Study: Trichotomous Outcome Prediction in Critical Care (TOPICC)
Study Type: Observational
Study Period: June 2011 –
Critical care in general and pediatric critical care in particular, has developed excellent measures of severity of illness calibrated to mortality. However, severity may be reflected in subsequent morbidity as well as survival. A major challenge of critical care outcomes research is the development of methodologies that predict the full range of outcomes from normal through the range of morbidities as well as death. Critical care mortality prediction models are highly dependent on physiological system dysfunctions such as cardiovascular, neurological, respiratory, renal, metabolic, and hematological dysfunction. Yet the same dysfunction may result in intermediate and/or long-term functional status changes. ICU therapies such as steroid use and mechanical ventilation are associated with long-term sequelae including myopathy and chronic lung disease. It is logical to postulate that morbidity related to the progression of injury resulting from physiologic dysfunction such that, in the context of critical care, morbidity is an intermediate outcome between complete recovery and death.
TOPICC was a prospective observational cohort study where a probability sample of all patients under 18 years of age, who were admitted to all non-neonatal CPCCRN PICUs, were selected. The final sample size estimated in at 10,078 patients. The duration of the study was two years. During this time, the project looked to determine the optimal time window in which to collect data elements representing the initial medical and physiological condition of PICU patients at the time of admission to the PICU. Also, investigators aimed to derive and validate a predictor of three or more outcome states following pediatric intensive care; specifically death, survival with reduced functional status, and survival with normal or unchanged functional status. The ultimate goal of this study was to develop and validate a new predictive instrument to measure quality of care provided to children in PICUs across the country. This instrument will facilitate comparisons in quality of care and help inform the development of new interventions aimed at improving the quality of pediatric critical care.
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