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340: VALIDATING A DEFINITION OF PEDIATRIC CHRONIC CRITICAL ILLNESS

Introduction/Hypothesis: As pediatric mortality declines, the complex technology-dependent child group is emerging. PCCI is a new term for this population proposed for clinical and research utilization; however, practitioners are diagnosing PCCI often without adhering to the term’s guidelines. We hypothesize that epidemiological adherence to the PCCI term by the pediatric intensivists is low due to its recent description. We intend to assess it and describe the basic parameters of the group. Methods: This is a prospective incidence and descriptive study. Patients were identified from a tertiary PICU and were analyzed for PCCI by chart review and attending perception. Results: 199 patients were prospectively identified over three months, and 62 (31.2%) fulfilled the PCCI criteria. The sensitivity and specificity of the definition (using the term vs. criteria adherence) were 79% (95% CI 68.9-89.2) and 84.6% (95% CI 78.5-90.6) respectively with a tendency of practitioners to “overidentify” PCCI 35.2% vs. 31.2%. Comparison between PCCI and non-PCCI were: oxygen dependence (40.3% vs 3.6%), tracheostomy dependence (25.8% vs 1.5%), ventilator dependence (14.5% vs 0%), feeding tube (41.9% vs 2.9 %), and brain ventricular shunt (3.2% vs 1.5%). The PCCI patients had a substantially longer ICU stay 112.4 (SD 94.2) vs. 31.1 (SD 38.8) days and mechanical ventilation time 98.7 (SD 120.7) vs. 12.4 (SD 23.7) days. Conclusions: Using the PCCI term without adherence to established criteria is large enough to create epidemiological errors and management confusion given the impact of PCCIs in the ICU function. Additional education is needed to validate further and raise awareness about PCCI for this growing population. This population utilizes significant hospital-based and home-based medical resources.