 (95% CI: 1.09, 3.15)] and greater organ system involvement [aRR 1.26 (1.00, 1.58)] were associated with activity impairments. Discussion: Among patients hospitalized, nearly one in three hospitalized with acute COVID-19 and one in four hospitalized with MIS-C had persistent impairments for ≥2 months post-hospitalization. Persistent impairments were associated with more severe illness and underlying health conditions, identifying populations to target for follow-up.
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    Severe Acute Kidney Injury is Associated with Increased Risk of Death and New Morbidity After Pediatric Septic Shock
    (Wolters Kluwer, 2020-09) Starr, Michelle C.; Banks, Russell; Reeder, Ron W.; Fitzgerald, Julie C.; Pollack, Murray M.; Meert, Kathleen L.; McQuillen, Patrick S.; Mourani, Peter M.; Chima, Ranjit S.; Sorenson, Samuel; Varni, James W.; Hingorani, Sangeeta; Zimmerman, Jerry J.; Pediatrics, School of Medicine
    Objectives: Acute kidney injury is common in critically ill children; however, the frequency of septic shock-associated acute kidney injury and impact on functional status are unknown. We evaluated functional outcomes of children with septic shock-associated acute kidney injury. Design: Secondary analysis of patients with septic shock from the prospective Life after Pediatric Sepsis Evaluation study. We defined acute kidney injury using Kidney Disease Improving Global Outcomes criteria, comparing patients with absent/Stage 1 acute kidney injury to those with Stage 2/3 acute kidney injury (severe acute kidney injury). Our primary outcome was a composite of mortality or new functional morbidity at day 28 of hospitalization or discharge. We also assessed poor long-term outcome, defined as mortality or a persistent, serious deterioration in health-related quality of life at 3 months. Setting: Twelve academic PICUs in the United States. Patients: Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support. Interventions: None. Measurements and main results: More than 50% of patients (176/348) developed severe acute kidney injury; of those, 21.6% (38/176) required renal replacement therapy. Twice as many patients with severe acute kidney injury died or developed new substantive functional morbidity (38.6 vs 16.3%; p < 0.001). After adjustment for age, malignancy, and initial illness severity, severe acute kidney injury was independently associated with mortality or new substantive morbidity (adjusted odds ratio, 2.78; 95% CI, 1.63-4.81; p < 0.001). Children with severe acute kidney injury had poorer health-related quality of life at 3 months (adjusted effect size 2.46; 95% CI, 1.44-4.20; p = 0.002). Children with severe acute kidney injury required longer duration of mechanical ventilation (11.0 vs 7.0 d; p < 0.001) and PICU stay (11.7 vs 7.1 d; p < 0.001). Conclusions: Among children with septic shock, severe acute kidney injury was independently associated with increased risk of death or new substantive functional morbidity. Survivors of sepsis with severe acute kidney injury were more likely to have persistent, serious health-related quality of life deterioration at 3 months.