Two Decades of Measuring Ins and Outs: 20 Years of Paediatric Intensive Care Unit Admissions and DISCHARGES At A Small, Tertiary Care Paediatric Hospital with A Large Geographic Catchment Area
Bibliographic record
Abstract
Abstract BACKGROUND: Over the past three decades, pediatric critical care has become recognized as its own subspecialty, with well documented benefits for critically ill children cared for by a pediatric intensivist, in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital. Previous studies describing the demographic of critically ill children have been conducted in large hospitals that provide tertiary and quaternary care, or nation-wide studies including several PICUs. OBJECTIVES: The primary objective of this study was to describe the volume and type of patients admitted to the PICU of a small, tertiary care pediatric hospital with a large geographic catchment area over a period of 20 years. DESIGN/METHODS: We audited a prospectively maintained, administrative database to determine the age, primary diagnosis, length of stay, and outcome for all children, newborn to 18 years of age, who were admitted to the PICU at the Janeway Children’s Health and Rehabilitation Centre in St. John’s, Newfoundland between January 1, 1995 and December 31, 2015. RESULTS: Data were available for 3800 admissions. Children requiring admission to PICU were a median age of 7.1 years (IQR 1.5 - 13.6 years). Medical patients accounted for 60% of admissions with most common diagnoses being respiratory insufficiency (32%), metabolic conditions (15%), neurological conditions (15%), trauma (14%), and cardiac insufficiency (6%). The remainder of admissions were for surgical patients from general surgery (50%), orthopedics (29%), and neurosurgery (21%). Median length of stay for admitted children was 2 days (IQR 1 – 5 days). Overall mortality rates were 2.8%. CONCLUSION: Despite the benefits associated with regionalization of pediatric critical care for acutely ill children, positive outcomes and low mortality rates are observed in a small, tertiary care hospital with a large catchment area that is geographically isolated from other parts of the country. We were able to identify common admission diagnoses for our patient population, comparable to those reported at larger institutions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".