Patient backgrounds and outcomes of mechanically ventilated children treated in pediatric intensive-care units versus general intensive-care units in Japan: a retrospective cohort study using a national inpatient database

Objective Pediatric intensive care units (PICUs) are well developed in Western countries and have been linked to improved survival. However, evidence comparing the outcomes between PICUs and general intensive care units (GICUs) remains inconsistent. In Japan, limited PICU capacity raises concerns that many children receive critical care in GICUs. This study compared the clinical outcomes between these settings using a national inpatient database and propensity score overlap weighting analyses. Methods We conducted a retrospective cohort study using a national Japanese inpatient database from July 2010 to March 2022. We included mechanically ventilated children aged ≤14 years admitted to ICUs and compared patient characteristics between those treated in PICUs and GICUs. In-hospital mortality was evaluated using overlap weighting analyses. Results Of the 48,106 eligible patients, 36% received care in PICUs. After overlap weighting analyses, PICU care was associated with a significantly lower in-hospital mortality than GICU care (mean 2.73% vs. 3.42%; odds ratio, 0.79; 95% CI, 0.69–0.91; p = 0.001). PICU care was associated with longer overall hospital stays (mean 22.74 vs. 22.13 days; difference, +0.61 days; 95% CI, 0.30–0.93; p < 0.001) and longer ICU stays (mean 6.37 vs. 5.42 days; difference, +0.95 days; 95% CI, 0.82–1.09; p < 0.001). Conclusion Most mechanically ventilated children in Japanese ICUs were treated in GICUs. Pediatric patient care in GICUs was associated with higher mortality relative to that in PICUs, underscoring the need for further centralization.