Factors affecting intensive care length of stay in critically ill pediatric patients with burn injuries
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In brief
In brief
This study identifies clinical predictors of prolonged PICU stays in severely burned children, finding that higher total body surface area burned, lower systolic blood pressure, and reduced platelet counts in the first 48 hours correlate with stays exceeding 7 days. The resulting predictive model achieved 100% specificity for identifying high-risk patients, offering a practical tool for optimizing resource allocation and care planning in pediatric burn units.
- Burn extent >33% TBSA strongly predicts PICU stay exceeding 7 days in pediatric burn patients.
- Lower systolic BP in first 48 hours correlates with prolonged PICU length of stay in severely burned children.
- Thrombocytopenia at 48 hours (platelets <185 K/µL) associates with extended PICU admission in pediatric burns.
- A model using %TBSA, SBP, lactate, and platelet count achieved 100% specificity for predicting LOS >7 days.
- Early identification of high-risk burn patients enables better resource allocation and care planning in PICU settings.
Written by the GCMD Library team from the article.
Abstract
Background
Burns in children are often complex injuries, leading to prolonged length of stay (LOS) and significant morbidity. LOS in pediatric intensive care units (PICUs) is a key measure for evaluating illness severity, clinical outcomes, and quality of care. Accurate prediction of LOS is vital for improving care planning and resource allocation. There is limited data for predicting LOS in severely burned children in PICU. This study aims to identify significant factors associated with prolonged PICU stays and offer a simple LOS-predicting model.
Methods
This historical cohort study included all patients < 18 years, admitted for severe burn injuries to Israel’s largest tertiary hospital PICU, from 2015 to 2020. Statistical analyses were conducted to identify factors linked to prolonged LOS and a predictive model was designed.
Results
The study included 39 pediatric burn patients and identified several factors associated with longer PICU stays. Patients with LOS of ˃7 days (i.e.—"long LOS") had significantly higher %TBSA (33.11 ± 17.87% vs. 16.67 ± 7.98%, p < 0.001. During the first 24 and 48 h, the "long LOS" group had lower minimal systolic blood pressure (SBP) (70.67 ± 17.49 mmHg vs. 84.38 ± 16.73 mmHg, p = 0.015 and 69.39 mmHg ± 16.44 vs. 81.10 mmHg ± 19.67, p = 0.018). Although serum lactate levels were higher in the "long LOS" group, the difference was not significant, and platelet counts in this group were significantly lower during the first 48 h (184 K/µL vs. 264.5 K/µL, p = 0.003). A predictive model based on %TBSA, SBP, lactate, and platelet count was developed, demonstrating 100% specificity and positive predictive value for predicting LOS over 7 days in severely burned children.
Conclusions
Key clinical indicators at PICU admission in severely burned children were associated with LOS > 7 days. The resulting predictive model, although requiring further validation in multi-site studies, offers a promising tool for enhancing care planning in this population.