Multi-institutional Profile of Adults Admitted to Pediatric Intensive Care Units Adults in Pediatric Intensive Care Units

Edwards JD, Houtrow AJ, Vasilevskis EE, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Growing numbers of persons with childhood-onset chronic illnesses are surviving to adulthood. Many use pediatric hospitals for their inpatient needs. To our knowledge, the prevalence and characteristics of adult pediatric intensive care unit patients have not been reported.

Objectives

To estimate the proportion of adults admitted to pediatric intensive care units (PICUs), characterize them, and compare them with older adolescents.

Design

One-year cross-sectional analysis.

Setting

Pediatric intensive care units in the United States that participated in the Virtual Pediatric Intensive Care Unit Systems.

Participants

Pediatric intensive care unit patients 15 years or older admitted in 2008.

Main Outcome Measures

We compared adults with adolescents across clinical characteristics and outcomes. Mixed-effects logistic regression was used to estimate the independent association of age with PICU mortality.

Results

Seventy PICUs had 67 629 admissions; 1954 admissions (2.7%) were patients 19 years or older; and 9105 admissions (13.5%) were patients aged 15 to 18 years. The proportion of adults (≥19 years) varied considerably by PICU (range, 0%-9.2%). As age increased, the proportion of patients who had a complex chronic condition and planned or perioperative admissions increased; the proportion of trauma-related admissions decreased. Patients aged 21 to 29 years had a 2 times (95% CI, 1.3-3.2; P = .004) greater odds of PICU mortality compared with adolescent patients, after adjusting for Paediatric Index of Mortality score, sex, trauma, and having a complex chronic condition. Being 30 years or older was associated with a 3.5 (95% CI, 1.3-9.7; P = .01) greater odds of mortality.

Conclusions and Relevance

In this multi-institutional study, adults constituted a small but high-risk proportion of patients in some PICUs, suggesting that these PICUs should have plans and protocols specifically focused on this group.

Nurse Staffing and NICU Infection Rates Nurse Staffing and NICU Infection Rates

Rogowski JA, Staiger D, Patrick T, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

There are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights.

Objective

To study the adequacy of NICU nurse staffing in the United States using national guidelines and analyze its association with infant outcomes.

Design

Retrospective cohort study. Data for 2008 were collected by web survey of staff nurses. Data for 2009 were collected for 4 shifts in 4 calendar quarters (3 in 2009 and 1 in 2010).

Setting

Sixty-seven US NICUs from the Vermont Oxford Network, a national voluntary network of hospital NICUs.

Participants

All inborn very low-birth-weight (VLBW) infants, with a NICU stay of at least 3 days, discharged from the NICUs in 2008 (n = 5771) and 2009 (n = 5630). All staff-registered nurses with infant assignments.

Exposures

We measured nurse understaffing relative to acuity-based guidelines using 2008 survey data (4046 nurses and 10 394 infant assignments) and data for 4 complete shifts (3645 nurses and 8804 infant assignments) in 2009-2010.

Main Outcomes and Measures

An infection in blood or cerebrospinal fluid culture occurring more than 3 days after birth among VLBW inborn infants. The hypothesis was formulated prior to data collection.

Results

Hospitals understaffed 31% of their NICU infants and 68% of high-acuity infants relative to guidelines. To meet minimum staffing guidelines on average would require an additional 0.11 of a nurse per infant overall and 0.34 of a nurse per high-acuity infant. Very low-birth-weight infant infection rates were 16.4% in 2008 and 13.9% in 2009. A 1 standard deviation–higher understaffing level (SD, 0.11 in 2008 and 0.08 in 2009) was associated with adjusted odds ratios of 1.39 (95% CI, 1.19-1.62; P < .001) in 2008 and 1.40 (95% CI, 1.19-1.65; P < .001) in 2009.

Conclusions and Relevance

Substantial NICU nurse understaffing relative to national guidelines is widespread. Understaffing is associated with an increased risk for VLBW nosocomial infection. Hospital administrators and NICU managers should assess their staffing decisions to devote needed nursing care to critically ill infants.

JAMA Pediatrics: Pediatric/Neonatal Critical Care Topic Collection

Multi-institutional Profile of Adults Admitted to Pediatric Intensive Care Units Adults in Pediatric Intensive Care Units

Nurse Staffing and NICU Infection Rates Nurse Staffing and NICU Infection Rates