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Characterization and Outcome of Two Pediatric Intensive Care Units with Different Resources
Rania G Abdelatif1, Montaser M Mohammed1, Ramadan A Mahmoud1
1Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag 82524, Egypt.
Insights
Pediatric intensive care units in developing countries face higher mortality due to resource limitations. Improving staff and equipment in these pediatric intensive care units (PICUs) is crucial for better outcomes.
Area of Science:
- Critical Care Medicine
- Pediatric Health
- Global Health Disparities
Background:
- Pediatric intensive care units (PICUs) in developing countries exhibit higher mortality rates.
- Resource limitations in these units contribute to adverse patient outcomes.
- Comparative studies are needed to inform critical care research and improve care for critically ill children in low-resource settings.
Purpose of the Study:
- To compare the structure, patient characteristics, and outcomes of resource-limited (Egyptian) and resource-rich (Japanese) pediatric intensive care units (PICUs).
- To identify factors contributing to higher mortality in resource-limited pediatric intensive care units (PICUs).
Main Methods:
- A retrospective study comparing Egyptian and Japanese pediatric intensive care units (PICUs) from March 2018 to February 2019.
- Data collected included patient demographics, diagnoses, length of stay, outcomes, and mortality risk (Pediatric Index of Mortality-2 [PIM-2]).
- Functional neurological status was assessed using the Pediatric Cerebral Performance Category (PCPC) scale.
Main Results:
- The Egyptian pediatric intensive care unit (PICU) had fewer beds, higher admission rates per bed, and a shortage of skilled staff compared to the Japanese unit.
- Despite availability of basic equipment, the Egyptian unit showed significantly higher actual and predicted mortality, associated with age, severe sepsis, and PIM-2.
- Patients in the Egyptian pediatric intensive care unit (PICU) had a shorter length of stay.
Conclusions:
- Inadequate infrastructure and a higher burden of severely ill children contribute to increased mortality in resource-limited pediatric intensive care units (PICUs).
- Enhancing qualified staff numbers and implementing cost-effective equipment are vital for improving mortality outcomes and care quality.
- Further research and resource allocation are necessary to support pediatric intensive care units (PICUs) in developing countries.
Background:
The pediatric intensive care units (PICUs) in developing countries have a higher mortality outcome due to a wide variety of causes. Identifying differences in the structure, patient characteristics, and outcome between PICUs with different resources may add evidence to the need for incorporating more PICUs with limited resources in the contemporary critical care research to improve the care provided for severely ill children.
Methods:
A retrospective study was conducted at Egyptian and Japanese PICUs as examples of resource-limited and resource-rich units, respectively. We collected and compared data of nonsurgical patients admitted between March 2018 and February 2019, including the patients' demographics, diagnosis, PICU length of stay, outcome, predicted risk of mortality using pediatric index of mortality-2 (PIM-2), and functional neurological status using the Pediatric Cerebral Performance Category (PCPC) scale.
Results:
The Egyptian unit had a lower number of beds with a higher number of annual admission/bed than the Japanese unit. There was a shortage in the number of the skilled staff at the Egyptian unit. Nurse : patient ratios in both units were only similar at the nighttime (1 : 2). Most of the basic equipment and supplies were available at the Egyptian unit. Both actual and PIM-2 predicted mortalities were markedly higher for patients admitted to the Egyptian unit, and the mortality was significantly associated with age, severe sepsis, and PIM-2. The length of stay was shorter at the Egyptian unit.
Conclusion:
The inadequate structure and the burden of more severely ill children at the Egyptian unit appear to be the most important causes behind the higher mortality at this unit. Increasing the number of qualified staff and providing cost-effective equipment may help in improving the mortality outcome and the quality of care.
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