Pediatric critical care in an adult ICU. Utility of the PIM index

Objectives: An analysis is made of the characteristics of patients younger than 14 years treated in an adult ICU (AICU), to determine the procedures and techniques required by such patients, and to evaluate the use of the Pediatric Index of Mortality (PIM) in stratifying severity. Design: A retrospective observational study was carried out. Setting: An AICU of a second level hospital. Patients: We studied 130 patients aged from 1 month to 14 years (average age 6.1 +/- 4 years) treated in the AICU from January 1997 to December 2010. Variables of interest: Clinical-demographic parameters, diagnosis, clinical procedures, PIM score, length of stay, transfer to pediatric ICU (PICU), and mortality. Classification by destination (AICU, PICU) and outcome (alive, dead). PIM and assessment of the diagnostic performance curve (ROC) for mortality. Results: The average age of the patients was 6.1 +/- 4 years. Most common diagnoses: trauma (26.9%) and sepsis (22.3%). Main procedures: mechanical ventilation (58.5%), central venous line (74.6%) and vasoactive drugs (20%). A total of 64.6% were transferred to PICU, and the overall mortality was 13%. Patients who stayed in the AICU were older (8.2 +/- 4 vs 5.5 +/- 4 years, p < 0.001), had low morbidity, and their stay was short (44.5 +/- 38 hours). The PIM score was significantly higher in the patients who died (60 +/- 20 AICU, 38 +/- 30 PICU) than in those who survived (4 +/- 1 AICU, 9 +/- 1 PICU) (p < 0.001). ROC curve with AUC = 0.91 (95%CI: 0.85 to 0.98). Conclusions: The PIM score can stratify severity and identify patients at an increased risk of death. Critical child care in the AICU requires the presence of adequate materials and the continuous learning of procedures adapted to pediatric patients in order to ensure adequate care. (C) 2011 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.