1 UK PICOS United Kingdom Paediatric Intensive Care Outcome Study Outcomes at 6 months post-admission to paediatric intensive care: report of a national study of paediatric intensive care units in the United Kingdom Contact details:

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 Mortality PRISM: 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) days Characteristics 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, & 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 Sensation level % C-indexRegression P-value PIM0.56<0.001 PRISM PRISM III

11 HUI2 Mobility C-indexRegression P-value PIM0.58<0.001 PRISM PRISM III

12 HUI2 Emotion C-indexRegression P-value PIM PRISM PRISM III

13 HUI2 Cognition C-indexRegression P-value PIM0.55<0.001 PRISM PRISM III

14 HUI2 Self-care C-indexRegression P-value PIM0.57<0.001 PRISM PRISM III

15 HUI2 Pain C-indexRegression P-value PIM PRISM PRISM III

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