Epidemiology of Pediatric Critical Care Admissions in 43 United States Children's Hospitals, 2014-2019.

To identify trends in the population of patients in PICUs over time. Cross-sectional, retrospective cohort study using the Pediatric Health Information System database. Forty-three U.S. children's hospitals. All patients admitted to Pediatric Health Information System-participating hospitals from January 2014 to December 2019. Individuals greater than 65 years old and normal newborns were excluded. None. PICU care occurred in 13.8% of all pediatric hospital encounters and increased over the study period from 13.3% to 14.3%. Resource intensity, based on average Hospitalization Resource Intensity Scores for Kids score, increased significantly across epochs (6.5 in 2014-2015 vs 6.9 in 2018-2019; p < 0.001), although this was not consistently manifested as additional procedural exposure. Geometric mean PICU cost per patient encounter was stable. The two most common disease categories in PICU patients were respiratory failure and cardiac and circulatory congenital anomalies. Of all PICU encounters, 35.5% involved mechanical ventilation, and 25.9% involved vasoactive infusions. Hospital-level variation in the percentage of days spent in the PICU ranged from 15.1% to 63.5% across the participating sites. Of the total hospital costs for patients admitted to the PICU, 41.7% of costs were accrued during the patients' PICU stay. The proportional use of PICU beds is increasing over time, although was variable across centers. Case-based resource use and complexity of pediatric patients are also increasing. Despite the higher use of PICU resources, the standardized costs of PICU care per patient encounter have remained stable. These data may help to inform current PICU resource allocation and future PICU capacity planning.

Heneghan JA ，Rogerson C ，Goodman DM ，Hall M ，Kohne JG ，Kane JM ... -  《Pediatric Critical Care Medicine》

Opioid-Related Critical Care Resource Use in US Children's Hospitals.

There has been a rapid increase in the rate of pediatric opioid-related hospitalizations. It is unknown how this increase has impacted the use of pediatric critical care. Our objective in this study was to assess the trends in pediatric hospitalization for opioid ingestions in a cohort of US children's hospitals and, specifically, to evaluate the impact on pediatric critical care resource use. A retrospective cohort study of the Pediatric Health Information System was performed to identify hospitalizations for opioid ingestions from 2004 to 2015. Admission to the PICU and the use of naloxone, vasopressors, and ventilation were assessed by using billing data. The primary outcome measure was the trend in the rate of PICU admission for opioid-related ingestion over time, assessed by using Poisson regression. There were 3647 opioid-related hospitalizations in 31 hospitals; 42.9% required PICU care. The overall mortality was 1.6%, with annual deaths decreasing from 2.8% to 1.3% (P < .001). The number of opioid-related hospitalizations requiring PICU care doubled between 2004 and 2015. The rate of PICU admission for opioid-related hospitalization increased significantly, from 24.9 to 35.9 per 10 000 PICU admissions (P < .001). Among PICU admissions, 37.0% required mechanical ventilator support, and 20.3% required vasopressors. The US opioid crisis is negatively impacting children, and the rate of hospitalization and PICU admission for pediatric opioid ingestions is increasing. Current efforts to reduce adult opioid use have not curtailed the incidence of pediatric opioid ingestions, and additional efforts are needed to reduce preventable opioid exposure in children.

Kane JM ，Colvin JD ，Bartlett AH ，Hall M ... -  《-》

Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database.

Ruth A ，McCracken CE ，Fortenberry JD ，Hall M ，Simon HK ，Hebbar KB ... -  《Pediatric Critical Care Medicine》

Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units.

Stover BH ，Shulman ST ，Bratcher DF ，Brady MT ，Levine GL ，Jarvis WR ，Pediatric Prevention Network ... -  《AMERICAN JOURNAL OF INFECTION CONTROL》

Impact of Retrieval, Distance Traveled, and Referral Center on Outcomes in Unplanned Admissions to a National PICU.

Moynihan K ，McSharry B ，Reed P ，Buckley D ... -  《Pediatric Critical Care Medicine》