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Factors Associated With Mortality in Low-Risk Pediatric Critical Care Patients in The Netherlands*

Verlaat, Carin W. MD; Visser, Idse H. MSc, MA; Wubben, Nina; Hazelzet, Jan A. MD, PhD; Lemson, Joris MD, PhD; van Waardenburg, Dick MD, PhD; van der Heide, Douwe RN; van Dam, Nicolette A. MD; Jansen, Nicolaas J. MD, PhD; van Heerde, Mark MD, PhD; van der Starre, Cynthia MD, PhD; van Asperen, Roelie MD, PhD; Kneyber, Martin MD, PhD, FCCM; van Woensel, Job B. MD, PhD; van den Boogaard, Mark RN, PhD; van der Hoeven, Johannes MD, PhD

Pediatric Critical Care Medicine: April 2017 - Volume 18 - Issue 4 - p e155–e161
doi: 10.1097/PCC.0000000000001086
Online Clinical Investigations

Objective: To determine differences between survivors and nonsurvivors and factors associated with mortality in pediatric intensive care patients with low risk of mortality.

Design: Retrospective cohort study.

Setting: Patients were selected from a national database including all admissions to the PICUs in The Netherlands between 2006 and 2012.

Patients: Patients less than 18 years old admitted to the PICU with a predicted mortality risk lower than 1% according to either the recalibrated Pediatric Risk of Mortality or the Pediatric Index of Mortality 2 were included.

Interventions: None.

Measurements and Main Results: In total, 16,874 low-risk admissions were included of which 86 patients (0.5%) died. Nonsurvivors had more unplanned admissions (74.4% vs 38.5%; p < 0.001), had more complex chronic conditions (76.7% vs 58.8%; p = 0.001), were more often mechanically ventilated (88.1% vs 34.9%; p < 0.001), and had a longer length of stay (median, 11 [interquartile range, 5–32] d vs median, 3 [interquartile range, 2–5] d; p < 0.001) when compared with survivors. Factors significantly associated with mortality were complex chronic conditions (odds ratio, 3.29; 95% CI, 1.97–5.50), unplanned admissions (odds ratio, 5.78; 95% CI, 3.40–9.81), and admissions in spring/summer (odds ratio, 1.67; 95% CI, 1.08–2.58).

Conclusions: Nonsurvivors in the PICU with a low predicted mortality risk have recognizable risk factors including complex chronic condition and unplanned admissions.

Supplemental Digital Content is available in the text.

1Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.

2Dutch Pediatric Intensive Care Evaluation, Department of Pediatric Intensive Care, Erasmus Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands.

3Radboud University, Nijmegen, The Netherlands.

4Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.

5Department of Pediatric Intensive Care, Academic Hospital Maastricht, The Netherlands.

6Faculty Board Member, PICE Registry, the Netherlands.

7Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, The Netherlands.

8Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.

9Department of Pediatric Intensive Care, VU University Medical Center, Amsterdam, The Netherlands.

10Department of Neonatal and Pediatric Intensive Care, Erasmus University Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands.

11Department of Pediatric Intensive Care, University Medical Center Groningen, Groningen, The Netherlands.

12Department of Pediatric Intensive Care, Academic Medical Center, Amsterdam, The Netherlands. This work was performed at the Department of Pediatric Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.

*See also p. 390.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

The authors have disclosed that they do not have any potential conflicts of interest.

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©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies