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Intensive Care Medicine
Published in: Intensive Care Medicine 8/2012

01-08-2012 | Pediatric Original

Clinical course and outcome for critically ill children with Down syndrome: a retrospective cohort study

Authors: Shane M. Tibby, Andrew Durward, Chong Tien Goh, Kentigern Thorburn, Kevin Morris, Mike Broadhead, Mark J. Peters

Published in: Intensive Care Medicine | Issue 8/2012

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Abstract

Purpose

Children with Down syndrome (DS) have several genetic anomalies within chromosome 21 which may influence their response to critical illness. We compared the intensive care course and outcome of children with DS versus those without.

Methods

Retrospective cohort study in four English paediatric intensive care units (ICUs) (2003–2009, n = 33,485). We examined, via a competing risks model, whether risk (subhazard) for ICU mortality differed for children with DS, after adjusting for important confounders.

Results

DS patients exhibited lower disease severity at ICU admission but subsequently required a higher proportion of cardiovascular support, and similar renal support to non-DS patients. Children with DS (n = 1,278) had lower crude mortality than those without (4.2 versus 6.2 %, p = 0.003). This was not significant when expressed as standardized mortality ratio: 0.83 [95 % confidence interval (CI) 0.63–1.09] versus 0.90 (95 % CI 0.86–0.94). However, the competing risks model showed that mortality risk was influenced by length of ICU stay. At admission, DS patients exhibited a subhazard for mortality of 0.63 (95 % CI 0.46–0.85), which increased to 1.00 by day 10 of admission, and continued rising above that of non-DS children thereafter.

Conclusions

Children with DS require a higher proportion of organ support than expected by disease severity at ICU admission. In addition, the mortality risk for children with DS is dependent upon length of ICU stay. These findings could reflect differences in case mix, but are also compatible with different response to critical illness in this group.
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Metadata
Title
Clinical course and outcome for critically ill children with Down syndrome: a retrospective cohort study
Authors
Shane M. Tibby
Andrew Durward
Chong Tien Goh
Kentigern Thorburn
Kevin Morris
Mike Broadhead
Mark J. Peters
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 8/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-012-2589-x

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