OBJECTIVES:To investigate the influence of non-medical social determinants of health on rates of admission and outcomes for children admitted to intensive care units (ICUs) in Australia. STUDY DESIGN:Retrospective cohort study; analysis of Australian and New Zealand Paediatric Intensive Care Registry data. SETTING, PARTICIPANTS:Children (18 years or younger) admitted to Australian ICUs during 1 January 2013 - 31 December 2020. MAIN OUTCOME MEASURES:Population-standardised ICU admission rates, overall and by residential socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD] quintile) and Indigenous status; likelihood of mortality in the ICU by residential socio-economic status (continuous, and quintile 1 v quintiles 2-5) and Indigenous status, adjusted for pre-illness, admission, and ICU and hospital factors. RESULTS:Data for 77 233 ICU admissions of children were available. The ICU admission rate for Indigenous children was 1.91 (95% confidence interval [CI], 1.87-1.94), for non-Indigenous children 1.60 (95% CI, 1.57-1.64) per 1000 children per year. The rate was higher for children living in areas in the lowest IRSD quintile (1.93; [95% CI, 1.89-1.96]) than for those living in quintile 5 (1.26 [95% CI, 1.23-1.29] per 1000 children per year). Unadjusted in-ICU mortality was higher for Indigenous than non-Indigenous children (2.5% v 2.1%) and also for children living in the lowest IRSD quintile than in quintiles 2-5 (2.5% v 2.0%). After adjustment for all factors, mortality among Indigenous children was similar to that for non-Indigenous children (adjusted odds ratio [aOR], 1.15; 95% CI, 0.92-1.43); it was higher for children living in the lowest IRSD quintile than for those living in quintiles 2-5 (aOR, 1.18; 95% CI, 1.03-1.36). Remoteness and distance between home and ICU did not influence the likelihood of death in the ICU. CONCLUSIONS:The population-standardised ICU admission rate is higher for Indigenous children and children residing in areas of greatest socio-economic disadvantage than for other children in Australia. Adjusted in-ICU mortality was higher for children from areas of greatest socio-economic disadvantage. Advancing health equity will require further investigation of the reasons for these differences.

OBJECTIVES:The long-term survival of children discharged from PICUs and factors associated with mortality following discharge have not been systematically studied. The objective was to describe the long-term survival of children discharged alive from Australian PICUs and identify factors associated with death after discharge. DESIGN:A cohort data linkage study. SETTING:The Australian and New Zealand Paediatric Intensive Care Registry linked with the Australian National Death Index. PATIENTS:Children discharged from PICUs in Australia between 1997 and 2018. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Exposures included the time period of admission, demographic, social, and admission factors. A multivariable Cox proportional hazards model and Kaplan-Meier survival curves were used to investigate exposures associated with mortality. The records of 96,743 children were available for analysis. The risk of death reduced over time: compared with children admitted from 1997 to 2002, the hazard ratios for death after discharge for children admitted from 2003-2008, 2009-2013, to 2014-2018 were 0.92 (95% CI, 0.85-0.99), 0.69 (0.64-0.745), and 0.60 (0.55-0.65). The risk of death associated with low-risk underlying conditions, such as asthma, was 70% lower than the reference (standard risk) group, while there was a seven-fold increase in the risk of death with very-high-risk underlying conditions, such as malignancy. Residing in outer regional and very remote areas was associated with higher risk of death. CONCLUSIONS:The survival of children discharged from Australian PICUs has improved over time; the risk of death reduced by 40% over the study period. The underlying disease, age, and residing in locations with reduced access to healthcare were associated with reduced probability of survival after discharge.

International and small Australian studies suggest a decrease in hospital presentations for acute coronary syndrome (ACS) during the COVID-19 pandemic. This study aims to examine the impact of local COVID-19 cases and lockdowns on the numbers and methods of ACS presentations to emergency departments (EDs) in Victoria, Australia.

Objectives: To describe regional differences and change over time in the degree of centralization of pediatric intensive care in Australia and New Zealand (ANZ) and to compare the characteristics and ICU mortality of children admitted to specialist PICUs and general ICUs (GICUs). Design: A retrospective cohort study using registry data for two epochs of ICU admissions, 2003-2005 and 2016-2018. Setting: Population-based study in ANZ. Patients: A total of 43,256 admissions of children aged younger than 16 years admitted to an ICU in ANZ were included. Infants aged younger than 28 days without cardiac conditions were excluded. Interventions: None. Measurements and Main Results: The primary outcome was risk-adjusted ICU mortality. Logistic regression was used to investigate the association of mortality with the exposure to ICU type, epoch, and their interaction. Compared with children admitted to GICUs, children admitted to PICUs were younger (median 25 vs 47 mo; p < 0.01) and stayed longer in ICU (median 1.6 vs 1.0 d; p < 0.01). For the study overall, 93% of admissions in Australia were to PICUs whereas in New Zealand only 63% of admissions were to PICUs. The adjusted odds of death in epoch 2 relative to epoch 1 decreased (adjusted odds ratio [AOR], 0.50; 95% CI, 0.42-0.59). There was an interaction between unit type and epoch with increased odds of death associated with care in a GICU in epoch 2 (AOR, 1.63; 95% CI, 1.05-2.53 for all admissions; 1.73, CI, 1.002-3.00 for high-risk admissions). Conclusions: Risk-adjusted mortality of children admitted to specialist PICUs decreased over a study period of 14 years; however, a similar association between time and outcome was not observed in high-risk children admitted to GICUs. The results support the continued use of a centralized model of delivering intensive care for critically ill children.

Schlapbach, L. J.; Tomaszewski, W.; Ablaza, C.; Straney, L.; Taylor, C.; Millar, J. Author Information

OBJECTIVES: Major postintensive care sequelae affect up to one in three adult survivors of critical illness. Large cohorts on educational outcomes after pediatric intensive care are lacking. We assessed primary school educational outcomes in a statewide cohort of children who survived PICU during childhood. DESIGN: Multicenter population-based study on children less than 5 years admitted to PICU. Using the National Assessment Program—Literacy and Numeracy database, the primary outcome was educational achievement below the National Minimum Standard (NMS) in year 3 of primary school. Cases were compared with controls matched for calendar year, grade, birth cohort, sex, socioeconomic status, Aboriginal and Torres Strait Islander status, and school. Multivariable logistic regression models to predict educational outcomes were derived. SETTING: Tertiary PICUs and mixed ICUs in Queensland, Australia. PATIENTS: Children less than 5 years admitted to PICU between 1998 and 2016. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Year 3 primary school data were available for 5,017 PICU survivors (median age, 8.0 mo at first PICU admission; interquartile range, 1.9–25.2). PICU survivors scored significantly lower than controls across each domain ( p < 0.001); 14.03% of PICU survivors did not meet the NMS compared with 8.96% of matched controls ( p < 0.001). In multivariate analyses, socioeconomic status (odds ratio, 2.14; 95% CI, 1.67–2.74), weight (0.94; 0.90–0.97), logit of Pediatric Index of Mortality-2 score (1.11; 1.03–1.19), presence of a syndrome (11.58; 8.87–15.11), prematurity (1.54; 1.09–2.19), chronic neurologic conditions (4.38; 3.27–5.87), chronic respiratory conditions (1.65; 1.24–2.19), and continuous renal replacement therapy (4.20; 1.40–12.55) were independently associated with a higher risk of not meeting the NMS. CONCLUSIONS: In this population-based study of childhood PICU survivors, 14.03% did not meet NMSs in the standardized primary school assessment. Socioeconomic status, underlying diseases, and severity on presentation allow risk-stratification to identify children most likely to benefit from individual follow-up and support.

Many Australians are intermittently exposed to landscape fire smoke from wildfires or planned (prescribed) burns. This study aimed to investigate effects of outdoor smoke from planned burns, wildfires and a coal mine fire by assessing biomarkers of inflammation in an exposed and predominantly older population. Participants were recruited from three communities in south-eastern Australia. Concentrations of fine particulate matter (PM2.5) were continuously measured within these communities, with participants performing a range of health measures during and without a smoke event. Changes in biomarkers were examined in response to PM2.5 concentrations from outdoor smoke. Increased levels of FeNO (fractional exhaled nitric oxide) (β = 0.500 [95%CI 0.192 to 0.808] p < 0.001) at a 4 h lag were associated with a 10 µg/m3 increase in PM2.5 levels from outdoor smoke, with effects also shown for wildfire smoke at 4, 12, 24 and 48-h lag periods and coal mine fire smoke at a 4 h lag. Total white cell (β = −0.088 [−0.171 to −0.006] p = 0.036) and neutrophil counts (β = −0.077 [−0.144 to −0.010] p = 0.024) declined in response to a 10 µg/m3 increase in PM2.5. However, exposure to outdoor smoke resulting from wildfires, planned burns and a coal mine fire was not found to affect other blood biomarkers.

There is growing interest in not only intensive care unit (ICU) outcomes but also the resources required to deliver this care and itscost-effectiveness. The most available metric of resource utilisation is ICU length of stay, which is influenced by casemix, illness severity, and institutional characteristics, including delays in discharge. For instance, ICU length of stay is generally longer for more severely ill patients. Comparison of length of stay between units must therefore account for differences in baseline patient characteristics.

BACKGROUND:The NSW Clinical Excellence commission introduced the 'Between the Flags' programme, in response to the death of a young patient, as a system-wide approach for early detection and management of the deteriorating patient in all NSW hospitals. The impact of BTF implementation on the 35 larger hospitals with intensive care units (ICU) has not been reported previously.AIM:To assess the impact of 'Between the Flags' (BTF), a two-tier rapid response system across 35 hospitals with an ICU in NSW, on the incidence of in-hospital cardiac arrests and the incidence and outcome of patients admitted to an ICU following cardiac arrest and rapid response team activation.METHODS:This is a prospective observational study of the BTF registry (August 2010 to June 2016) and the Australian and New Zealand Intensive Care Society Adult Patient Database (January 2008 to December 2016) in 35 New South Wales public hospitals with an ICU. The primary outcome studied was the proportion of in-hospital cardiac arrests. Secondary outcomes included changes in the severity of illness and outcomes of cardiac arrest admissions to the ICU and changes in the volume of rapid response calls.RESULTS:The cardiac arrest rate per 1000 hospital admissions declined from 0.91 in the implementation period to 0.70. Propensity score analysis showed significant declines in ICU and hospital mortality and length of stay for cardiac arrest patients admitted to the ICU (all P < 0.001).CONCLUSIONS:The BTF programme was associated with a significant reduction in cardiac arrests in hospitals and ICU admissions secondary to cardiac arrests in 35 NSW hospitals with an ICU.

Objectives: To assess the feasibility, safety, and efficacy of a sedation protocol using dexmedetomidine as the primary sedative in mechanically ventilated critically ill children. Design: Open-label, pilot, prospective, multicenter, randomized, controlled trial. The primary outcome was the proportion of sedation scores in the target sedation range in the first 48 hours. Safety outcomes included device removal, adverse events, and vasopressor use. Feasibility outcomes included time to randomization and protocol fidelity. Setting: Six tertiary PICUs in Australia and New Zealand. Patients: Critically ill children, younger than 16 years old, requiring intubation and mechanical ventilation and expected to be mechanically ventilated for at least 24 hours. Interventions: Children randomized to dexmedetomidine received a dexmedetomidine-based algorithm targeted to light sedation (State Behavioral Scale –1 to +1). Children randomized to usual care received sedation as determined by the treating clinician (but not dexmedetomidine), also targeted to light sedation. Measurements and Main Results: Sedation with dexmedetomidine as the primary sedative resulted in a greater proportion of sedation measurements in the light sedation range (State Behavioral Scale –1 to +1) over the first 48 hours (229/325 [71%] vs 181/331 [58%]; p = 0.04) and the first 24 hours (66/103 [64%] vs 48/116 [41%]; p < 0.001) compared with usual care. Cumulative midazolam dosage was significantly reduced in the dexmedetomidine arm compared with usual care ( p = 0.002).There were more episodes of hypotension and bradycardia with dexmedetomidine (including one serious adverse event) but no difference in vasopressor requirements. Median time to randomization after intubation was 6.0 hours (interquartile range, 2.0–9.0 hr) in the dexmedetomidine arm compared with 3.0 hours (interquartile range, 1.0–7.0 hr) in the usual care arm ( p = 0.24). Conclusions: A sedation protocol using dexmedetomidine as the primary sedative was feasible, appeared safe, achieved early, light sedation, and reduced midazolam requirements. The findings of this pilot study justify further studies of sedative agents in critically ill children.

OBJECTIVES:To investigate if the performance of Pediatric Index of Mortality 3 is improved by including imputed values for the PaO2/FIO2 ratio where measurements of PaO2 or FIO2 are missing. DESIGN:A prospective observational study. SETTING:A bi-national pediatric intensive care registry. PATIENTS:The records of 37,983 admissions of children less than 16 years old admitted to 19 ICUs. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Seven published equations describing an association between PaO2/FIO2 and oxygen saturation measured by pulse oximetry (SpO2)/FIO2 were used to derive an alternative variable d100 × FIO2/PaO2 for the Pediatric Index of Mortality 3 variable 100 × FIO2/PaO2. Six equations exclude SpO2/FIO2 values if SpO2 is greater than 96-98%. 100 × FIO2/PaO2 was missing in 72% of patient records primarily due to missing PaO2, d100 × FIO2/PaO2 was missing in 71% of patient records if values of SpO2greater than 97% were excluded or in 17% of patient records if all measurements of SpO2 were included. Univariable analysis supported the inclusion of SpO2 values greater than 97%. Compared to the standard Pediatric Index of Mortality 3 model, two alternative models imputing 100 × FIO2/PaO2 from d100 × FIO2/PaO2 only if 100 × FIO2/PaO2 was missing, or using d100 × FIO2/PaO2 values exclusively, resulted in a small but statistically significant improvements in discrimination of Pediatric Index of Mortality 3 (area under the receiver operator curve 0.9068 [0. 8965-0. 9171]; 0.9083 [0.8981-0.9184]; 0.9087 [0.8987-0.9188], respectively). CONCLUSIONS:Imputation of the PaO2/FIO2 ratio in cases where arterial sampling was not performed resulted in a large reduction in the rate of missing data if all values of SpO2 were included. The imputation technique improved the discrimination of Pediatric Index of Mortality 3; however, the magnitude of the increment in overall model performance was small. A possible benefit of the approach is reducing the potential for bias resulting from variation in practice for invasive monitoring of oxygenation.

OBJECTIVES:We aimed to examine the change in rates of hospital emergency presentations or hospital admissions during the coal mine fire, and their associations with the coal mine fire-related fine particles (PM2.5). METHODS:Daily data on hospital emergency presentations and admissions were collected from the Department of Health and Human Services for the period January 01, 2009 to June 30, 2015, at Statistical Area Level 2 (SA2). The coal mine fire-related PM2.5 concentrations were modelled by the Chemical Transport Model coupled with the Cubic Conformal Atmospheric Model. A generalised additive mixed model was used to estimate the change in rates of hospital emergency presentations and hospital admissions during the coal mine fire period, and to examine their associations with PM2.5 concentrations for smoke impacted areas, after controlling for potential confounders. RESULTS:Compared with non-fire periods, we found increased risks of all-causes, respiratory diseases, and asthma related emergency presentations and hospital admissions as well as chronic obstructive pulmonary disease (COPD) related emergency presentations during the fire period. Associations between daily concentrations of coal mine fire-related PM2.5 and emergency presentations for all-causes and respiratory diseases, including COPD and asthma, appeared after two days' exposure. Associations with hospital admissions for cerebrovascular and respiratory diseases appeared on the same day of exposure. CONCLUSIONS:Coal mine fire smoke created a substantial health burden. People with respiratory diseases should receive targeted messages, follow self-management plans and take preventive medication during future coal mine fires.

Background The surviving sepsis campaign recommends consideration for extracorporeal membrane oxygenation (ECMO) in refractory septic shock. We aimed to define the benefit threshold of ECMO in pediatric septic shock. Methods Retrospective binational multicenter cohort study of all ICUs contributing to the Australian and New Zealand Paediatric Intensive Care Registry. We included patients < 16 years admitted to ICU with sepsis and septic shock between 2002 and 2016. Sepsis-specific risk-adjusted models to establish ECMO benefit thresholds with mortality as the primary outcome were performed. Models were based on clinical variables available early after admission to ICU. Multivariate analyses were performed to identify predictors of survival in children treated with ECMO. Results Five thousand sixty-two children with sepsis and septic shock met eligibility criteria, of which 80 (1.6%) were treated with veno-arterial ECMO. A model based on 12 clinical variables predicted mortality with an AUROC of 0.879 (95% CI 0.864–0.895). The benefit threshold was calculated as 47.1% predicted risk of mortality. The observed mortality for children treated with ECMO below the threshold was 41.8% (23 deaths), compared to a predicted mortality of 30.0% as per the baseline model (16.5 deaths; standardized mortality rate 1.40, 95% CI 0.89–2.09). Among patients above the benefit threshold, the observed mortality was 52.0% (13 deaths) compared to 68.2% as per the baseline model (16.5 deaths; standardized mortality rate 0.61, 95% CI 0.39–0.92). Multivariable analyses identified lower lactate, the absence of cardiac arrest prior to ECMO, and the central cannulation (OR 0.31, 95% CI 0.10–0.98, p = 0.046) as significant predictors of survival for those treated with VA-ECMO. Conclusions This binational study demonstrates that a rapidly available sepsis mortality prediction model can define thresholds for survival benefit in children with septic shock considered for ECMO. Survival on ECMO was associated with central cannulation. Our findings suggest that a fully powered RCT on ECMO in sepsis is unlikely to be feasible.

Learning Objectives: Despite improvements in early recognition and treatment of infections, sepsis remains a frequent causes of childhood mortality worldwide. The Surviving Sepsis Campaign recommends consideration for extracorporeal membrane oxygenation (ECMO) for refractory septic shock. Case series and single institution reports suggest reduced mortality if ECMO is used in sepsis, but there is a lack of larger multicenter data. We aimed to assess incidence and treatment benefit of ECMO in children with sepsis and septic shock. Methods: Retrospective multicenter cohort study of children younger than 16 years admitted to PICU with sepsis and septic shock in Australia and New Zealand between 2002 and 2017. Sepsis-specific adjusted models to predict baseline mortality were performed to compare sepsis cases treated with ECMO versus cases not treated with ECMO. Results: During the study period, 5062 children with sepsis met eligibility criteria, of which 80 were treated with ECMO for sepsis. There were 14.2 ECMO treated children per 1000 pediatric sepsis admissions in 2002-2009 compared with 17.0/1000 in 2010-2017 (p=0.425). The benefit threshold, defined as the baseline mortality risk for which ECMO became beneficial was calculated as 46.4% risk of mortality. Among children receiving ECMO, the observed mortality for those below the threshold was 42.8% (24 deaths) which was higher than the number of deaths predicted in the baseline model (28.3%, 15.9 deaths; SMR=1.51, 95%CI: 0.972.25). In contrast, the observed mortality was lower than predicted among patients above the benefit threshold (50.0% (12) versus 68.8% (16.5); SMR=0.73, 95%CI: 0.38-1.27). Based on these figures, a sufficiently powered randomized controlled trial of ECMO in pediatric sepsis would require 507 patients to be enrolled. Conclusions: This large population-based study indicates that ECMO is used in approximatively 1 out of 60 children admitted to PICU with sepsis. We were able to demonstrate a threshold for survival benefit of ECMO in children with sepsis using a sepsis mortality prediction model. Our findings suggest that a fully powered RCT on ECMO in sepsis is unlikely to be feasible. Future research should instead focus on improving identification of chiildren with sepsis most likely to benefit from ECMO to improve adequacy and timing of decision-making in relation to ECMO in sepsis.

Aim: Targeted temperature management (TTM) in post-resuscitation care has changed dramatically over the last two decades. However, uptake across Australian and New Zealand (NZ) intensive care units (ICUs) is unclear. We aimed to describe post-resuscitation care in our region, with a focus on TTM, and to gain insights into clinician's opinions about the level of evidence supporting TTM. Methods: In December 2017, we sent an online survey to 163 ICU medical directors in Australia (n = 141) and NZ (n = 22). Results: Sixty-one ICU medical directors responded (50 from Australia and 11 from NZ). Two respondents were excluded from analysis as their Private ICUs did not admit post-arrest patients. The majority of remaining respondents stated their ICU followed a post-resuscitation care clinical guideline (n = 41/59, 70%). TTM was used in 57 (of 59, 97%) ICUs, of these only 64% had a specific TTM clinical guideline/policy and there was variation in the types of patients treated, temperatures targeted (range = 33-37.5 degrees C), methods for cooling and duration of cooling (range = 12-72 h). The majority of respondents stated that their ICU (n = 45/57, 88%) changed TTM practice following the TTM trial: with 28% targeting temperatures >36 degrees C, and 23 (of 46, 50%) respondents expressed concerns with current level of evidence for TTM. Only 38% of post-resuscitation guidelines included prognostication procedures, few ICUs reported the use of electrophysiological tests. Conclusions: In Australian and New Zealand ICUs there is widespread variation in post-resuscitation care, including TTM practice and prognostication. There also seems to be concerns with current TTM evidence and recommendations.

Background Outcomes for pediatric cardiac surgery are commonly reported from international databases compiled from voluntary data submissions. Surgical outcomes for all children in a country or region are less commonly reported. We aimed to describe the bi‐national population‐based outcome for children undergoing cardiac surgery in Australia and New Zealand and determine whether the Risk Adjustment for Congenital Heart Surgery (RACHS) classification could be used to create a model that accurately predicts in‐hospital mortality in this population. Methods and Results The study was conducted in all children's hospitals performing cardiac surgery in Australia and New Zealand between January 2007 and December 2015. The performance of the original RACHS‐1 model was assessed and compared with an alternative RACHS‐ANZ (Australia and New Zealand) model, developed balancing discrimination with parsimonious variable selection. A total of 14 324 hospital admissions were analyzed. The overall hospital mortality was 2.3%, ranging from 0.5% for RACHS category 1 procedures, to 17.0% for RACHS category 5 or 6 procedures. The original RACHS‐1 model was poorly calibrated with death overpredicted (1161 deaths predicted, 289 deaths observed). The RACHS‐ANZ model had better performance in this population with excellent discrimination (Az‐ROC of 0.830) and acceptable Hosmer and Lemeshow goodness‐of‐fit (P=0.216). Conclusions The original RACHS‐1 model overpredicts mortality in children undergoing heart surgery in the current era. The RACHS‐ANZ model requires only 3 risk variables in addition to the RACHS procedure category, can be applied to a wider range of patients than RACHS‐1, and is suitable to use to monitor regional pediatric cardiac surgery outcomes.

Background: Heart disease significantly increases the risk of further cardiac events including out-of-hospital cardiac arrest (OHCA). Given the majority of OHCAs occur in the home, family members of those with heart disease should be trained in cardiopulmonary resuscitation (CPR). Aim: To describe CPR training rates in households with heart disease, and examine if training increases knowledge, confidence and willingness to perform CPR in this population. Methods: A cross-sectional, telephone survey was conducted with adults residing in Victoria, Australia. Findings: Of 404 respondents, 78 (19.3%) reported the presence of heart disease in their household. Prevalence of CPR training was the same among households with (67.9%) and without (67.8%) heart disease, with the majority (51.5%) receiving training more than five years ago. There were no significant differences in barriers to training- the most prevalent barrier was lack of awareness to seek training. Among households with heart disease, physical ability was the most common concern relating to the provision of CPR, while households without heart disease described decreased confidence. Those with heart disease in their household who were CPR trained, had higher self-ratings of CPR knowledge and confidence, and were more willing to perform CPR (all p<0.05). Conclusions: A large proportion of Victorians with heart disease in their household did not have recent CPR training. CPR training should be targeted to high-risk households containing a member with heart disease, as knowledge and confidence in skills are increased. Cardiac health professionals are well placed to provide CPR training information during patient contacts. (C) 2018 Published by Elsevier Ltd on behalf of Australian College of Nursing Ltd.

Unauthorized reproduction of this article is prohibited Pediatric Critical Care Medicine 2018 • Volume 19 • Number 6 (Suppl.) Copenhagen. The children and infants are admitted to four separate intensive care units: Infants above 28 days of age and below 1 year to the Neonatal Intensive Care Unit (NICU), above 1 year to the Multidisciplinary Intensive Care Unit (MICU), children with neurosurgical diseases to the Neurosurgical Intensive Care Unit (NNICU) and children with heart diseases to the Cardiac Intensive Care Unit (CICU). MICU, NNICU and CICU also care for adult intensive care patients. The aim of this paper is to present the organization and outcome of the intensive care of children in eastern Denmark, excluding CICU admissions.

The Sepsis-3 consensus task force defined sepsis as life-threatening organ dysfunction caused by dysregulated host response to infection. However, the clinical criteria for this definition were neither designed for nor validated in children. We validated the performance of SIRS, age-adapted SOFA, quick SOFA and PELOD-2 scores as predictors of outcome in children.

Aims & Objectives: Paediatric Index of Mortality 2 (PIM2) is used as a mortality predictor in PICU and includes absolute base excess (BE) along with other clinical and physiological variables. Small scale studies have shown that lactate is a better predictor than base excess (BE). We investigated the effect on PIM2 of a) utilising venous samples, which have historically been excluded, b) adding lactate to the model, with or without BE, c) utilising separate terms for positive and negative BE, and d) the treatment of missing values. Methods Data were abstracted from the UK and Republic of Ireland Paediatric Intensive Care Audit Network (PICANet) and the Australian and New Zealand Paediatric Intensive Care Registry (ANZPICR). All admissions between 1st January 2012 and 31st December 2015 were analysed (N= 123,252) using a series of logistic regression models. Area under the Receiver Operating Characteristic (ROC) Curve (AUROC) and the Akaike Information Criterion (AIC) were used to assess model fit. Results Addition of venous BE measurements improved the fit of PIM2 (AUROC improved by 0.0016). Addition of positive and negative BE as two separate terms didn’t improve the model fit, but showed that negative BE is a stronger mortality predictor. A model with missing lactate values set to 1 gave a better fit than replacing with 0. Table shows results of the different models.Conclusions Lactate improves the fit of PIM2. Addition of two variables for BE, inclusion of lactate, and using only lactate measurements if both lactate and BE are obtained should be considered.