PP260 Topic: AS25–Sedation/Analgesia/Delirium/Withdrawal Syndrome/Other: COMFORT-HOLDING IN PEDIATRIC CRITICAL CARE UNITS WORLDWIDE– ANALYSIS OF THE PARK-PICU POINT PREVALENCE DATA
Bibliographic record
Abstract
Aims & Objectives: Patient discomfort is associated with negative sequelae. Despite recommendations for non-pharmacological therapies, a paucity of evidence informs their use and analgosedation remains the standard of care for PICU comfort. Comfort-holding in NICUs decreases neonatal mortality, and discomfort; improves stability and cognitive development; and decreases maternal stress. Little is known about comfort-holding in PICUs. We aimed to describe the current state of comfort-holding in PICUs. Methods: Secondary analysis of data from the PARK-PICU study, which included children admitted for > 72 hours to 13 Canadian, 38 European, and 82 American PICUs during 2 days in 2018. Prevalence of holding, adverse events and patient characteristics were described. Multilevel multivariable logistic regression identified factors associated with comfort-holding. Results: 2,362 patients were included and 35.5% (n=839) received comfort-holding. Most patients receiving comfort-holding were < 2 years (n=738, 88.0%) with a median weight of 6.2kg (IQR 3.1-9.8kg). Safety events occurred in 3.1% (62/1998) of comfort-holding events. The odds of comfort-holding increased with higher nurse:patient ratio (OR 1.50; 95% CI: 1.12-2.02) and family presence (OR 8.42; 95%CI: 6.13-11.56); and decreased with older age (reference 0-2 years) [3-6 years (OR 0.17; 95%CI: 0.11-0.25), 7-12 years (OR 0.05; 95%CI: 0.03-0.09), 13-18 years (OR 0.04; 95%CI: 0.02-0.07)], invasive ventilation (OR 0.49; 95%CI: 0.36-0.67), and presence of a dialysis line, ECLS cannula or VAD (OR 0.27; 95% CI: 0.11-0.67). Conclusions: Comfort-holding is not widely practiced in PICUs. Given the low safety event rate and potential to optimize PICU comfort, further study of it’s effectiveness and implementation is warranted. Keywords: comfort holding, PICU, therapeutic cuddles, early mobility, Pain, agitation, and delirium
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.014 | 0.002 |
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".