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Titolo:
Variation in therapy and outcome for pediatric head trauma patients
Autore:
Tilford, JM; Simpson, PM; Yeh, TS; Lensing, S; Aitken, ME; Green, JW; Harr, J; Fiser, DH;
Indirizzi:
Univ Arkansas Med Sci, Dept Pediat, Little Rock, AR USA Univ Arkansas Med Sci Little Rock AR USA ept Pediat, Little Rock, AR USA Arkansas Childrens Hosp, Little Rock, AR 72202 USA Arkansas Childrens Hosp Little Rock AR USA 72202 ittle Rock, AR 72202 USA Univ Calif San Francisco, Dept Pediat, San Francisco, CA USA Univ Calif San Francisco San Francisco CA USA iat, San Francisco, CA USA Childrens Hosp Oakland, Oakland, CA USA Childrens Hosp Oakland Oakland CAUSA rens Hosp Oakland, Oakland, CA USA Univ San Francisco, Sch Nursing, San Francisco, CA 94117 USA Univ San Francisco San Francisco CA USA 94117 San Francisco, CA 94117 USA
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 5, volume: 29, anno: 2001,
pagine: 1056 - 1061
SICI:
0090-3493(200105)29:5<1056:VITAOF>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
INTENSIVE-CARE UNIT; COMA DATA-BANK; INJURED PATIENTS; POSTTRAUMATIC SEIZURES; CHILDREN; QUALITY; PERFORMANCE; MORTALITY; MANAGEMENT; PRESSURE;
Keywords:
patient outcome assessment; mortality prediction; severity of illness; head trauma; resource utilization; intensive care; pediatrics; seizure medications;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
50
Recensione:
Indirizzi per estratti:
Indirizzo: Tilford, JM Arkansas Childrens Hosp, Dept Pediat CARE, 800 Marshall St, Little Rock, AR 72202 USA Arkansas Childrens Hosp 800 Marshall St Little RockAR USA 72202
Citazione:
J.M. Tilford et al., "Variation in therapy and outcome for pediatric head trauma patients", CRIT CARE M, 29(5), 2001, pp. 1056-1061

Abstract

Objective: This study was undertaken to examine variation in therapies andoutcome for pediatric head trauma patients by patient characteristics and by pediatric intensive care unit. Specifically, the study was designed to examine severity of illness on admission to the pediatric intensive care unit, the therapies used during the pediatric intensive care unit stay, and patient outcomes. Data Sources and Setting: Consecutive admissions from three pediatric intensive care units were recorded prospectively (n = 5,749). For this study, all patients with an admitting diagnosis of head trauma were included (n = 477). Data collection occurred during an 18-month period beginning in June 1996. All of the pediatric intensive care units were located in children's hospitals, had residency and fellowship training programs, and were headed by a pediatric intensivist. Methods: Admission severity was measured as the worst recorded physiological derangement during the period less than or equal to6 hrs before pediatric intensive care unit admission. Therapies and resource use were based on the Therapeutic Intervention Scoring System with adaptations for pediatrics. The use of intracranial pressure monitoring was recorded on admission to the unit (within 1 hr) and at any time during the pediatric intensive care unit stay. Outcomes were measured at the time of pediatric intensive care unit discharge by the Pediatric Overall Performance Category scale. Risk factors for mortality were examined by using bivariate analyses with significant predictors as candidate variables in a logistic regression to predict expected mortality. Intracranial pressure monitoring and other therapies were added lo the mortality prediction model to test for protective effects. Finally, race and insurance status were added to the model to test for differences in the quality of care. Results: The overall mortality rate for the entire sample was 7.8%. Mortality rates far children less than or equal to1 yr old were significantly higher than for children >1 yr old (16.1% vs. 6.1%; p = .002), Comparisons by insurance status indicated that observed mortality rates were highest for self-paying patients. However, patient characteristics were not associated with use of therapies or standardized mortality rates after adjustment for patient severity. There was significant variation in the use of paralytic agents, seizure medications, induced hypothermia, and intracranial pressure monitoring on admission across the three pediatric intensive care units. In multivariate models, only the use of seizure medications was associated significantly with reduced mortality risk (odds ratio = 0.17; 95% confidence interval = 0.04-0.70; p = 014). Conclusions: Therapies and outcomes vary across pediatric intensive care units that care for children with head injuries. Increased use of seizure medications may be warranted based on data from this observational study. Large randomized controlled trials of seizure prophylaxis in children with head injury have not been conducted and are needed to confirm the findings presented here.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 07/08/20 alle ore 07:03:23