Infant ICU deaths drop by 45% due to advancements

Technology, clinical efforts credited for progress

Advancements in medical technology and organizational systems are being credited for sharply reducing the death rate among young children receiving medical care in pediatric ICUs. Children given intensive care for serious respiratory ailments and other life-threatening diseases have a significantly better chance of surviving today than as recently as a decade ago, according to the federal Agency for Health Care Policy and Research (AHCPR) in Washington, DC.

According to a study jointly sponsored by the AHCPR and Arkansas Children’s Hospital in Little Rock, the mortality rate among children admitted to a pediatric ICU declined by 45% between 1983 and 1993. The survival rate involved patients diagnosed with severe asthma, bronchitis, and pneumonia.1

Health officials cited the findings in calling for continuing investments in critical care medical research and technology. Advancements in mechanical ventilation and other ICU-related technology were cited as examples of factors that have led to the higher survival rate. Also identified as a possible factor was the development of pediatric ICUs that are larger in size and staffing today than a decade ago.

Survival rates differ by age

The results were also used to urge greater private-sector and government investment in pediatric critical care. Officials expressed growing concerns over financial shortfalls created by managed care and system-wide changes in Medicare hospital payments from one based on costs, to one based on fixed fees and prospective payment formulas.

"A great deal has been known about the effects of technological improvements in adult critical care. One of our goals here was to assess the impact of change on children’s ICUs," according to John M. Tilford, PhD, a researcher in the department of pediatrics at Children’s Hospital.

Declines in mortality risk were greatest among younger infants. The risk for children younger than one month improved by 39%. A 28% improvement was reported among infants between one and 12 months of age. The study reviewed data from 16 pediatric ICUs across the country. (For a breakdown of data among the ICUs, see chart, below.)

According to researchers, the improvements in mortality risk also has altered the way pediatric intensivists evaluate costs and quality measures using a commonly accepted severity-of-illness system to monitor risk-adjusted outcomes. Several severity adjustment systems are available in adult critical care, including the Acute Physiology and Chronic Health Evaluation III scale.

Pediatric ICUs use a proprietary system called the Pediatric Risk of Mortality scoring system, known as PRISM III. "Improvement in mortality risk substantially deteriorated the [assigned values] of the original PRISM severity system," researchers concluded. As a result, standardized mortality ratios across the 16 pediatric ICUs showed "substantial disparities."

The latest findings may require a revision of the current values in PRISM III to adjust for the improved mortality risk’s effects on pediatric ICU cost and quality.

Reference

1. Tilford JM, Roberson PK, Lensing S, et al. Differences in pediatric ICU mortality risk over time. Crit Care Med 1998; 26:1,737-1,743.

Source

For additional information about fast-tracking in the ICU, contact:

Vallire D. Hooper, RN, MSN, instructor, department of adult nursing, Medical College of Georgia, Augusta, GA 30912. Fax: (706) 721-0655. E-mail: rhooper@mail.mcg.edu.