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Survival and Predictors of Mortality Among Critically Ill Children Admitted to an Intensive Care Unit in a
Mesfin Wubishet Gurmu1, Solomon Gelaye Yinges1, Tahir Aman2
1Department of Pediatrics Arsi University College of Health Sciences Asella Ethiopia.
Insights
Pediatric intensive care unit (ICU) mortality in Ethiopia is high, with most deaths occurring within the first week. Lack of health insurance, organ dysfunction, and anemia are key predictors of mortality in critically ill children.
Area of Science:
- Pediatric Critical Care
- Public Health
- Epidemiology
Background:
- Critically ill children in low- and middle-income countries (LMICs) face high mortality rates due to limited resources and delayed care.
- Ethiopia struggles with improving pediatric critical care, lacking prospective data on survival and mortality predictors.
- This study addresses the scarcity of data by assessing survival and identifying mortality predictors in critically ill children at ARTH.
Purpose of the Study:
- To determine survival outcomes for critically ill children admitted to the intensive care unit (ICU) at ARTH.
- To identify independent predictors of mortality among this vulnerable pediatric population.
- To inform strategies for reducing pediatric ICU mortality in resource-limited settings.
Main Methods:
- An institution-based prospective cohort study involved 305 critically ill children admitted to ARTH's ICU from June 2023 to November 2024.
- Kaplan-Meier method estimated survival probabilities; log-rank test compared groups.
- Cox proportional hazards regression identified independent mortality predictors, reporting adjusted hazard ratios (AHRs) and 95% confidence intervals (CIs).
Main Results:
- The study enrolled 305 children, with 129 (42.3%) deaths during follow-up. The mortality incidence rate was 7.1 per 100 person-days; median survival was 10 days.
- Most deaths (86.8%) occurred within the first 7 days of ICU admission.
- Independent mortality predictors included lack of health insurance (AHR=2.03), multiple organ dysfunction syndrome (MODS) (AHR=1.73), acute kidney injury (AKI) (AHR=1.82), anemia (AHR=1.73), and a modified PIM-2 score >5 (AHR=1.58).
Conclusions:
- Pediatric ICU mortality in this Ethiopian setting is alarmingly high, particularly within the first week of admission.
- Both clinical severity indicators (MODS, AKI, anemia, PIM-2 score) and socioeconomic factors (lack of health insurance) significantly predict mortality.
- There is a critical need for early risk stratification, prompt interventions, and policies enhancing financial access to critical care to reduce pediatric mortality in resource-constrained environments.
Background:
Mortality among critically ill children remains disproportionately high in low- and middle-income countries (LMICs), reflecting persistent challenges related to limited critical care capacity, delayed healthcare utilization, and a substantial burden of preventable and treatable illnesses. Despite ongoing efforts to improve pediatric critical care services in Ethiopia, prospective data on survival outcomes and predictors of mortality among critically ill children remain scarce. This study aimed to assess survival outcomes and identify independent predictors of mortality among children admitted to the intensive care unit at ARTH in southeastern Ethiopia.
Methods:
An institution-based prospective cohort study was conducted among 305 critically ill children admitted to the intensive care unit (ICU) at ARTH between June 2023 and November 2024. Participants were followed from ICU admission until death or censoring. Survival probabilities were estimated using the Kaplan-Meier method, and differences between groups were compared using the log-rank test. Cox proportional hazards regression analysis was performed to identify independent predictors of mortality. Adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) were reported, and statistical significance was set at p < 0.05.
Results:
Among the 305 enrolled patients, 129 (42.3%) died during follow-up. The overall mortality incidence rate was 7.1 deaths per 100 person-days (95% CI: 5.86-8.32), and the median survival time was 10 days (95% CI: 7.58-12.42). Most deaths (86.8%) occurred within the first 7 days of ICU admission. Independent predictors of mortality included lack of health insurance (AHR = 2.03; 95% CI: 1.22-3.39), MODS (AHR = 1.73; 95% CI: 1.09-2.73), AKI (AHR = 1.82; 95% CI: 1.13-2.93), anemia at admission (AHR = 1.73; 95% CI: 1.15-2.60), and a modified PIM-2 score greater than five (AHR = 1.58; 95% CI: 1.03-2.43).
Conclusion:
In-ICU mortality among critically ill pediatric patients was alarmingly high, with the greatest risk occurring during the first week of admission. Both clinical severity indicators and socioeconomic factors were independently associated with mortality. These findings highlight the need for early risk stratification, timely targeted interventions, and policies that improve financial access to critical care services to reduce pediatric ICU mortality in resource-constrained settings.
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