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Outcome of children with different accessibility to tertiary pediatric intensive care in a developing country--a
Adrian Yu-Teik Goh1, Mohd El-Amin Abdel-Latif, Lucy Chai-See Lum
1Pediatric Intensive Care Unit, University Malaya Medical Center, 50603 Kuala Lumpur, Malaysia. adriangoh@um.edu.my
Insights
Critically ill children transferred from rural hospitals had similar outcomes, including mortality and unexpected deaths, compared to those directly admitted to a tertiary pediatric intensive care unit. Initial access to care did not impact final outcomes.
Area of Science:
- Pediatric critical care medicine
- Healthcare accessibility research
- Public health policy
Background:
- Limited access to tertiary pediatric intensive care services in rural areas may negatively impact critically ill children.
- Inter-hospital transport by non-specialized teams can increase patient morbidity and mortality.
Purpose of the Study:
- To investigate the outcomes of critically ill children with varying degrees of access to tertiary pediatric intensive care in Malaysia.
- To compare outcomes between children transported from rural hospitals and those transferred from within a tertiary center.
Main Methods:
- Prospective study comparing 131 patients from rural hospitals (limited access) with 215 patients from tertiary center wards (direct access).
- Evaluated Pediatric Risk of Mortality (PRISM II) adjusted standardized mortality ratio (SMR), unanticipated deaths, and length of stay.
- Utilized non-specialized teams for inter-hospital transport.
Main Results:
- Transported patients were younger and more likely to have respiratory diseases.
- Limited access was associated with a longer median length of stay (4.0 vs. 2.0 days).
- No significant differences were observed in SMR (p=0.348), unexpected deaths (p=0.485), or adjusted odds ratio for mortality (p=0.248).
Conclusions:
- Outcomes for critically ill children transferred from community hospitals were comparable to those receiving direct care in a tertiary pediatric ICU.
- Initial inaccessibility to intensive care did not adversely affect patient outcomes if tertiary care was ultimately received.
- Transport by non-specialized teams did not significantly alter the outcomes in this cohort.
Objective:
Lack of direct access to tertiary pediatric intensive care services in rural hospitals may be associated with poorer outcome among critically ill children. Inter-hospital transport by non-specialized teams may also lead to increased morbidity and even mortality. We therefore studied the outcome of children with different accessibility to tertiary pediatric care in Malaysia.
Methods:
We prospectively compared the Pediatric Risk of Mortality (PRISM II) adjusted standardized mortality ratio (SMR), unanticipated deaths and length of stay of 131 patients transported from rural hospitals (limited access) with 215 transferred from the casualty wards or other in-hospital wards (direct access) to a tertiary pediatric ICU.
Results:
The transported patients were younger than the in-hospital patients (median age 1.0 versus 6.0 months, p=0.000) and were more likely to have respiratory diseases. Other baseline characteristics did not differ significantly. Differences in access to tertiary intensive care from community hospitals was associated with an extended median length of stay (4.0 versus 2.0 days, p=0.000) but did not affect SMR (0.92 versus 0.84, rate ratio 1.09, 95% CI 0.57-2.01; p=0.348) or percentage of unexpected deaths (4.8% versus 2.8%, p=0.485). The adjusted odds ratio for mortality (1.7, 95% CI 0.7-4.3) associated with transfer was not statistically significant (p=0.248).
Conclusions:
The outcome of critically ill children transferred from community hospitals did not differ from that of those who develop ICU needs in the wards of a tertiary center, despite being transported by non-specialized teams. Outcome was not affected by initial inaccessibility to intensive care if the children finally received care in a tertiary center.
