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Outcomes Following Intensive Care Unit Admission in a Pediatric Cohort in Malawi
Laura N Purcell1, Meghan Prin2, John Sincavage3
1Department of Surgery, University of North Carolina at Chapel Hill, NC 27599, USA.
Insights
Pediatric intensive care unit (ICU) mortality in Malawi is high at 54.3%. Younger children, anemia, and shock requiring epinephrine support significantly increase mortality risk in critically ill children.
Area of Science:
- Critical care medicine
- Pediatric health
- Global health
Background:
- Low- and middle-income countries (LMICs) face a significant burden of critical illness.
- There is a lack of data on pediatric critical care outcomes in LMICs.
Purpose of the Study:
- To describe pediatric intensive care unit (ICU) outcomes in Malawi.
- To identify risk factors for mortality in critically ill children in Malawi.
Main Methods:
- A prospective observational study was conducted in Malawi from August 2016 to May 2018.
- Data included patient demographics, clinical data, admission criteria, and outcomes for pediatric ICU patients (≤18 years).
- Multivariate Poisson regression was used to determine mortality risk factors.
Main Results:
- Out of 499 ICU admissions, 105 (21.0%) were children.
- The overall pediatric ICU mortality rate was 54.3%.
- Key predictors of increased mortality included age ≤5 years (RR 1.96), hemoglobin < 10 g/dL (RR 1.58), and shock requiring epinephrine support (RR 2.76).
Conclusions:
- Pediatric ICU mortality in Malawi is alarmingly high.
- Younger age (≤5 years), anemia, and the need for epinephrine support are significant predictors of mortality.
- Improving pediatric critical care specialist training and blood product availability may reduce mortality rates.
Introduction:
The burden of critical illness in low- and middle-income countries (LMICs) is high; however, there is a paucity of data describing pediatric critical care outcomes in this setting.
Methods:
We performed a prospective observational study of the pediatric (≤18 years) intensive care population in Malawi, from August 2016 to May 2018. Data collected include patient demographics and clinical data, admission criteria and outcome. A multivariate Poisson regression was performed to determine risk factors for mortality.
Results:
Over the study period, 499 patients were admitted to the intensive care unit (ICU) and 105 (21.0%) were children. The average age was 10.6 ± 5.4 years. Primary indications for ICU admission were sepsis (n = 30, 30.3%) and traumatic brain injury (TBI, n = 23, 23.2%). Of those who died, sepsis (n = 18, 32.7%), acute respiratory failure (n = 11, 20.0%) and TBI (n = 11, 20.0%) were the primary admission diagnoses. Overall, ICU mortality was 54.3% (n = 57). Multivariate regression for increased ICU mortality revealed: age ≤5 years [risk ratio (RR) 1.96, 95% CI 1.10-2.26, p < 0.001], hemoglobin < 10 g/dl (RR 1.58, 95% CI 1.08-2.01, p = 0.01) and shock requiring epinephrine support (RR 2.76, 95% CI 1.80-4.23, p < 0.001).
Conclusions:
Pediatric ICU mortality is high. Predictors of mortality were age ≤5 years, anemia at ICU admission and the need for epinephrine support. Training of pediatric intensive care specialists and increased blood product availability may attenuate the high mortality for critically ill children in Malawi.
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