Effectiveness and Efficiency in Pediatric Intensive Care

  • F. Shann
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 25)

Abstract

Pediatric intensive care makes a substantial contribution to the health of children in developed countries. For example, in Victoria, a state of Australia with a population of 4.5 million, one child in 70 (1.5% or 15 per 1000) is admitted to the pediatric intensive care unit at the Royal Children’s Hospital. A conservative estimate is that half the children admitted would die without intensive care (15 × 0.5 = 7.5 per 1000), so Victoria’s under 15 years mortality rate would double from 7.1 to 14.6 deaths per 1000 live births without pediatric intensive care.

Keywords

Neurol Doyle Croup 

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References

  1. 1.
    Kitchen WH, Ryan MM, Rickards A, et al (1978) A Longitudinal study of very low-birth- weight infants: study design and mortality rates. Develop Med Child Neurol 20:605–618.PubMedCrossRefGoogle Scholar
  2. 2.
    Mugford M (1991) Commentary. Arch Dis Child 66:410–411.CrossRefGoogle Scholar
  3. 3.
    Bakketeig LS, Hoffman HJ, Sternthal PM (1978) Obstetric service and perinatal mortality in Norway. Acta Obstet Gyn Scand Suppl 77:1–19.Google Scholar
  4. 4.
    Watson AB (1981) A review of perinatal mortality in Colorado, 1971 to 1978, and its relationship to the regionalization of perinatal services. Am J Obstet Gynecol 141:1045.Google Scholar
  5. 5.
    Cooke RWI (1987) Referral to a regional centre improves outcome in extremely low birth weight infants. Arch Dis Child 62:619–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Forbes JF, Larssen KE, Bakketeig LS (1987) Access to intensive neonatal care and neonatal survival in low birthweight infants: a population study in Norway. Paed Perinatol Epidemiol 1:33–42.CrossRefGoogle Scholar
  7. 7.
    Hopwood SP, Boyle MH, Torrance GW, Sinclair JC (1982) Mortality and morbidity of 500- to 1,499-gram birth weight infants live-born to residents of a defined geographic region before and after neonatal intensive care. Pediatrics 69:613–620.Google Scholar
  8. 8.
    Kitchen WH (1991) Improvement of outcome for infants of birth weight under 1000 g. Arch Dis Child 66:765–769.CrossRefGoogle Scholar
  9. 9.
    Paneth N, Kiely JL, Wallenstein S, Marcus M, Pakter J, Sussre M (1982) Newborn intensive care and neonatal mortality in low-birth-weight infants. N Engl J Med 307:149–155.PubMedCrossRefGoogle Scholar
  10. 10.
    Rosenblatt RA, Reinken J, Shoemack P (1985) Is obstetrics safe in small hospitals? Lancet 2:429–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Saigai S, Rosenbaum P, Hattersley B (1989) Decreased disability rate among 3-year-old survivors weighing 501 to 1000 grams at birth and born to residents of a geographically defined region from 1981 to 1984 compared with 1977 to 1980. J Pediatr 114:839–46.CrossRefGoogle Scholar
  12. 12.
    Verloove-Vanhorick SP, Verwey RA, Ebeling MCA, Brand R, Ruys IH (1988) Mortality in very preterm and very low birth weight infants according to place of birth and level of care: results of a national collaborative survey of preterm and very low birth weight infants in the Netherlands. Pediatrics 81:405–411.Google Scholar
  13. 13.
    Williams RL (1979) Measuring the effectiveness of perinatal medical care. Med Care 17:95–110.PubMedCrossRefGoogle Scholar
  14. 14.
    Yankauer A, Allaway NC (1958) An analysis of hospital neonatal mortality rates in New York State. AMA J Dis Child 95:240–44.PubMedGoogle Scholar
  15. 15.
    Budetti PP, McManus P (1982) Assessing the effectiveness of neonatal intensive care. Med Care 20:1027–39.PubMedCrossRefGoogle Scholar
  16. 16.
    Budetti P, Barrand N, McManus P, Heinen LA (1981) The implications of cost-effectiveness analysis of medical technology: background paper 2; case study 10: the costs and effectiveness of neonatal intensive care. Office of Technology Assessment, Congress of the United States, Washington.Google Scholar
  17. 17.
    Bereson RA (1984) Intensive care units (ICUs): clinical outcomes, costs and decisionmaking. Health Technology Case Study 28. Office of Technology Assessment, Congress of the United States, Washington.Google Scholar
  18. 18.
    Doyle LW, Murton LJ, Kitchen WH (1989) Increasing the survival of extremely-immature (24- to 28-weeks’ gestation) infants - at what cost? Med J Aust 150:558–568.PubMedGoogle Scholar
  19. 19.
    Kitchen WH, Doyle LW, Ford GW, et al (1991) Changing two-year outcome of infants weighing 500 to 999 grams at birth: a hospital study. J Pediatr 118:938–43.PubMedCrossRefGoogle Scholar
  20. 20.
    Butt W, Shann F, Tibballs J, et al (1990) Long-term outcome of children after intensive care. Crit Care Med 18:961–965.PubMedCrossRefGoogle Scholar
  21. 21.
    Boyle MH, Torrance GW, Sinclair JC, Horwood SP (1983) Economic evaluation of neonatal intensive care of very-low-birth-weight infants. N Engl J Med 308:1330–1337.PubMedCrossRefGoogle Scholar
  22. 22.
    Bull C, Rigby ML, Shinebourne EA (1985) Should management of complete atrioventricular canal defect be influenced by co-existent Down syndrome? Lancet 1:1147–1149.PubMedCrossRefGoogle Scholar
  23. 23.
    Chassin MR (1982) Costs and outcomes of medical intensive care. Med Care 20:165- 179.PubMedCrossRefGoogle Scholar
  24. 24.
    Castles I (1988) Year Book Australia. Australian Bureau of Statistics, Canberra.Google Scholar
  25. 25.
    Ruttimann UE, Albert A, Pollack MM, Glass NL (1986) Dynamic assessment of severity of illness in pediatric intensive care. Crit Care Med 14:215–221.PubMedCrossRefGoogle Scholar
  26. 26.
    Pollack MM, Buttimann UE, Getson PR, (1988) Pediatric risk of mortality (PRISM) score. Crit Care Med 16:1110–1116.PubMedCrossRefGoogle Scholar
  27. 27.
    Balakrishnan G, Aitchison T, Hallworth D, Morton NS (1992) Prospective evaluation of the paediatric risk of mortality (PRISM) score. Arch Dis Child 67:196–200.PubMedCrossRefGoogle Scholar
  28. 28.
    Gemke RJBJ, Bonsel GJ, van Vught J A (1994) Effectiveness and efficiency of a Dutch pediatric intensive care unit: validity and application of the pediatric risk of mortality score. Crit Care Med 22:1477–1484.PubMedCrossRefGoogle Scholar
  29. 29.
    Goddard JM (1992) Pediatric risk of mortality socring overestimates severity of illness in infants. Crit Care Med 20:1662–1665.PubMedCrossRefGoogle Scholar
  30. 30.
    Pollack MM, Getson PR, Ruttimann UE, et al (1987) Efficiency of intensive care. JAMA 258:1481–1486.PubMedCrossRefGoogle Scholar
  31. 31.
    Klem SA, Pollack MM, Getson PR (1990) Cost, resource utilization, and severity of illness in intensive care. J Pediatr 116:231–237.PubMedCrossRefGoogle Scholar
  32. 32.
    Stambouly J J, Pollack MM, Ruttimann UE (1991) An objective method to evaluate rationing of pediatric intensive care beds. Intensive Care Med 17:154–158.PubMedCrossRefGoogle Scholar
  33. 33.
    Pollack MM Alexander SR, Clarke N, Ruttimann UE, Tesselaar HM, Bachulis AC (1991) Improved outcomes from tertiary center pediatric intensive care: a statewide comparison of tertiary and nontertiary care facilities. Crit Care Med 19:150–159.PubMedCrossRefGoogle Scholar
  34. 34.
    Edge WE, Kanter RK, Weigle CGM, Walsh RF (1994) Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care Med 22:1186–1191.PubMedCrossRefGoogle Scholar
  35. 35.
    Castella X, Artigas A, Bion J, Kari A (1995) A comparison of severity of illness scoring systems for intensive care unit patients: results of a multicenter, multinational study. Crit Care Med 23:1327–1335.PubMedCrossRefGoogle Scholar
  36. 36.
    Flora JD (1978) A method for comparing survival of burn patients to a standard survival curve. J Trauma 18:701–705.PubMedCrossRefGoogle Scholar
  37. 37.
    Gemke RJ (1994) Outcome assessment of pediatric intensive care: principles and applications. Gemke, Maarssen, 115–128.Google Scholar
  38. 38.
    Pollack MM, Guerdon TT, Patel KM, Ruttimann UE, Getson PR, Levetown M (1994) Impact of quality-of-care factors on pediatric intensive care unit mortality. JAMA 272:941- 946.PubMedCrossRefGoogle Scholar
  39. 39.
    Teres D (1991) Are we ready to regionalize pediatric intensive care? Crit Care Med 19:139–140.PubMedCrossRefGoogle Scholar
  40. 40.
    Gemke RJBJ, Bonsel GJ (1995) Comparative assessment of pediatric intensive care: a national multicenter study. Crit Care Med 23:238–245.PubMedCrossRefGoogle Scholar
  41. 41.
    Luft HS, Garnick DW, Mark DH, McPhee SJ (1990) Hospital volume, physician volume, and patient outcomes. Health Administration Press Perspectives, Ann Arbor.Google Scholar
  42. 42.
    Farley DE, Ozminkowski RJ (1992) Volume-outcome relationships and inhospital mortality: the effect of changes in volume over time. Med Care 30:77–94.PubMedCrossRefGoogle Scholar
  43. 43.
    Thompson DR, Clemmer TP, Applefeld JJ et al (1994) Regionalization of critical care medicine: task force report of the American College of Critical Care Medicine. Crit Care Med 22:1306–1313.PubMedCrossRefGoogle Scholar
  44. 44.
    British Paediatric Association (1993) The care of critically ill children. British Paediatric Association, London.Google Scholar
  45. 45.
    National Health and Medical Research Council (1983) Management of seriously ill children in adult intensive care units. NH&MRC, CanberraGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

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  • F. Shann

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