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Published on: January 17, 2011
Outcome of pediatric intensive care at six centers in Mexico and Ecuador
M Earle1, O Martinez Natera, A Zaslavsky
1Division of Pediatric Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Insights
Critically ill children in Mexico and Ecuador experienced higher mortality than predicted, especially low-risk patients. Invasive procedures like tracheal intubation and central catheters were linked to poor outcomes, suggesting a need for reduced use and better infection control.
Area of Science:
- Pediatric critical care medicine
- Global health outcomes
- Epidemiology of childhood diseases
Background:
- Understanding drivers of mortality in pediatric intensive care units (PICUs) is crucial for improving patient outcomes.
- Previous studies have highlighted variations in care and outcomes across different healthcare settings.
Purpose of the Study:
- To investigate the causes of morbidity and mortality among critically ill children in selected PICUs in Mexico and Ecuador.
- To compare observed outcomes with predicted outcomes using the Pediatric Risk of Mortality (PRISM) score.
Main Methods:
- A retrospective survey of hospital records from six pediatric intensive care units (four in Mexico, two in Ecuador) between 1992 and 1994.
- Analysis of data from 1,061 consecutive patients admitted to these units.
- Utilized the Pediatric Risk of Mortality (PRISM) score to assess patient risk stratification.
Main Results:
- Mortality rates for low-risk (PRISM score ≤10) and moderate-risk (PRISM scores 11-20) patients were significantly higher than predicted (8.1% vs. 1.8% and 28% vs. 12%, respectively).
- Major morbidity affected an additional 11.3% of low-risk patients.
- Factors associated with death in low-risk patients included tracheal intubation, central venous cannulation, pneumonia, young age (<2 months), multiple antibiotics, and nonsurgical diagnosis.
- Invasive procedures like central venous cannulation and tracheal intubation were more frequent in Mexican units compared to a US comparison unit.
Conclusions:
- PICUs in Mexico and Ecuador exhibited higher-than-predicted mortality, particularly among lower-risk pediatric patients.
- Tracheal intubation, central catheters, pneumonia, and sepsis were identified as key factors associated with adverse outcomes in low-risk groups.
- Recommendations include reducing invasive procedures for lower-risk patients and enhancing infection control measures to potentially decrease mortality rates.
Objective:
To improve understanding of the causes of morbidity and mortality among critically ill children in the countries studied.
Design:
Survey of hospital records between 1992 and 1994.
Setting:
Six pediatric intensive care units (ICUs) (four ICUs in Mexico City and two ICUs in Ecuador).
Patients:
Consecutive patients (n = 1,061) admitted to the units studied.
Interventions:
None.
Measurements And Main Results:
The mortality rate for low-risk patients (pediatric Risk of Mortality [PRISM] score of < or = 10, n = 701) was more than four times the rate predicted by the PRISM score (8.1% vs. 1.8%, p < .001), with an additional 11.3% of this group incurring major morbidity. The mortality rate for moderate-risk patients (PRISM scores of 11 to 20, n = 232) was more than twice predicted (28% vs. 12%, p < .001). For low-risk patients, death was significantly associated with tracheal intubation, central venous cannulation, pneumonia, age of < 2 months, use of more than two antibiotics, and nonsurgical diagnosis (after controlling for PRISM score). Central venous cannulation and tracheal intubation in the lower-risk groups were performed more commonly in units in Mexico than in one comparison unit in the United States (p < .001).
Conclusions:
For six pediatric ICUs in Mexico and Ecuador, mortality was significantly higher than predicted among lower-risk patients. Tracheal intubation, central catheters, pneumonia, sepsis, and nonsurgical status were associated with poor outcome for low-risk groups. We speculate that reducing the use of invasive central catheters and endotracheal intubation for lower-risk patients, coupled with improved infection control, could lower mortality rates in the population studied.
