TY - JOUR
T1 - Development of the Pediatric Extracorporeal Membrane Oxygenation Prediction Model for Risk-Adjusting Mortality
AU - Bailly, David K.
AU - Reeder, Ron W.
AU - Winder, Melissa
AU - Barbaro, Ryan P.
AU - Pollack, Murray M.
AU - Moler, Frank W.
AU - Meert, Kathleen L.
AU - Berg, Robert A.
AU - Carcillo, Joseph
AU - Zuppa, Athena F.
AU - Newth, Christopher
AU - Berger, John
AU - Bell, Michael J.
AU - Dean, Michael J.
AU - Nicholson, Carol
AU - Garcia-Filion, Pamela
AU - Wessel, David
AU - Heidemann, Sabrina
AU - Doctor, Allan
AU - Harrison, Rick
AU - Bratton, Susan L.
AU - Dalton, Heidi
N1 - Publisher Copyright:
© 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Objectives: To develop a prognostic model for predicting mortality at time of extracorporeal membrane oxygenation initiation for children which is important for determining center-specific risk-adjusted outcomes. Design: Multivariable logistic regression using a large national cohort of pediatric extracorporeal membrane oxygenation patients. Setting: The ICUs of the eight tertiary care children's hospitals of the Collaborative Pediatric Critical Care Research Network. Patients: Five-hundred fourteen children (< 19 yr old), enrolled with an initial extracorporeal membrane oxygenation run for any indication between January 2012 and September 2014. Interventions: None. Measurements and Main Results: A total of 514 first extracorporeal membrane oxygenation runs were analyzed with an overall mortality of 45% (n = 232). Weighted logistic regression was used for model selection and internal validation was performed using cross validation. The variables included in the Pediatric Extracorporeal Membrane Oxygenation Prediction model were age (pre-term neonate, full-term neonate, infant, child, and adolescent), indication for extracorporeal membrane oxygenation (extracorporeal cardiopulmonary resuscitation, cardiac, or respiratory), meconium aspiration, congenital diaphragmatic hernia, documented blood stream infection, arterial blood pH, partial thromboplastin time, and international normalized ratio. The highest risk of mortality was associated with the presence of a documented blood stream infection (odds ratio, 5.26; CI, 1.90-14.57) followed by extracorporeal cardiopulmonary resuscitation (odds ratio, 4.36; CI, 2.23-8.51). The C-statistic was 0.75 (95% CI, 0.70-0.80). Conclusions: The Pediatric Extracorporeal Membrane Oxygenation Prediction model represents a model for predicting in-hospital mortality among children receiving extracorporeal membrane oxygenation support for any indication. Consequently, it holds promise as the first comprehensive pediatric extracorporeal membrane oxygenation risk stratification model which is important for benchmarking extracorporeal membrane oxygenation outcomes across many centers.
AB - Objectives: To develop a prognostic model for predicting mortality at time of extracorporeal membrane oxygenation initiation for children which is important for determining center-specific risk-adjusted outcomes. Design: Multivariable logistic regression using a large national cohort of pediatric extracorporeal membrane oxygenation patients. Setting: The ICUs of the eight tertiary care children's hospitals of the Collaborative Pediatric Critical Care Research Network. Patients: Five-hundred fourteen children (< 19 yr old), enrolled with an initial extracorporeal membrane oxygenation run for any indication between January 2012 and September 2014. Interventions: None. Measurements and Main Results: A total of 514 first extracorporeal membrane oxygenation runs were analyzed with an overall mortality of 45% (n = 232). Weighted logistic regression was used for model selection and internal validation was performed using cross validation. The variables included in the Pediatric Extracorporeal Membrane Oxygenation Prediction model were age (pre-term neonate, full-term neonate, infant, child, and adolescent), indication for extracorporeal membrane oxygenation (extracorporeal cardiopulmonary resuscitation, cardiac, or respiratory), meconium aspiration, congenital diaphragmatic hernia, documented blood stream infection, arterial blood pH, partial thromboplastin time, and international normalized ratio. The highest risk of mortality was associated with the presence of a documented blood stream infection (odds ratio, 5.26; CI, 1.90-14.57) followed by extracorporeal cardiopulmonary resuscitation (odds ratio, 4.36; CI, 2.23-8.51). The C-statistic was 0.75 (95% CI, 0.70-0.80). Conclusions: The Pediatric Extracorporeal Membrane Oxygenation Prediction model represents a model for predicting in-hospital mortality among children receiving extracorporeal membrane oxygenation support for any indication. Consequently, it holds promise as the first comprehensive pediatric extracorporeal membrane oxygenation risk stratification model which is important for benchmarking extracorporeal membrane oxygenation outcomes across many centers.
KW - decision support
KW - extracorporeal membrane oxygenation
KW - pediatric
KW - predictive score model
KW - risk adjustment
KW - risk assessment
UR - http://www.scopus.com/inward/record.url?scp=85065677202&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000001882
DO - 10.1097/PCC.0000000000001882
M3 - Article
C2 - 30664590
AN - SCOPUS:85065677202
SN - 1529-7535
VL - 20
SP - 426
EP - 434
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 5
ER -