Intensive Care Med (1996) 22:1098-1104 9 Springer-Verlag 1996 J. J. Stambouly L. L. McLaughlin F. S. Mandel R. A. Boxer Complications of care in a pediatric intensive care unit: a prospective study Received: 9 January 1996 Accepted: 16 May 1996 J.J. Stambouly 1 ([~). L.L. McLaughlin. F.S. Mandel 9 R.A. Boxer Departments of Pediatrics and Research, North Shore University Hospital-Cornell University Medical College, Manhasset, New York 11030, USA 1Mailing address: Pediatric Critical Care Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA FAX: -F 1 (516) 562 4090 Tel.: +1 (516) 562 2542 Abstract Objectives: (a) To exam- ine the frequency, type, and severity of complications occurring in a pediatric intensive care unit; (b) to identify populations at risk; and (c) to study the impact of complications on morbidity and mortality. Design: Prospective survey. Setting: Pediatric intensive care unit (PICU) of a university-affili- ated hospital. Patients: 1035 consecutive admis- sions over an 18-month period. Results: 115 complications occur- red during 83 (8,0%) admissions, for 2.7 complications per 100 PICU- days; 48 (42%) complications were major, 45 (39%) moderate, and 22 (19%) minor. Sixty complications (52%) were ventilator-related, 14 were drug-related, 13 procedure- related, 24 infectious, and 22 in- volved invasive devices (18 vascular catheters). Human error was in- volved in 41 (36%) cases, 21 of which were major (18%). Treat- ments included reintubation < 24 h (28), intravenous antimi- crobials (24), and invasive bed- side procedures (14). Cardiopul- monary resuscitation was required in 6 patients. Thirteen patients with complications died (15.7%); 2 deaths were directly due to com- plications. Patients with complications were younger, had longer lengths of stay, and had a higher mortality. Length of stay was a positive risk factor for complication risk (odds ratio = 1.09, 95% confidence inter- val: 1.05 to 1.13; p = 0.0001); other patient characteristics had no pre- dictive effect. Kaplan-Meier esti- mates showed that the most severe complications occurred early in the PICU stay. The best indicators of patient mortality were number of complications (odds ratio -= 2.96, 95% confidence interval 1.72 to 5.08; p = 0.0001), and mortality risk derived from the Pediatric Risk of Mortality Score (odds ratio = 1.08, 95% confidence interval 1.06 to 1.10; p = 0.0001). Mortality was correlated with increasing severity of complications. Conclusion: Complications have a significant impact on patient care. Patients may be at increased risk earlier in their PICU course, when the number of interventions may be greatest, Complications may in- crease patient mortality and predict patient death better than other patient variables. Key words Pediatric critical care 9 Complications 9 Iatrogenic illness 9 Intensive care unit 9 Quality improvement