Embed Size (px)
DESCRIPTION
3 What is UK PICOS? A nationwide multi-centre study funded by the MRC in 2001 to undertake a comprehensive study of the outcomes (mortality and morbidity) of children receiving paediatric intensive care in the United Kingdom The aim was to measure the health status of children using the Health Utilities Index (HUI2), 6 months after admission to a paediatric intensive care unit (PICU) and to assess the relationship between this and measures of illness severity at admission
Citation preview
1
UK PICOS
United Kingdom Paediatric Intensive Care Outcome
StudyOutcomes at 6 months post-admission to paediatric
intensive care: report of a national study of paediatric intensive care units in the United Kingdom
Medical Research Council
Contact details: [email protected]
2
S Jones*, K Rantell*, K Stevens*, K Rowan#, C McCabe*, GJ Parry**University of Sheffield, #ICNARC
3
What is UK PICOS?
A nationwide multi-centre study funded by the MRC in 2001 to undertake a comprehensive study of the outcomes (mortality and morbidity) of children receiving paediatric intensive care in the United Kingdom
The aim was to measure the health status of children using the Health Utilities Index (HUI2), 6 months after admission to a paediatric intensive care unit (PICU) and to assess the relationship between this and measures of illness severity at admission
4
Study participants
Twenty nine PICUs identified in the UK
Twenty three PICUs participated
One year data collection period Over 12,000 admissions
5
Data collected Admission data, including medical history, reason
for admission and illness severity as measured by PIM, PRISM & PRISM III
PICU outcome (died/survived) Hospital outcome (died/survived) Health status at 6 months as measured by HUI2
PIM: Paediatric Index of MortalityPRISM: Paediatric Risk of Mortality
6
Health Utilities Index (HUI2) A parent/guardian completed 15 item questionnaire
providing measures on six dimensions of health:– Sensation (sight, hearing and speech)
– Mobility (ability to move around without help)
– Emotion (anxious or suffering from nightmares)
– Cognition (ability to learn and remember)
– Self-care (ability to wash, dress and bathe)
– Pain (extent to which pain interferes with usual activities)
7
Children included All children who survived to PICU discharge were eligible
(n = 10,533, 6% unit mortality) Consent was obtained from 3842 admissions, of which
3042 survived to 6 months HUI2 questionnaires sent to 2895 and returned from 2044 Uncertainty of the validity of HUI2 in children <1 year of
age led to their exclusion from this analysis Final sample included 1246 children
8
Characteristics of children with HUI2 data 54% male 54% unplanned admissions 61% received mechanical ventilation Median (quartiles) age at admission was 5.4 (2.1,
10.3) years Median (quartiles) length of stay was 1.2 (0.8, 3.0)
daysCharacteristics were similar for those who survived PICU, those who consented, those who returned a HUI2 and those who did not return a HUI2, e.g. the probability of mortality as measured using PIM was 0.026, 0.027, 0.025 & 0.026 respectively.
9
Risk adjustment models Used ordinal logistic regression models with a
proportional odds assumption Each dimension of the HUI2 was used as an
outcome Explanatory variables: probability of mortality
as calculated using PIM, PRISM and PRISM III Used the index of concordance (c-index) to
assess model discriminatory power (analogous to the ROC area in binary outcomes)
10
HUI2 Sensation
0
0.02
0.04
0.06
0.08
1 2 3 4
Sensation levelPr
ob. o
f mor
talit
y
PIM
PRISM
PRISM III
0
20
40
60
80
1 2 3 4
Sensation level
%
C-index Regression P-value
PIM 0.56 <0.001PRISM 0.53 0.030PRISM III 0.51 0.215
11
HUI2 Mobility
0
20
40
60
80
1 2 3 4 5
Mobility level
%
0
0.02
0.04
0.06
0.08
0.1
1 2 3 4 5
Mobility levelPr
ob. o
f mor
talit
y
PIM
PRISM
PRISM III
C-index Regression P-value
PIM 0.58 <0.001PRISM 0.53 0.491PRISM III 0.55 0.004
12
HUI2 Emotion
0
20
40
60
80
1 2 3 4 5
Emotion level
%
00.020.040.060.08
0.10.120.140.16
1 2 3 4 5
Emotion levelPr
ob. o
f mor
talit
y
PIM
PRISM
PRISM III
C-index Regression P-value
PIM 0.53 0.003PRISM 0.52 0.368PRISM III 0.54 0.034
13
HUI2 Cognition
0
20
40
60
80
1 2 3 4
Cognition level
%
0
0.02
0.04
0.06
0.08
1 2 3 4
Cognition levelPr
ob. o
f mor
talit
y
PIM
PRISM
PRISM III
C-index Regression P-value
PIM 0.55 <0.001PRISM 0.50 0.366PRISM III 0.52 0.254
14
HUI2 Self-care
0
20
40
60
80
1 2 3 4
Self-care level
%
0
0.02
0.04
0.06
0.08
0.1
1 2 3 4
Self-care levelPr
ob. o
f mor
talit
y
PIM
PRISM
PRISM III
C-index Regression P-value
PIM 0.57 <0.001PRISM 0.50 0.433PRISM III 0.52 0.302
15
HUI2 Pain
0
20
40
60
80
1 2 3 4 5
Pain level
%
0
0.02
0.04
0.06
0.08
1 2 3 4 5
Pain levelPr
ob. o
f mor
talit
y
PIM
PRISM
PRISM III
C-index Regression P-value
PIM 0.52 0.007PRISM 0.50 0.841PRISM III 0.54 0.026
16
Summary of results Overall, 28% of children were in full health 6 months
post admission to paediatric intensive care PIM is associated with all HUI2 dimensions but has
limited discriminatory power PRISM and PRISM III are associated with some
dimensions but also have limited discriminatory power
Additional potential explanatory variables are needed to develop adequate risk adjustments models
17
Conclusions Mortality following paediatric intensive care is
currently around 6% in the UK In determining the quality and performance of
PICUs, it is important to take into account variations in the health status of survivors post discharge
Morbidity appears to be related to initial illness severity, however this information alone is insufficient to predict long term outcomes
18
Conclusions In attempting to develop policies to improve
longer-term outcomes of children post paediatric intensive care, it may be important to also take into account factors such as co-morbidities, socioeconomic status and the quality of care received by children following discharge from intensive care
