• Murray M Pollack, Richard Holubkov, Tomohiko Funai, Amy Clark, John T Berger, Kathleen Meert, Christopher J L Newth, Thomas Shanley, Frank Moler, Joseph Carcillo, Robert A Berg, Heidi Dalton, David L Wessel, Rick E Harrison, Allan Doctor, J Michael Dean, Tammara L Jenkins, and Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network.
• 1Department of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine-Phoenix, Phoenix, AZ. 2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Pediatrics, Children's National Medical Center, Washington, DC. 4Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 5Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 6Department of Pediatrics, University of Michigan, Ann Arbor, MI. 7Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 9Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA. 10Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 11Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, the National Institutes of Health, Bethesda, MD.
• Pediatr Crit Care Me. 2014 Nov 1; 15 (9): 821-7.

ObjectiveTo investigate significant new morbidities associated with pediatric critical care.DesignRandomly selected, prospective cohort.SettingPICU patients from eight medical and cardiac PICUs.PatientsThis was a randomly selected, prospective cohort of PICU patients from eight medical and cardiac PICUs.Measurements And Main ResultsThe main outcomes measures were hospital discharge functional status measured by Functional Status Scale scores and new morbidity defined as an increase in the Functional Status Scale of more than or equal to 3. Of the 5,017 patients, there were 242 new morbidities (4.8%), 99 PICU deaths (2.0%), and 120 hospital deaths (2.4%). Both morbidity and mortality rates differed (p < 0.001) among the sites. The worst functional status profile was on PICU discharge and improved on hospital discharge. On hospital discharge, the good category decreased from a baseline of 72% to 63%, mild abnormality increased from 10% to 15%, moderate abnormality status increased from 13% to 14%, severe status increased from 4% to 5%, and very severe was unchanged at 1%. The highest new morbidity rates were in the neurological diagnoses (7.3%), acquired cardiovascular disease (5.9%), cancer (5.3%), and congenital cardiovascular disease (4.9%). New morbidities occurred in all ages with more in those under 12 months. New morbidities involved all Functional Status Scale domains with the highest proportions involving respiratory, motor, and feeding dysfunction.ConclusionsThe prevalence of new morbidity was 4.8%, twice the mortality rate, and occurred in essentially all types of patients, in relatively equal proportions, and involved all aspects of function. Compared with historical data, it is possible that pediatric critical care has exchanged improved mortality rates for increased morbidity rates.

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