Critically Ill or Injured Children Should Be Centralized in Pediatric Intensive Care Unit

DOI 7 Citations 31 References
  • Takei Kenkichi
    Department of Emergency and Critical Care Medicine, Chiba Hokusou Hospital, Nippon Medical School
  • Shimizu Naoki
    Department of Anesthesia and ICU, National Center for Child Health and Development
  • Matsumoto Hisashi
    Department of Emergency and Critical Care Medicine, Chiba Hokusou Hospital, Nippon Medical School
  • Yagi Takanori
    Department of Emergency and Critical Care Medicine, Chiba Hokusou Hospital, Nippon Medical School
  • Obara Soichiro
    Department of Anesthesia and ICU, National Center for Child Health and Development
  • Sakai Hirokazu
    Department of Anesthesia and ICU, National Center for Child Health and Development
  • Mashiko Kunihiro
    Department of Emergency and Critical Care Medicine, Chiba Hokusou Hospital, Nippon Medical School

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Other Title
  • 小児重症患者の救命には小児集中治療施設への患者集約が必要である

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Background: In Europe and America, it has been proved that centralized management of critically ill or injured children in the pediatric intensive care unit (PICU) improves the outcomes. However, the system of centralized management of severely ill children in Japan is still immature. In this study, we compared the management of critically ill or injured children in the PICU with that in the intensive care unit (ICU), and considered highlight the need of centralization for critically ill children.<BR>Methods: From January 2001 to December 2006, we extracted patients younger than 15 years of age with critical illnesses who required ventilatory support, and divided them into two groups: the ICU group, treated in the ICU, and the PICU group, centralized and treated in the PICU. We calculated the mortality in the ICU group and the PICU group, and compared the rates with the expected mortality calculated by Pediatric Index of Mortality 2 (PIM2).<BR>Results: There were 22 cases in the ICU group and 11 cases in the PICU group, and 6 and 1 cases from the two groups died, respectively. The actual death rate in the ICU group was 27.3%, which was similar to the expected mortality calculated by PIM2 of 24.5%. On the other hand, the actual death rate in the PICU group was 9.1%, significantly lower than the expected mortality calculated by PIM2 of 29.6%.<BR>Conclusions: Critically ill or injured children should receive centralized management in the PICU. For this purpose, construction of a wide-area transport system is necessary.

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