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[Prognostic factors in a pediatric intensive care unit]
J Garduño-Espinosa1, M E Campos-Leyva, A Fajardo-Gutiérrez
1Unidad de Epidemiología Clínica, Hospital de Pediatría, Instituto Mexicano del Seguro Social, México, D.F.
Insights
Pediatric intensive care unit (PICU) mortality is 30%. Key predictors of death include cardiovascular disease, need for blood products, low Glasgow score, and organ failure, especially respiratory and heart failure.
Area of Science:
- Pediatric Intensive Care Medicine
- Critical Care Research
- Prognostic Factor Analysis
Objectives:
To identify the mortality prognostic factors from a pediatric intensive care unit.
Study Design:
Retrolective cohort study with an analysis of cases and controls (ambidirectional design). PLACE OF STUDY: The intensive care unit at a Pediatric Third Level Hospital.
Study Units:
All of the patients admitted into the I.C.U. for a year (August 1989 to August 1990).
Main Measurements:
The patients were identified when admitted into I.C.U., while evaluating their clinical course through their charts. Afterwards, they were placed into two groups, those who died while in I.C.U. (n = 49) and those in the control group which constituted the initial cohort survivors (n = 115). The prognostic factors evaluated were age, sex, diagnosis when admitted, organic failure, changes in diagnosis and treatment.
Main Results:
164 patients were studied, with a slight predominance of the male sex (53%). The patient's age fluctuated between 1 day and 17 years of age, with a mean age of 10 months. The diagnosis established when admitted were predominantly dealing with infectious problems (n = 54, 32%). The most important prognostic factors seen during the bivaried analysis were the peritoneal dialysis (RM = 12.71, IC 95% = 2.41-98.29, P less than 0.01); a Glasgow index less than or equal to 10 points (RM = 7.33, IC 95% = 1.25-47.26, P less than 0.01), respiratory organic failure (RM = 6.32, IC 95% = 2.46-16.8, P less than 0.01) and assisted mechanical ventilation (RM = 5.61, IC 95% = 2.52-12.68, P less than 0.01).
Conclusions:
The mortality rate in I.C.U. was 30%. The most important prognostic factors associated to mortality after adjusting for severity were having a cardiovascular ailment, the need to administer blood products, a Glasgow index less than or equal to 10 points, heart and hematologic organic failure and when respiratory mechanical assistance was provided.