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A Study of Mortality in Cardiac Patients in a Pediatric Intensive Care Unit
Zuhal Gundogdu1, Kadir Babaoglu2, Murat Deveci2
1Pediatrics, Kocaeli University, Kocaeli, TUR.
Insights
Heart disease is a major cause of death in pediatric intensive care units (PICUs). Septic shock and infections are the leading causes of mortality in children with heart conditions admitted to the PICU.
Area of Science:
- Pediatric Intensive Care
- Cardiology
- Critical Care Medicine
Background:
- Heart disease is a significant cause of mortality in pediatric intensive care units (PICUs).
- Children with pre-existing cardiac abnormalities face heightened risks during PICU admissions.
Purpose of the Study:
- To determine the primary causes of mortality in pediatric patients with pre-existing cardiac conditions admitted to the PICU.
- To analyze the prognostic impact of various heart diseases in the PICU setting.
Main Methods:
- Retrospective review of medical records for pediatric patients admitted to the PICU.
- Utilized updated Pediatric Index of Mortality 2 (PIM2) scores for risk assessment.
- Performed exploratory data analysis with descriptive measures and Kolmogorov-Smirnov tests for data distribution.
Main Results:
- Out of 566 admissions, 76 (13.4%) had cardiac abnormalities. Common conditions included atrioventricular septal defect, cardiomyopathy, ventricular septal defect, and tetralogy of Fallot.
- The leading causes of cardiac mortality were septic shock (26.0%), cardiogenic shock (20.6%), and cardiac failure (13.7%).
- The nosocomial infection rate among cardiac patients in the PICU was 10.5%.
Conclusions:
- The Pediatric Index of Mortality 2 (PIM2) score is a reliable indicator for cardiac disease prognosis in the PICU.
- Infections, particularly septic shock and nosocomial infections, are the primary drivers of mortality in pediatric cardiac patients.
- Enhanced infection control strategies in the PICU are crucial for reducing mortality rates in this vulnerable population.
Objective:
One of the major causes of mortality in the pediatric intensive care unit (PICU) is heart disease. This study aimed to determine the causes of mortality in children with pre-existing cardiac abnormalities who were admitted into the PICU.
Methods:
Data were collected through patient profile assessment and outcome and heart diseases affecting prognosis were analyzed. Medical records of children were reviewed retrospectively. The updated Pediatric Index of Mortality 2 (PIM2) scores were used. Exploratory data analysis was performed using descriptive measures. Kolmogorov-Smirnov tests were used to test the normality of data distribution.
Results:
Out of 566 admissions into PICU, 76 (13.4%) had cardiac abnormalities. Median and range of PICU stay were 5.50 and 417.88 days. The mean PIM2 score on admission was found to be 31.05. The most common admission was due to atrioventricular septal defect (AVSD) (15.7%), cardiomyopathy (13.1%), ventricular septal defect (VSD) (11.8%), tetralogy of Fallot (10.5%) and others (48.9%). There were multiple cardiac anomalies in 3.9% of patients. The most important cause of cardiac mortality in PICU was septic shock (26.0%) followed by cardiogenic shock (20.6%), and cardiac failure (13.7%). The nosocomial infection rate of cardiac patients in PICU was 10.5%.
Conclusions:
Our study reconfirmed that the PIM2 score is a good indicator of cardiac diseases. Infections, nosocomial infections, pneumonia, and septic shock were the leading causes of mortality in cardiac patients. Better infection control in the PICU may have a significant impact on decreasing mortality rates.
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