Patient Backgrounds and Outcomes of Mechanically Ventilated Children Treated in ICUs Versus General Wards in Japan: A Retrospective Cohort Study Using a National Inpatient Database.

Abstract

In western countries, adult and pediatric patients requiring mechanical ventilation are treated in ICUs. However, in Japan, there is concern that many children on mechanical ventilation are being treated in general wards. This study aimed to compare patient characteristics and treatment outcomes between mechanically ventilated children in general wards and ICUs using a national inpatient database in Japan. A retrospective cohort study using a national inpatient database. The study was carried out using a national inpatient database in Japan between July 2010 and March 2022, which includes data from multiple hospitals across the country. Patient characteristics were compared between patients in general wards and ICUs. We performed a 1:1 propensity score matching to compare in-hospital mortality between the groups. A total of 129,375 mechanically ventilated children 14 years old or younger who were hospitalized in general wards or ICUs were included in the study. None. During the study period, we identified 129,375 eligible patients. Of these, 63% of all patients, 78% of nonoperative patients, and 17% of postoperative patients were treated in general wards. Overall, 56% of the 48,137 ICU patients were postoperative and 70% of them underwent cardiac surgery. The one-to-one propensity score matching created 15,760 pairs, and in-hospital mortality was significantly higher in general ward patients than in ICU patients (6.4% vs. 4.1%; odds ratio, 1.49; 95% CI, 1.35-1.65; p < 0.001). Most of the children on mechanical ventilation in Japan were treated in general wards. The treatment of patients in general wards was associated with higher mortality than in ICUs, suggesting the need to centralize the care for mechanically ventilated pediatric patients in ICUs.