• Angelo Polito, Christophe Combescure, Yann Levy-Jamet, Peter Rimensberger, and Swiss Society of Intensive Care Medicine.
• Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
• Plos One. 2019 Jan 1; 14 (10): e0223369.

AimsTo stipulate a new definition for long-stay patients (LSPs) in pediatric intensive care unit (PICU). We defined LSPs as the 10% of patients with the longest PICU length-of-stay (LOS) for each age and diagnostic group. To assess whether the thresholds (days of PICU stay) for the definition of LSPs in PICU significantly differ among diagnostic and age categories. To determine whether independent associations exist between patients' characteristics at admission and LSPs diagnosis in pre-specified diagnostic and age groups.MethodsThis was a multicenter retrospective cohort study including all PICUs in Switzerland. Multivariable regression analysis was used to seek for association between patients' variables at admission and LSPs.ResultsWe included 22,284 patients with a median (IQR) age of 12 (1-84) months. Significantly different thresholds across diagnostic and age subgroups are identified. Readmission to PICU, higher PIM2 and NEMS (a score used to quantify nursing workload at intensive care unit level) at admission were associated with higher likelihood of becoming LSPs.ConclusionsOur results showed a significantly different definitions of LSPs for specific diagnoses and age categories. Readmission to PICU and higher acuity at admission are associated with longer PICU length-of-stay in the majority of diagnostic groups. A more personalized definition of LSPs in children based on actual patients' characteristics should probably be used in an effort to optimize care and reduce costs.

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