RESUMO
INTRODUCTION AND OBJECTIVES: With the aim of making informed decisions on resource allocation, there is a critical need for studies that provide accurate information on hospital costs for treating pediatric asthma exacerbations, mainly in middle-income countries (MICs). The aim of the present study was to evaluate the direct medical costs associated with pediatric asthma exacerbations requiring hospital attendance in Bogota, Colombia. PATIENTS AND METHODS: We reviewed the available electronic medical records (EMRs) for all pediatric patients who were admitted to the Fundacion Hospital de La Misericordia with a discharge principal diagnosis pediatric asthma exacerbation over a 24-month period from January 2016 to December 2017. Direct medical costs of pediatric asthma exacerbations were retrospectively collected by dividing the patients into four groups: those admitted to the emergency department (ED) only; those admitted to the pediatric ward (PW); those admitted to the pediatric intermediate care unit (PIMC); and those admitted to the pediatric intensive care unit (PICU). RESULTS: A total of 252 patients with a median (IQR) age of 5.0 (3.0-7.0) years were analyzed, of whom 142 (56.3%) were males. Overall, the median (IQR) cost of patients treated in the ED, PW, PIMC, and PICU was US$38.8 (21.1-64.1) vs. US$260.5 (113.7-567.4) vs. 1212.4 (717.6-1609.6) vs. 2501.8 (1771.6-3405.0), respectively: this difference was statistically significant (p<0.001). CONCLUSIONS: The present study helps to further our understanding of the economic burden of pediatric asthma exacerbations requiring hospital attendance among pediatric patients in a MIC.
Assuntos
Asma/economia , Custos de Cuidados de Saúde , Hospitalização/economia , Adolescente , Criança , Pré-Escolar , Colômbia , Serviço Hospitalar de Emergência/economia , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica/economia , Tempo de Internação/economia , Masculino , Exacerbação dos SintomasRESUMO
Background Problems related to pharmacotherapy are common in patients admitted to the paediatric intensive care unit (PICU) and are associated with increased healthcare costs. Data on the impact of clinical pharmacist interventions to prevent pharmacotherapy-related problems and to minimize costs in the PICU are limited. Objectives To evaluate the number and type of clinical pharmacist interventions in the PICU and to determine cost savings associated with them. Setting a ten bed PICU of a tertiary-care university hospital in Brazil. Method This was a prospective, observational study conducted over 1-year. The Failure Mode and Effects Analysis (FMEA) tool was applied at the beginning of the study to assess drug-related risks in the PICU and to guide clinical pharmacist interventions. Main outcome measure Number and type of clinical pharmacist interventions and healthcare-related costs. Results One hundred sixty-two children were followed-up by the clinical pharmacist and 1586 prescriptions were evaluated; pharmacotherapy-related problems were identified in 12.4% of them. Sixteen of 75 failure modes identified by FMEA were potentially reduced by the clinical pharmacist interventions. There were 197 interventions with a cost saving of R$ 15,118.73 (US$ 4828.00). Clinical pharmacist interventions were related to drug interaction and therapeutic monitoring (34.5%), drug selection (22.3%), dosing and frequency (16.8%), prescription (13.2%) and administration (13.2%). Ninety-seven per cent of the clinical pharmacist interventions were accepted by the medical team. The interventions with larger cost savings were related to administration (39%). Conclusion The clinical pharmacist interventions minimized the risks of pharmacotherapy-related problems and contributed to the reduction of costs associated with medical prescription.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/economia , Erros de Medicação/economia , Erros de Medicação/prevenção & controle , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos ProspectivosRESUMO
BACKGROUND: Pediatric oncology patients are at high risk of clinical deterioration, particularly in hospitals with resource limitations. The performance of pediatric early warning systems (PEWS) to identify deterioration has not been assessed in these settings. This study evaluates the validity of PEWS to predict the need for unplanned transfer to the pediatric intensive care unit (PICU) among pediatric oncology patients in a resource-limited hospital. METHODS: A retrospective case-control study comparing the highest documented and corrected PEWS score before unplanned PICU transfer in pediatric oncology patients (129 cases) with matched controls (those not requiring PICU care) was performed. RESULTS: Documented and corrected PEWS scores were found to be highly correlated with the need for PICU transfer (area under the receiver operating characteristic, 0.940 and 0.930, respectively). PEWS scores increased 24 hours prior to unplanned transfer (P = .0006). In cases, organ dysfunction at the time of PICU admission correlated with maximum PEWS score (correlation coefficient, 0.26; P = .003), patients with PEWS results ≥4 had a higher Pediatric Index of Mortality 2 (PIM2) (P = .028), and PEWS results were higher in patients with septic shock (P = .01). The PICU mortality rate was 17.1%; nonsurvivors had higher mean PEWS scores before PICU transfer (P = .0009). A single-point increase in the PEWS score increased the odds of mechanical ventilation or vasopressors within the first 24 hours and during PICU admission (odds ratio 1.3-1.4). CONCLUSIONS: PEWS accurately predicted the need for unplanned PICU transfer in pediatric oncology patients in this resource-limited setting, with abnormal results beginning 24 hours before PICU admission and higher scores predicting the severity of illness at the time of PICU admission, need for PICU interventions, and mortality. These results demonstrate that PEWS aid in the identification of clinical deterioration in this high-risk population, regardless of a hospital's resource-level. Cancer 2017;123:4903-13. © 2017 American Cancer Society.
Assuntos
Recursos em Saúde/economia , Mortalidade Hospitalar/tendências , Unidades de Terapia Intensiva Pediátrica/economia , Neoplasias/economia , Neoplasias/terapia , Estudos de Casos e Controles , Criança , Pré-Escolar , Países em Desenvolvimento , Feminino , Guatemala , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Neoplasias/patologia , Pediatria/economia , Curva ROC , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
OBJECTIVE: With increasing emphasis on high "value" care, we designed this study to evaluate the relationship between hospital costs and patient outcomes in pediatric critical care. DESIGN: Post hoc analysis of data from an existing administrative national database, Pediatric Health Information Systems. Multivariable mixed effects logistic regression models were fitted to evaluate association of hospital cost tertiles with odds of mortality after adjusting for patient and center characteristics. SETTING: Forty-seven children's hospitals across the United States. PATIENTS: Patients 18 years old or younger admitted to a PICU at a Pediatric Health Information Systems participating hospital were included (2004-2015). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 917,663 patients from 47 hospitals were included. Median cost per patient was $42,181 in the low-cost hospitals (341,689 patients, 16 hospitals), $56,806 in the middle-cost hospitals (310,293 patients, 16 hospitals), and $82,588 in the high-cost hospitals (265,681 patients, 15 hospitals). In unadjusted analysis, patients cared for in the high-cost tertile hospitals were younger in age, associated with more comorbidities, had higher resource utilization (including extracorporeal membrane oxygenation and nitric oxide), had higher prevalence of cardiac arrest, and were associated with worse outcomes (including mortality). In adjusted analysis, high-cost tertile hospitals were not associated with improved mortality, when compared with low- and medium-cost tertile hospitals (low cost vs high cost: odds ratio, 0.99; 95% CI, 0.79-1.25 and middle cost vs high cost: odds ratio, 1.10; 95% CI, 0.86-1.41). When stratified by diagnoses category, we noted similar trends among cardiac and noncardiac patients. CONCLUSIONS: This large observational study did not demonstrate any relationship between hospital costs and patient outcomes in children with critical illness. Further efforts are needed to evaluate quality-cost relationship and high value care in critically ill children across centers of varying volume by linking data from clinical and administrative databases.
Assuntos
Cuidados Críticos/economia , Estado Terminal/mortalidade , Custos Hospitalares/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Pediátricos/economia , Unidades de Terapia Intensiva Pediátrica/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Adolescente , Criança , Pré-Escolar , Cuidados Críticos/estatística & dados numéricos , Estado Terminal/economia , Estado Terminal/terapia , Bases de Dados Factuais , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Modelos Logísticos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Risco Ajustado , Estados UnidosRESUMO
O gerenciamento de custos de materiais de consumo hospitalar é um tema atual em pesquisa, principalmente em unidades de saúde especializadas. Os enfermeiros são destacados como os principais gestores do consumo e custo de materiais hospitalares. Neste estudo, objetivou-se caracterizar unidades pediátricas semi-intensivas e intensivas de um hospital de ensino e verificar o consumo e os custos de materiais utilizados na assistência a pacientes internados nessas unidades. Estudo descritivo, exploratório, retrospectivo, com abordagem quantitativa; os dados foram obtidos do Sistema de Informação Hospitalar; analisados com base na classificação ABC. O gasto médio foi semelhante entre as UTIs cardiológica e neonatal e menor nas UTI e semi-intensiva pediátricas; houve variação significativa de consumo mensal de materiais; os materiais de maior custo tiveram mais impacto no orçamento das unidades estudadas. Os dados obtidos revelaram a importância do uso de método sistêmico de análise de consumo e gastos de materiais em unidades pediátricas e subsidiam ações administrativas de economia.
Cost management of hospital material resources is a trendy research topic, especially in specialized health units. Nurses are pointed out as the main managers for costs and consumption of hospital materials resources. This study aimed to characterize Pediatric Intensive and Semi-Intensive Care Units of a teaching hospital and investigate costs and consumption of material resources used to treat patients admitted to these units. This is a descriptive exploratory study with retrospective data and quantitative approach. Data were obtained from a Hospital Information System and analyzed according to the ABC classification. The average expenditures were similar in both the neonatal and cardiac units, and lower in Pediatric Intensive and Semi-Intensive care units. There was a significant variation in the monthly consumption of materials. Higher cost materials had a greater impact on the budget of the studied units. The data revealed the importance of using a systematic method for the analysis of materials consumption and expenditure in pediatric units. They subsidize administrative and economic actions.
La gestión de costos de materiales de consumo hospitalario es un tema actual en investigación, especialmente en unidades de salud especializadas. Los enfermeros son destacados como los principales gestores de consumo y costos de materiales hospitalarios. En este estudio, objetivó-se caracterizar Unidades Pediátricas de Terapia Intensiva (UTI) y Semi-intensiva de un hospital escuela e investigar el consumo y costo de materiales utilizados en la asistencia de pacientes ingresados en esas unidades. Estudio descriptivo, exploratorio, retrospectivo, de abordaje cuantitativo. Los datos fueron obtenidos del Sistema de Información Hospitalaria y analizados de acuerdo con la clasificación ABC. El gasto medio fue semejante entre las UTIs cardiológica y neonatal, y menor en las unidades de terapia intensiva y semi-intensiva pediátricas. Hubo variación significativa en el consumo mensual de materiales. Los materiales de mayor costo presentaron un mayor impacto en el presupuesto de las unidades estudiadas. Los datos revelan la importancia del uso de un método sistémico de análisis de consumo y gastos de materiales en unidades pediátricas y subsidian acciones administrativas de economía.
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Recursos em Saúde/economia , Recursos em Saúde , Unidades de Terapia Intensiva Pediátrica/economia , Custos e Análise de Custo , Estudos RetrospectivosRESUMO
Cost management of hospital material resources is a trendy research topic, especially in specialized health units. Nurses are pointed out as the main managers for costs and consumption of hospital materials resources. This study aimed to characterize Pediatric Intensive and Semi-Intensive Care Units of a teaching hospital and investigate costs and consumption of material resources used to treat patients admitted to these units. This is a descriptive exploratory study with retrospective data and quantitative approach. Data were obtained from a Hospital Information System and analyzed according to the ABC classification. The average expenditures were similar in both the neonatal and cardiac units, and lower in Pediatric Intensive and Semi-Intensive care units. There was a significant variation in the monthly consumption of materials. Higher cost materials had a greater impact on the budget of the studied units. The data revealed the importance of using a systematic method for the analysis of materials consumption and expenditure in pediatric units. They subsidize administrative and economic actions.
Assuntos
Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/economia , Criança , Pré-Escolar , Custos e Análise de Custo , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosAssuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Cuidados Críticos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva , Unidades de Terapia Intensiva Neonatal/normas , Unidades de Terapia Intensiva Pediátrica/classificação , Unidades de Terapia Intensiva Pediátrica/economia , Medicina de Emergência/normasAssuntos
Masculino , Feminino , Humanos , Recém-Nascido , Lactente , Criança , Adulto , Idoso , Cuidados Críticos , Medicina de Emergência/normas , Unidades de Terapia Intensiva , Unidades de Terapia Intensiva Neonatal/normas , Unidades de Terapia Intensiva Pediátrica/classificação , Unidades de Terapia Intensiva Pediátrica/economia , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/organização & administraçãoRESUMO
OBJECTIVE: We estimated associated costs to nosocomial infections in two pediatric intensive care units in Mexico City. MATERIAL AND METHODS: A transversal study in the neonatal (NICU) and pediatric (PICU) intensive care units, was done. We reviewed use and cost of diagnostic procedures, medications, and excess of hospital stay. RESULTS: There were 102 infections, 46 in the NICU and 56 in the PICU. The average cost per infection was $11,682 USD and the overall expense was 1,184.71 USD. Infected children had an excess of hospital stay of 9.6 days, 13.7 more laboratory tests and 3.3 more cultures. Hospital stay represented 97% of the overall cost. CONCLUSIONS: This is one of the first estimations of nosocomial infections cost done in Mexico. These results justify the introduction of infection control programs to decrease these complications.
Assuntos
Infecção Hospitalar/economia , Unidades de Terapia Intensiva Pediátrica/economia , Fatores Etários , Criança , Pré-Escolar , Custos e Análise de Custo , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/economia , Tempo de Internação/economia , MéxicoAssuntos
Ética Médica , Unidades de Terapia Intensiva Pediátrica/economia , Programas de Assistência Gerenciada/economia , Futilidade Médica , Sistema de Pagamento Prospectivo/economia , Centros Médicos Acadêmicos/economia , Adolescente , Criança , Pré-Escolar , Redução de Custos , Humanos , Lactente , Resultado do Tratamento , Estados UnidosRESUMO
OBJECTIVES: To estimate resource consumption and the extent of futile care among patients admitted to the pediatric intensive care unit (PICU). STUDY DESIGN: A prospective cohort study of 353 consecutive admissions followed for 1334 patient-days during the PICU stay at the Texas Children's Hospital in Houston, Texas. Participants were 353 children and adolescents who were hospitalized in the PICU during September and October 1993. Three broad operational definitions of futility were developed to capture the maximum extent of resource consumption related to medical futility. Definition 1 (imminent demise futility) was developed by an objective, validated, severity of illness measure (Pediatric Risk of Mortality Score) to identify patients with high mortality risks. Definition 2 (lethal condition futility) was used to identify patients in the PICU whose long-term survival was unlikely. Definition 3 (qualitative futility) was used to identify patients with high morbidity. Resource consumption was measured according to the number of patient-days in the PICU and the Therapeutic Intervention Scoring System. RESULTS: Twenty-three (6.5%) patients representing 36 (2.7%) patient-days met at least one of the definitions of medical futility for some of the days when they were in the PICU. None of the patient-days that met any of the definitions of medical futility were associated with high resource consumption compared with non-futile care patient-days. CONCLUSIONS: Despite our use of broad definitions of medical futility, relatively small amounts of resources were used in futile PICU care. This suggests that attempts to reduce resource consumption in the PICU by focusing on medical futility are unlikely to be successful.
Assuntos
Recursos em Saúde/economia , Unidades de Terapia Intensiva Pediátrica/economia , Futilidade Médica , Alocação de Recursos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Tempo de Internação/economia , Cuidados para Prolongar a Vida/economia , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Texas , Resultado do TratamentoRESUMO
OBJECTIVE: Coincident with a change in the physician staff in our pediatric intensive care unit (PICU), the frequency and duration of invasive monitoring were decreased. We examined the impact of this change on outcomes, complications, and hospital charges in infants admitted to the PICU with respiratory syncytial virus (RSV) infection. STUDY DESIGN: We reviewed medical records of all children less than 1 year of age who were admitted to the PICU from January 1989 to July 1993 with confirmed RSV infection. Patient characteristics, therapeutic interventions, outcomes, and hospital charges were extracted and compared. RESULTS: Seventy-eight patients were identified, 38 admitted from January 1989 through July 1991 (group 1) and 40 from July 1991 through July 1993 (group 2). The groups were well matched in age, preexisting disease, and cardiorespiratory status on admission. Group 1 had significantly greater use of invasive monitoring, pharmacologic paralysis, inotropes, blood products, antibiotics, and parenteral nutrition. Outcomes were not different, but group 1 patients had significantly longer stays, more complications, and higher hospital charges. CONCLUSIONS: Routine use of invasive monitoring of PICU patients with RSV disease was associated with increased laboratory testing, overtreatment, and significant increases in costs and morbidity without improvement in outcome.
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Unidades de Terapia Intensiva Pediátrica/economia , Monitorização Fisiológica/estatística & dados numéricos , Insuficiência Respiratória/terapia , Infecções por Vírus Respiratório Sincicial/terapia , Vírus Sincicial Respiratório Humano , Estudos de Casos e Controles , Custos e Análise de Custo , Feminino , Preços Hospitalares , Humanos , Lactente , Masculino , Monitorização Fisiológica/economia , Monitorização Fisiológica/métodos , Morbidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Respiração Artificial , Insuficiência Respiratória/economia , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/virologia , Infecções por Vírus Respiratório Sincicial/economia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Estudos RetrospectivosAssuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adolescente , Recém-Nascido , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva Pediátrica/organização & administração , Equipamentos Médicos Duráveis/normas , Unidades de Terapia Intensiva Pediátrica/economia , Unidades de Terapia Intensiva PediátricaAssuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adolescente , Recém-Nascido , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva Pediátrica/organização & administração , Unidades de Terapia Intensiva Pediátrica , Unidades de Terapia Intensiva Pediátrica/economia , Equipamentos Médicos Duráveis/normasRESUMO
OBJECTIVE: To determine the relationship of demographic and clinical variables to cost, to revenue based on diagnosis-related groups, and to profit in patients in a pediatric intensive care unit (PICU). DESIGN: Prospective collection of clinical and demographic data of patients sampled. Detailed financial data for all patients discharged from the hospital were compiled by the office of financial planning. A combined data set was used for analysis. SETTING: A multidisciplinary PICU within a general, tertiary-care, teaching hospital in an urban environment. PATIENTS: Consecutive sample of 1174 pediatric patients discharged from the PICU during a 24-month period. MEASUREMENTS AND MAIN RESULTS: Hospital cost (not charges) determined according to industry standards. Revenue was determined by the DRG system. Of the 1174 cases identified, DRG coding and financial data were 97% complete. The mean loss (negative profit) per patient was $9218 +/- $33,676. Profit was significantly and adversely affected by outlier status, death, high risk of death, interhospital transfer, emergency admission, young age, and mechanical ventilation. Multivariate analysis revealed that duration of stay, death, interhospital transfer, and age negatively correlated with profit. CONCLUSION: Under a DRG-based reimbursement system, the operation of an active PICU with a broad referral base may not be desirable from a financial perspective. Similar studies at other institutions could help establish a data base with which the DRG system can be refined.
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Cuidados Críticos/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/economia , Sistema de Pagamento Prospectivo/estatística & dados numéricos , Cuidados Críticos/estatística & dados numéricos , Grupos Diagnósticos Relacionados , Pesquisa sobre Serviços de Saúde , Hospitais de Ensino/economia , Renda/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Tempo de Internação , Análise Multivariada , Cidade de Nova Iorque , Discrepância de GDH , População UrbanaRESUMO
Reanimación cardiopulmonar-cerebral del recién nacido. Traslado prehospitalario de adultos. Programa de traslado médico neonatal y pediátrico. Reanimación en situaciones de emergencia aguda con algoritmos clínico, y con líquidos coloidales y cristaloideos. Alimentación enteral. Diagnóstico y tratamiento del envenenamiento. Aspectos médicos y legales de la muerte cerebral. Reclutamiento, desarrollo y retención de las enfermeras de terapia intensiva
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Cuidados Críticos/métodos , Unidades de Terapia Intensiva/normas , Medicina de Emergência/normas , Cuidados Críticos/normas , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva , Unidades de Terapia Intensiva Neonatal/normas , Primeiros Socorros/métodos , Primeiros Socorros/normas , Medicina de Emergência/educação , Medicina de Emergência/métodos , Unidades de Terapia Intensiva Pediátrica/classificação , Unidades de Terapia Intensiva Pediátrica/economia , Unidades de Terapia Intensiva Pediátrica/normasRESUMO
Reanimación cardiopulmonar-cerebral del recién nacido. Traslado prehospitalario de adultos. Programa de traslado médico neonatal y pediátrico. Reanimación en situaciones de emergencia aguda con algoritmos clínico, y con líquidos coloidales y cristaloideos. Alimentación enteral. Diagnóstico y tratamiento del envenenamiento. Aspectos médicos y legales de la muerte cerebral. Reclutamiento, desarrollo y retención de las enfermeras de terapia intensiva
Assuntos
Masculino , Feminino , Humanos , Recém-Nascido , Lactente , Criança , Adulto , Idoso , Cuidados Críticos/métodos , Medicina de Emergência/normas , Unidades de Terapia Intensiva/normas , Cuidados Críticos/normas , Medicina de Emergência/educação , Medicina de Emergência/métodos , Primeiros Socorros/métodos , Primeiros Socorros/normas , Unidades de Terapia Intensiva , Unidades de Terapia Intensiva Neonatal/normas , Unidades de Terapia Intensiva Pediátrica/classificação , Unidades de Terapia Intensiva Pediátrica/economia , Unidades de Terapia Intensiva Pediátrica/normas , Unidades de Terapia Intensiva/organização & administraçãoRESUMO
The relationship between health care resource use and severity of illness is important to hospitals providing care to sicker patients, so we investigated the relationship between resource utilization, cost, and severity of illness in 229 consecutive patients admitted to a pediatric intensive care unit. Resources measured included length of stay and number and cost of laboratory and imaging studies. Pediatric intensive care unit and daily mortality risks (assessed by the Physiologic Stability Index and the Dynamic Risk Index) were stratified as very low risk (less than 1%), low risk (1% to 2.5%), moderate risk (2.5% to 5.0%), and high risk (greater than 5%). Increasing daily resource use was directly related to increasing gradations of severity of illness. For very low, low-, moderate-, and high-risk patient days, the daily numbers of diagnostic studies were (mean +/- SEM) 20.1 +/- 0.6, 31.4 +/- 1.1, 37.7 +/- 1.6, and 43.0 +/- 1.8, respectively. Total resource use, including diagnostic tests and length of stay, also increased with pediatric intensive care unit mortality risk. Diagnostic testing and corresponding costs were significantly higher for infants who died in the pediatric intensive care unit than for survivors on a day-by-day basis as well as for the entire stay in the care unit. We conclude that there is a direct, positive relationship between resource use, cost, and gradations of severity of illness that, if accounted for, would result in more equitable health care reimbursement.