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Frequency and outcome of infectious disease admissions to a pediatric intensive care unit
S A Storgion1, R J Beck, R J Leggiadro
1Department of Pediatrics, University of Tennessee, Memphis.
Insights
Critically ill children with infectious diseases (ID) admitted to the pediatric intensive care unit (PICU) were younger and had higher severity scores than those with noninfectious diseases (NID). Sepsis syndrome increased risk in pediatric patients with infectious disease.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Critical Care Medicine
Background:
- Infectious diseases (ID) are a significant cause of critical illness in children.
- Understanding the characteristics and outcomes of pediatric patients with ID in the intensive care unit is crucial for improving care.
- Comparing these patients with those admitted for noninfectious diseases (NID) can elucidate specific risk factors and challenges.
Purpose of the Study:
- To assess pediatric patients with primary infectious disease (ID) admitted to a pediatric intensive care unit (PICU).
- To identify morbidity and mortality risk factors in this population.
- To compare critically ill children with ID to those with NID.
Main Methods:
- Prospective clinical study of 1,151 patients admitted to a multidisciplinary PICU over one year.
- Patients classified as ID or NID based on primary admission diagnosis.
- Assessed variables included age, sex, mechanical ventilation, and Pediatric Risk of Mortality (PRISM) score.
Main Results:
- 187 patients (16%) had ID; they were significantly younger than NID patients.
- ID patients had higher PRISM scores, but similar mortality rates (11% vs. 9%) compared to NID patients.
- Sepsis syndrome patients (30% of ID group) had higher PRISM scores and mortality than other ID patients.
Conclusions:
- Pediatric patients admitted to PICU with ID are younger and have higher illness severity than those with NID.
- Multisystem organ failure was the leading cause of death in both groups.
- Sepsis syndrome in ID patients is associated with increased severity and mortality within the infectious disease cohort.
Abstract:
This prospective clinical study was designed to assess patients with primary infectious disease (ID) necessitating admission to a pediatric intensive care unit (PICU), to identify morbidity and mortality risk factors, and to better define this subpopulation of critically ill children and compare them with patients who had a noninfectious disease (NID). All patients (N = 1,151) admitted to a multidisciplinary, university-affiliated, 20-bed PICU from January through December 1988 were studied. The patients were classified as having either ID or NID as the primary indication for PICU admission. Other variables assessed included age, sex, requirement for mechanical ventilatory support, and severity of illness at admission as determined by Pediatric Risk of Mortality (PRISM) score. Of the 1,151 patients admitted, 187 (16%) had ID. Patients with ID had significantly higher PRISM scores than NID patients, but mortality rates were not significantly different between the NID group (9%) and the ID group (11%). The ID and NID groups showed no significant difference with regard to sex, number of days in the ICU, or number of days of mechanical ventilatory support. Patients with ID were significantly younger than those without. Although the highest mortality overall was in neonates, there was no difference in mortality rate for this age group between ID and NID. Fifty-five (30%) of the 187 ID patients had a diagnosis of sepsis syndrome on admission, and had significantly higher PRISM scores and mortality than patients with other ID. We concluded that patients admitted to our PICU with a diagnosis of infectious disease were significantly younger and had higher severity of illness scores than patients admitted with a diagnosis of noninfectious disease. The most frequent cause of death in both groups was multisystem organ failure. Patients with sepsis syndrome showed showed no significant difference in overall mortality, but their PRISM scores and mortality rate were significantly greater than those of the other ID patients.