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Outcome of children admitted to adult intensive care units in Italy between 2003 and 2007

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Abstract

Background

Centralisation of critically ill children to paediatric intensive care units is supported by a strong rationale, but evidence is not overwhelming.

Objective

To compare the outcome of children admitted to adult intensive care units (ICUs) in Italy between 2003 and 2007 with that of children admitted to paediatric intensive care units (PICUs) in Italy between 1994 and 1995.

Methods

Prospective, multicenter cohort study and historical controls. Risk of ICU mortality was assessed with the PRISM score in both study and historical control groups. Descriptive statistics, standardized mortality ratios (SMRs) with their 95% confidence intervals, and the calibration plots were reported.

Results

A total of 1,265 children admitted to 124 adult ICUs between 2003 and 2007 were compared with an historical control group formed by 1,533 children admitted to 26 PICUs between 1994 and 1995. The PRISM score slightly underestimated hospital deaths for low-risk patients in both groups. The overall SMR was 1.11 (95% CI 0.91–1.31) for adult ICUs and 1.04 (95% CI: 0.88–1.19) for PICUs.

Conclusions

The level of care provided nowadays to children admitted to adult ICUs in Italy is similar to that provided by Italian PICUs 10 years earlier. On the other hand, there is evidence that Italian PICUs have improved the level of care in the same period. These findings, if confirmed, suggest a better quality of care for children admitted to PICUs as compared to adult ICUs and support the indication, when possible, of early referral to more specialized units in countries where paediatric intensive care is not centralised.

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Acknowledgements

The study was wholly funded by GiViTI-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo (Italy). GiViTI is the recipient of unconditioned grants from Drager Medical Italia, Bellco, Brahms, and Astellas, which did not, however, have any role in this study. The authors would like to thank Abramo Anghileri and Michele Giardino (Istituto di Ricerche Farmacologiche Mario Negri) for their contribution in developing and maintaining the software for data collection.

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Pediatric Intensive Care Unit, University of Padova, Via Giustiniani 3, 35128, Padova, Italy

    Paola E. Cogo & Anna Capretta

  2. Department of Anesthesia and Intensive Care, Intensive Care Unit, San Martino Hospital, Belluno, Italy

    Daniele Poole

  3. Pediatric Intensive Care Unit, Ospedali Riuniti, Bergamo, Italy

    Daniela Codazzi

  4. Pediatric Intensive Care Unit, Ospedale dei Bambini, Spedali Civili, Brescia, Italy

    Corinne Boniotti

  5. Fondazione IRCCS Istituto Nazionale Tumor, Università degli Studi di Milano, Milan, Italy

    Martin Langer

  6. Unit of Clinical Knowledge Engineering, Laboratory of Clinical Epidemiology, Mario Negri Institute for Pharmacological Research, Milan, Italy

    Davide Luciani

  7. GiViTI Coordinating Center, Laboratory of Clinical Epidemiology, Mario Negri Institute for Pharmacological Research, Ranica (BG), Italy

    Carlotta Rossi & Guido Bertolini

Authors
  1. Paola E. Cogo
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  2. Daniele Poole
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  3. Daniela Codazzi
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  4. Corinne Boniotti
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  5. Anna Capretta
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  6. Martin Langer
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  7. Davide Luciani
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  8. Carlotta Rossi
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  9. Guido Bertolini
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Corresponding author

Correspondence to Paola E. Cogo.

Additional information

For the GiViTI group Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (Italian Group for the Evaluation of Interventions in Intensive Care Medicine). A complete list of study participants appears in the Appendix.

Appendix

Appendix

GiViTI Steering Committee (in alphabetical order, with location in brackets)

Guido Bertolini (Ranica, BG), Daniela Boccalatte (Lucca), Paola Cogo (Padova), Maria Giovanna De Cristofaro (Napoli), Emiliano Gamberini (Cesena), Adonella Gorietti (Perugia), Martin Langer (Milano), Nicola Latronico (Brescia), Paolo Malacarne (Pisa), Daniele Poole (Belluno), Danilo Radrizzani (Legnano, MI), Mario Tavola (Lecco), Franco Zuccaro (Matera).

List of participating clinicians (in alphabetical order, with their location in brackets)

Silvia Scarrone (Alessandria), Teresa Bartoli (Antella, FI), Massimo Gianni (Aosta), Claudia Acciarri (Ascoli Piceno), Elvio De Blasio (Benevento), Giancarlo Negro (Casarano, LE), Aristide Morigi (Bologna), Massimo Neri (Bologna), Elena Chinelli (Bologna), Arcangelo Bartoccini (Borgomanero, NO), Stefano Mancosu (Cagliari), Annamaria Acquarolo (Brescia), Enrico Arditi (Genova), Simonetta Pastorini (Camposampiero, PD), Pierfrancesco Di Masi (Castellana Grotte, BA), Pasqualino Quattrocchi (Catania), Maria Grazia Visconti (Cernusco sul Naviglio, MI), Arturo Chieregato (Cesena, FC), Livio Todesco (Cittadella, PD), Maria Federica Magatti (Como), Paolo Dal Cero (Conegliano, TV), Clemente Possamai (Conegliano, TV), Luciano Crema (Cremona), Silvia Tinacci (Empoli, FI), Pierpaolo Casalini (Faenza, RA), Giorgio Mantovani (Ferrara), Remo Barbagli (Firenze), Maurizio Berardino (Torino), Roberto Madonna (Grosseto), Maria Giovanna Vespignani (Imola, BO), Fausto Maria Molino (Roma), Rosa Salcuni (Ivrea, TO), Sergio Livigni (Torino), Viscardo Murri (Lanciano, CH), Ezio Crestan (Lecco), Mario Tavola (Lecco), Leonardo Bossi (Legnano, MI), Giancarlo Rossi (Livorno), Davide Archi (Lodi), Daniela Boccalatte (Lucca), Tito Cottignoli (Lugo di Romagna, RA), Giovanni Negri (Magenta, MI), Alessandro Mastroianni (Chieri, TO), Riccardo Colombo (Milano), Alberto Sicignano (Milano), Alberto Parma (Milano), Luisa Ranzini (Milano), Marco Pulici (Milano), Massimo Raffaeli (Milano), Angelo Pezzi (Milano), Sergio Colombo (Milano), Roberto Rona (Monza, MI), Maurizio Postiglione (Napoli), Carlo Olivieri (Novara), Lorenzo Odetto (Orbassano, TO), Romano Tetamo (Palermo), Livio Carnevale (Pavia), Adonella Gorietti (Perugia), Cesare Breschi (Pesaro), Rosamaria Zocaro (Pescara), Cesare Benanti (Pescia, PT), Carlo Mosca (Pisa), Paolo Malacarne (Pisa), Andrea Bonfà (Prato), Simona Rossi (Rho, MI), Mara Olga Bernasconi (Rovigo), Tiziana Garzilli (Perugia), Domenico Nuovo (Torino), Mauro Torta (Torino), Vincenzo Segala (Torino), Sally Calva (Torino), Ennio Nascimben (Treviso), Silvio Marafon (Vicenza), Franco Zuccaro (Matera), Giacomo Castiglione (Catania), Maria Cristina Fabi (Fano, PU), Monica Baroncia (Roma), Giorgio Paganini (Sanremo, IM), Federica Rottoli (Bergamo), Giuseppe Tibaldi (Brescia), Cristina Carsana (Busto Arsizio, VA), Eduardo Beck (Desio, MI), Emanuela Brunori (Macerata), Eleonora Costanzo (Asti), Adalgisa Caracciolo (Acquaviva delle Fonti, BA), Marianna Messina (Olbia), Alberto Guadagnucci (Massa), Paola Staccioli (Pistoia), Daniele Poole (Belluno), Elsa Galeotti (Feltre, BL), Giuseppina Bonaccorso (Padova), Lucia Casagrande (Treviso), Alberto Garelli (Ravenna), Valter Bottari (Reggio Emilia), Monica Bonfiglio (Lavagna, GE), Renzo Miglioranzi (Pieve di Coriano, MN), Marialuisa Pizzaballa (Zingonia, BG), Antonino Ortoleva (Ome, BS), Pasquale De Negri (Rionero in Vulture, PZ), Marco Chiarello (Camerino, MC), Massimo Barattini (Firenze), Maurizio Pegoraro (Castelfranco Veneto, TV), Maurizio Palmer (Aversa, CE), Guido Paganoni (Bergamo), Michele Isetta (Genova), Luigi Giacopuzzi (Negrar, VR), Giampiero Di Serafino (Fermo, AP), Daniela Maria Pacini (Genova), Giuseppe Calicchio (Salerno), Andrea Bianchin (Montebelluna, TV), Flavio Badii (San Donà di Piave, VE), Giuseppe Natalini (Brescia), Roberto Buonanno (Lacco Ameno, NA), Giuseppe Garofalo (Catania), Silvano Papiri (San Benedetto del Tronto, AP), Giuseppe Angelo Vulcano (Rossano, CS), Carlo Maestrone (Domodossola, VB), Benita Capannolo (L’Aquila), Emiliano Gamberini (Cesena, FC), Giovanni Bassi (Carrara, MS), Manuela Bonizzoli (Firenze), Sergio Casagli (Pisa), Emilio Fabbri (Forlì, FC), Angelo Blasetti (Avezzano, AQ), Sergio Zappa (Brescia), Piero Aurelio Segalini (Piacenza), Virginio Buzzetti (Orbetello Scalo, GR), Pier Giorgio Fabbri (Palermo), Dino Di Pasquale (Pontedera, PI), Carlo Maggiolo (Adria, RO), Alberto Sicignano (Milano), Edith Casadei (Siena), Giuseppe Sera (Reggio Calabria), Valentina Bellato (Rozzano, MI), Antonella Potalivo (Bologna), Ivan Donato (Cantù, CO), Carlo Tripepi (Monselice, PD), Dolores Da Re (Este, PD), Giuseppe Nardi (Roma), Gilberto Fiore (Moncalieri, TO).

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Cogo, P.E., Poole, D., Codazzi, D. et al. Outcome of children admitted to adult intensive care units in Italy between 2003 and 2007. Intensive Care Med 36, 1403–1409 (2010). https://doi.org/10.1007/s00134-010-1914-5

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  • DOI: https://doi.org/10.1007/s00134-010-1914-5

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