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Predictors of mortality in a paediatric intensive care unit in Kigali, Rwanda

Rosine Nyirasafari1, Mark H Corden2, Angélique Charlie Karambizi3

  • 1a Department of Pediatrics and Child Health , Ministry of Health, Rwamagana Provincial Hospital , Rwamagana , Rwanda.

Paediatrics and International Child Health
|December 7, 2016
PubMed

Insights

In resource-limited settings, a modified PRISM (MP) score of 5 or higher and use of vasoactive drugs significantly predicted mortality in a paediatric intensive care unit (PICU). These findings can help identify high-risk children for improved care.

Area of Science:

  • Paediatric Critical Care
  • Global Health
  • Epidemiology

Background:

  • Critical illness poses a significant burden in resource-limited settings, increasing the need for paediatric critical care.
  • Data on paediatric intensive care unit (PICU) practices and outcomes in these regions are scarce.

Purpose of the Study:

  • To identify mortality risk factors in a new PICU at Kigali University Teaching Hospital (KUTH), Rwanda.
  • To evaluate the predictive accuracy of a novel mortality risk score, the modified PRISM (MP) score.

Main Methods:

  • A prospective cross-sectional study included 213 children admitted to the KUTH PICU from October 2012 to October 2014.
  • Demographic and physiological data were collected, and patients were assigned an MP score.
  • Logistic regression analysis identified factors associated with PICU mortality.

Main Results:

  • The overall PICU mortality rate was 50%.
  • Factors associated with increased mortality included male sex, vasoactive medication use, MP score ≥ 5, septic shock, and malnutrition.
  • Multivariate analysis confirmed vasoactive drug use (OR 12.24) and MP score ≥ 5 (OR 16.1) as significant predictors of mortality.

Conclusions:

  • The observed mortality rate aligns with other resource-limited settings.
  • The MP score effectively identified patients at higher risk of mortality.
  • Implementing data collection and severity of illness tools in PICUs in resource-limited settings can enhance patient care.
Abstract

Keywords:
Critical careMP, modified PRISMMechanical ventilationPCC, paediatric critical carePICU, paediatric critical care unitPRISM, paediatric risk of mortalityResource-limited settingsSOI, severity of illnessSepsis

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