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Abstract

Objectives: Long-stay patients in PICU are at-risk of higher mortality. The long-stay PICU population is growing larger. Identification of indicators of adverse outcomes in this cohort may provide opportunities for timely counselling and support. We aim to analyse the factors associated with higher mortality in the long-stay PICU patient cohort. Methods: Retrospective single centre study of long-stay PICU admissions defined as a PICU length of stay of at least 28 days during a three-year study period (1st April 2017 to 31st March 2020). Outcomes analysed included in-PICU mortality, and mortality within 12 months of PICU discharge. Variables analysed for association with outcomes, included primary diagnostic category, number and nature of additional comorbidities, long-term ventilation pathway etc. Results: During a three-year period, there were 2848 unique individual patient admissions to the PICU. 165 children had 172 long-stay admissions. The overall in-PICU mortality of long-stay patients was 30.2% compared to 6.4% (p<0.0001) for whole PICU population. 42% of the long-stay patients had died by 12 months post-discharge. Certain primary diagnostic groups e.g. haematology/oncology, had a statistically significant increased likelihood of death (OR (8.6, p= 0.004, CI 2.0-39.5)). Children on a long-term ventilation (LTV) pathway had relatively lower odds of death [OR 0.1 (p= 0.003, CI 0.01-0.34)]. Conclusion: We described factors associated with higher and lower mortality rates in a group of long-stay PICU patients. Understanding the impact of specific combinations of factors as shown in this analysis on outcomes may be important for clinicians to help counsel families.

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