Research Snapshot Theater: Epidemiology Pediatrics III
384
FACTORS ASSOCIATED WITH USE OF PLASMA
EXCHANGE FOR CRITICAL ILLNESS AT A
LARGE CHILDREN’s HOSPITAL
Monique Gardner1, Sajel Kantawala1, Joseph Carcillo1, Robert Clark1,
Christopher Horvat1
Learning Objectives: Plasma exchange (PLEX) has a demon-
strated role in treating multi-organ dysfunction syndrome
(MODS) in children with septic shock with thrombocytopenia-
associated multi-organ failure. We aimed to identify factors that
are associated with receiving PLEX among critically-ill children
admitted to our institution.
Methods: This is a single-center, retrospective cohort study in-
cluding all PICU encounters at UPMC Children’s Hospital of
Pittsburgh between 2015 and 2017. An electronic pediatric lo-
gistic organ dysfunction score 2 (e-PELOD2) and pediatric risk
of mortality score (e-PRISM IV) were developed to identify and
characterize MODS and acuity, respectively. Univariable logis-
tic regression examined relevant demographic and clinical vari-
ables for associations with PLEX. Both the composite e-PELOD2
and e-PRISM IV, as well as subcomponents of each score, were
evaluated. A multivariable model was constructed using forward-
backward stepwise regression with variable selection according to
Akaike Information Criterion. Analyses were performed in Stata
(Stata Corp, College Station, TX) and R (www.r-project.org). Data
are displayed as medians with interquartile range or odds ratios
(OR) with 95% confidence intervals.
Results: Of 5,118 PICU encounters, 55 received PLEX. Patients
receiving PLEX had a median age of 8 years (2–16), 51% were
male, 69% of white race, and had higher encounter e-PELOD2
scores (17 [10–22] vs. 4 [2–7]; P<0.001) compared to non-PLEX
patients. Univariable analysis indicated extracorporeal life support
(ECLS), renal replacement therapy (CRRT), mechanical ventila-
tion, neurologic dysfunction, renal dysfunction, respiratory dys-
function, hematologic dysfunction and the presence of a low-risk
diagnosis (subcomponent of e-PRISM IV) were associated with
PLEX (all P<0.0001). The final multivariable model included he-
matologic dysfunction (OR 3.86[3.7–21.5]; P<0.01), ECLS (12.8
[7.8–50.1]; P<0.001), CRRT (28.5 [11.2–72.7];P<0.0001), as well
as low-risk diagnosis and neurologic dysfunction (both P=NS).
Conclusions: We identified factors associated with receipt of PLEX
in this large, single-center cohort of PICU patients. These data can
be used to facilitate propensity analyses of future PLEX cohort
studies and help with trial design.
UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
1
Critical Care Medicine • Volume 47 • Number 1 (Supplement) www.ccmjournal.org
Copyright © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
385
EPIDEMIOLOGY OF BURN-INJURED
CHILDREN IN U.S. PICUS
Michael McCrory1, Alan Woodruff1, Elizabeth Halvorson1, Amit Saha2,
Brittany Critcher2, James Holmes3
Learning Objectives: Burn injury represents the 4th most com-
mon cause of unintentional injury and death in children and
adolescents, accounting for approximately 400 deaths/year
in the United States (U.S.). Children sustaining moderate-to-
severe burns may undergo initial treatment in a pediatric inten-
sive care unit (PICU); however, little data are available regarding
the epidemiology, management, or outcomes of such patients.
We hypothesized that a) children cared for in U.S. PICUs for
burn injury overall have a low mortality and b) respiratory
insufficiency on admission is associated with mortality in pedi-
atric burn patients.
Methods: The Virtual Pediatric Systems (VPS) database was que-
ried for patients admitted to PICUs in the U.S. with an active
diagnosis of burn from 2009–2017. Descriptive statistics were
performed with continuous variables compared by Wilcoxon
rank-sum test and proportions compared by chi-square test. Two-
sided p value of <0.05 was considered statistically significant.
Results: A total of 2809 children admitted to 131 PICUs were in-
cluded in the study. The most common age group was 1 month-23
months (34.4%), followed by 2–5 years (30.2%), and 6–12 years
(20.1%). Race was recorded most commonly as white (39.7%),
black or African-American (28.6%), or Hispanic/Latino (10.7%),
and 61.5% of patients were male. The most common primary di-
agnosis was “burns to external body surface” (43.7%), followed by
“Pulmonary insufficiency/shock lung/ARDS” (4.1%) and “burn/
scald by hot liquids/steam/caustics” (3.6%). Overall mortality was
4.6%; mortality was significantly higher for patients with a prima-
ry diagnosis of pulmonary insufficiency/shock lung/ARDS (8.8%)
as compared with burns to external body surface (2.0%) or burn/
scald by hot liquids/steam/caustics (0%) (p<0.001). Median PICU
length of stay was 2.0 days (IQR 0.9–5.6); PICU length of stay was
also longer for patients with a primary diagnosis of pulmonary
insufficiency/shock lung/ARDS (median 5.1 days, IQR 2.2–15.6)
vs burns to external body surface (median 1.7 days, IQR 0.8–4.9)
(p<0.0001). The most common discharge disposition was the
general care floor (58.3%), followed by another ICU (12.6%), and
home (10.7%).
Conclusions: Burn-injured children in U.S. PICUs in the VPS da-
tabase are predominantly male, <6 years of age, and most com-
monly have suffered external body surface burns. PICU mortality
is higher in burn-injured patients than the general PICU popula-
tion, and is highest in children with respiratory insufficiency on
admission.
1
Wake Forest Baptist Medical Center, Winston-Salem, NC, 2Wake Forest Uni-
versity Baptist Medical Center, Winston-Salem, NC, 3Wake Forest Baptist Medi-
cal Center, Winsto- Salem, NC