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Demographic profile and outcome analysis of a tertiary level pediatric intensive care unit
Praveen Khilnani1, Devajit Sarma, Reeta Singh
1Apollo Center for Advanced Pediatrics, I P Apollo Hospital, New Delhi, India. pkhilnani@vsnl.com
Insights
This study analyzed pediatric intensive care unit (PICU) admissions in India, finding outcomes similar to Western data but a high rate of nosocomial infections. Multiorgan failure was a key factor in mortality among critically ill children.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Epidemiology of Pediatric Illnesses
Background:
- Tertiary level pediatric intensive care units (PICUs) are crucial for managing critically ill children.
- Understanding the profile and outcomes of PICU admissions is vital for improving pediatric critical care in India.
- Existing data on PICU outcomes in India is limited, necessitating localized studies.
Purpose of the Study:
- To investigate the demographic profile, common diagnoses, and treatment patterns of children admitted to a tertiary PICU in India.
- To evaluate the morbidity, mortality, and length of stay for critically ill children in the Indian PICU setting.
- To compare PICU outcomes in India with previously published data from Western countries.
Main Methods:
- A prospective study was conducted involving all admissions to a tertiary level PICU.
- Data collected included patient demographics, Pediatric Risk of Mortality (PRISM) III scores, diagnoses, treatments, and outcomes.
- Morbidity indicators such as mechanical ventilation, acute respiratory distress syndrome, and nosocomial infections were recorded.
Main Results:
- 948 children were admitted, with a mean age of 41.48 months and a male to female ratio of 2.95:1.
- Common diagnoses included respiratory (19.7%), neurological (17.9%), and infectious (12.5%) conditions. Mean PRISM III score was 18.50.
- Overall mortality was 6.7%, with multiorgan failure in 49.5% of non-survivors. Nosocomial infections occurred in 16.86% of patients.
Conclusions:
- PICU outcomes in India, including PRISM III scores, adjusted mortality, and ventilation duration, align with Western data.
- Multiorgan failure remains a significant cause of death in critically ill children.
- The incidence of nosocomial infections was noted to be relatively high, warranting further investigation and intervention.
Objective:
To study the profile and outcome of children admitted to a tertiary level pediatric intensive care unit (PICU) in India.
Methods:
Prospective study of patient demographics, PRISM III scores, diagnoses, treatment, morbidity and mortality of all PICU admissions.
Results:
948 children were admitted to the PICU. Mean age was 41.48 months. Male to female ratio was 2.95:1. Mean PRISM III score on admission was 18.50. Diagnoses included respiratory (19.7%), cardiac (9.7%), neurological (17.9%), infectious (12.5%), trauma (11.7%), other surgical (8.8%).196 children (20.68%) required mechanical ventilation. Average duration of ventilation was 6.39 days. 27 children (30.7 children /1000 admissions) had acute respiratory distress syndrome. Gross mortality was 6.7% (59 patients). PRISMIII adjusted mortality was directly proportional to PRISMIII scores. 49.5% of nonsurvivors had multiorgan failure. Average length of PICU stay was 4.52 +/- 2.6 days. Complications commonly encountered were atelectasis (6.37%), accidental extubation (2%), and pneumothorax (0.9%). Incidence of nosocomial infections was 16.86%.
Conclusion:
Our data appears to be similar with regards to PRISMIII scores and adjusted mortality, length of the PICU stay, and duration of ventilation, to previously published western data. Multiorgan failure remains a major cause of death. As expected, Dengue and malaria were common. Incidence of nosocomial infections was somewhat high. Interestingly, more boys got admitted to the PICU as compared to girls. Clearly more studies are required to assess the overall outcomes of critically ill children in India.
