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Five-Year Survival of Children With Chronic Critical Illness in Australia and New Zealand*

Namachivayam, Siva P. MEpi, FCICM1,2; Alexander, Janet3; Slater, Anthony FRACP, FCICM4; Millar, Johnny PhD, FRACP, FCICM1; Erickson, Simon FRACP, FCICM5; Tibballs, James MD, FANZCA, FCICM1,6; Festa, Marino MD, FCICM7; Ganu, Subodh MD, FCICM8; Segedin, Liz FRACP, FCICM9; Schlapbach, Luregn J. MD, FCICM4,10,11; Williams, Gary FCICM12; Shann, Frank MD, FRACP, FCICM1,6; Butt, Warwick FRACP, FCICM1,2,6

doi: 10.1097/CCM.0000000000001076
Pediatric Critical Care

Objective: Outcomes for children with chronic critical illness are not defined. We examined the long-term survival of these children in Australia and New Zealand.

Design: All cases of PICU chronic critical illness with length of stay more than 28 days and age 16 years old or younger in Australia and New Zealand from 2000 to 2011 were studied. Five-year survival was analyzed using Kaplan-Meir estimates, and risk factors for mortality evaluated using Cox regression.

Setting: All PICUs in Australia and New Zealand.

Patients: Nine hundred twenty-four children with chronic critical illness.

Intervention: None.

Measurements and Main Results: Nine hundred twenty-four children were admitted to PICU for longer than 28 days on 1,056 occasions, accounting for 1.3% of total admissions and 23.5% of bed days. Survival was known for 883 of 924 patients (95.5%), with a median follow-up of 3.4 years. The proportion with primary cardiac diagnosis increased from 27% in 2000–2001 to 41% in 2010–2011. Survival was 81.4% (95% CI, 78.6–83.9) to PICU discharge, 70% (95% CI, 66.7–72.8) at 1 year, and 65.5% (95% CI, 62.1–68.6) at 5 years. Five-year survival was 64% (95% CI, 58.7–68.6) for children admitted in 2000–2005 and 66% (95% CI, 61.7–70) if admitted in 2006–2011 (log-rank test, p = 0.37). After adjusting for admission severity of illness using the Paediatric Index of Mortality 2 score, predictors for 5-year mortality included bone marrow transplant (hazard ratio, 3.66; 95% CI, 2.26–5.92) and single-ventricle physiology (hazard ratio, 1.98; 95% CI, 1.37–2.87). Five-year survival for single-ventricle physiology was 47.2% (95% CI, 34.3–59.1) and for bone marrow transplantation 22.8% (95% CI, 8.7–40.8).

Conclusions: Two thirds of children with chronic critical illness survive for at-least 5 years, but there was no improvement between 2000 and 2011. Cardiac disease constitutes an increasing proportion of pediatric chronic critical illness. Bone marrow transplant recipients and single-ventricle physiology have the poorest outcomes.

1Department of Paediatric Intensive Care, Royal Children’s Hospital, Melbourne, VIC, Australia.

2Murdoch Children’s Research Institute, Melbourne, VIC, Australia.

3Australia and New Zealand Paediatric Intensive Care Registry, Brisbane, QLD, Australia.

4Paediatric Intensive Care Unit, Lady Cilento Children’s Hospital, Children’s Health Queensland, Brisbane, QLD, Australia.

5Paediatric Intensive Care Unit, Princess Margaret Hospital, Perth, WA, Australia.

6Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.

7Paediatric Intensive Care Unit, Children’s Hospital at Westmead, Sydney, NSW, Australia.

8Paediatric Intensive Care Unit, Women’s and Children’s Hospital, Adelaide, SA, Australia.

9Pediatric Intensive Care Unit, Starship Children’s Hospital, Auckland, New Zealand.

10Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland.

11Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.

12Paediatric Intensive Care Unit, Sydney Children’s Hospital, Sydney, NSW, Australia.

*See also p. 2035.

Dr. Namachivayam is employed by the Royal Children’s Hospital, Melbourne. Ms. Alexander is employed by the Australian and New Zealand Intensive Care Society. Dr. Slater is employed by Children’s Health Queensland, has stock (personal investments but none of these investments are in the health industry), and received support for travel from Intensive Care Societies (he had travel and accommodation paid for when presenting at scientific meetings). His institution received grant support (Australian States and Territories and New Zealand provide funding for the Australian and New Zealand Intensive Care Society for the ANZPIC Registry). Dr. Tibballs received support for participation in review activities (reimbursement of travel and accommodation expenses); is employed by the Royal Children’s Hospital, Melbourne; provided expert testimony (numerous payments of expert opinions from legal firms); and has stock (numerous dividends from shares). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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