PURPOSE: Growing numbers of children with chronic illnesses are surviving to adulthood. Many of these adults continue to utilize pediatric institutions for their inpatient care. We sought to characterize adults admitted to pediatric intensive care units (PICU) and compare them to adolescent patients.
METHODS: We analyzed patients > or = 19 years of age admitted in 2008 to 70 geographically-diverse, North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Performance System. We compared these adult patients to older adolescent patients aged 15-18 years using descriptive statistics.
RESULTS: Seventy PICUs had 67,629 admissions. Among all admissions, 752 (1.1%) were > or = 21 years of age; 1,854 (2.7%) were > or = 19; and 9,105 (13.5%) were 15-18. Childhood complex chronic conditions (CCC) were more common among adults (> or = 19 years) compared to adolescents (72% v. 48%, P<0.001). Compared to adolescents, adults had statistically higher proportions (P<0.001) with structural cardiac abnormalities (14% v. 5%), malignancy (16% v. 10%), and cerebral palsy/hypoxic ischemic encephalopathy/development delay (15% v. 7%). Adults had lower median baseline functionality scores (moderate disability v. normal, P=0.0001). They had more pre-/post-operative (45% v. 37%) and elective (35% v. 27%) admissions, and less trauma-related admissions (2.7% v. 11%, all P<0.001). Adults had a longer median length of stay (1.9 v. 1.4 days, P<0.001). Adults had a 125% higher incidence of PICU mortality compared to adolescent patients (risk ratio 2.25, 95% CI 1.78-2.9; risk difference 2.8%, 95% CI 1.8-3.9%).
CONCLUSIONS: A small, yet notable, number of adults are admitted to PICUs. This population often has childhood CCC and disabilities, are admitted pre-/post-operatively, and have a greater risk of PICU mortality compared to children aged 15-18 years.
CLINICAL IMPLICATIONS: It is unclear if PICUs or adult ICUs are the best place to meet the critical care needs of adults with CCC. As the number of adults with CCC increases, PICUs will need to prepare for increasingly older patients and/or adult ICUs will increasingly need to care for these patients.
DISCLOSURE: The following authors have nothing to disclose: Jeff Edwards, Amy Houtrow, Eduard Vasilevskis, R Adams Dudley, Megumi Okumura
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