Women tend to have higher illness severity scores at ICU admission, according to a study published in the Journal of Critical Care. Women also appear to have higher risk-adjusted mortality than men at ICU discharge and at 1 year. Researchers investigated the association between sex and illness severity and mortality of ICU patients. They performed systematic searches of medical literature for observational studies of adult patients in the ICU that explicitly examined the association between sex and illness severity or mortality. They used a random effects model to calculate standardized mean differences in illness severity scores and pooled ORs for mortality of women compared with men, identifying 21 studies with 505,138 participants in total (43.1% women). There was substantial heterogeneity among studies. At ICU admission, there was a pattern of higher illness severity scores among women (standardized mean difference, 0.04; 95% CI, -0.01-0.09). Women had higher risk-adjusted mortality than men at ICU discharge (OR, 1.25; 95% CI, 1.03-1.50) and 1 year (OR, 1.08; 95% CI, 1.02–1.13); however, this finding was not robust to sensitivity analysis.

Health-Related Quality of Life Examined Following Pediatric Critical Illness

Deconditioning, sleep, fear, and pain are important targets for intervention to improve health related quality of life (HRQOL) outcomes for critically ill children, according to a study published in Critical Care Medicine. Investigators conducted a retrospective cohort study of ICU patients aged 1 month to 18 years admitted to Seattle Children’s Hospital between December 2011 and February 2017. They assessed HRQOL decline from baseline to post-discharge (median, 6 weeks) and determined the individual items of the Pediatric Quality of Life Inventory Infant Scales (younger than 2) and Generic Core Scales (aged 2-18) with the highest prevalence of decline. The study team used multivariable regression to estimate the risk for decline in each of seven thematic categories by patient age, baseline health status, diagnosis, Pediatric Risk of Mortality score, and ICU length of stay. Decline from baseline HRQOL occurred in 22.5% of 539 patients. Items most affected for infants younger than 2 were primarily emotional (cranky/crying, sleep, and self-soothing). Children aged 2-18 mostly experienced declines in physical functioning (play/exercise, lifting, and pain). Across the entire cohort, declines in categories of energy (31.5%), activity (31.0%), sleep (28.0%), and fear (24.7%) were most endorsed. The study found that risk of decline in each category varied with patient age, medical complexity, and diagnosis.