Outcome Analyses of the Admitted Patients in a Paediatric Intensive Care Unit in a Resource Poor Setting: A Prospective Observational Study

Abstract

Introduction: Paediatric intensive care is an indispensible part in the management of critically ill children. Facilities for intensive care are sparse in low income countries requiring strict admission criteria. Adequate data generation regarding the profile of patients, outcomes and identification of the risk factor for poor prognosis can help in appropriate utilisation of this specialised care. Aim: To analyse the outcome of admissions in the Paediatric Intensive Care Unit (PICU) of a tertiary care centre in upper Assam and identification of risk factors for poor prognosis. Materials and Methods: A prospective observational study was carried out at the PICU of Assam Medical College Hospital, Dibrugarh, Assam, India, from March 2019 to April 2020. Data collected were -demographic details of the admitted children, the outcome and the risk factors affecting the mortality. Statistical methods used were Odds Ratio (OR), simple proportion test, Chi-square test and Relative Risk (RR) estimation with 95% confidence intervals, backward and forward logistic regression. Results: Total 495 children were enrolled in the study. The three most common disease categories were neurological disease (33.3%), respiratory disease (31.1%), and sepsis (10.7%). The overall mortality was 17.8%. Diseases related to the nervous system were the leading cause of death (38.6%). Highest mortality (43.2%) was in the age group of 1 month to 1 year. Highest disease specific mortality was due to Acute Encephalitis Syndrome (28.4%). Presence of circulatory shock, Poor Glasgow Coma Scale (GCS) (GCS<8), hypoxia, dyselectrolytemia, malnutrition, renal failure, and requirement of ionotropic support, mechanical ventilation were significantly associated with mortality with p value<0.05. Conclusion: Mortality rate (17.7%) was relatively high. Requirement of mechanical ventilation and Cardiopulmonary Resuscitation (CPR), use of inotropes, GCS ≤8, malnutrition, renal failure, dyselectrolytemia, hypoxia and sepsis were associated with increased mortality. Circulatory shock, requirement of CPR and mechanical ventilation were the independent predictors of mortality.