Affiliation:
1. Department of Surgery, University of North Carolina at Chapel Hill, NC 27599, USA
2. Department of Anesthesiology, University of Colorado, Denver, CO 80045, USA
3. Department of Surgery, UNC Project-Malawi, Lilongwe, Malawi
4. Department of Anesthesia, Kamuzu Central Hospital, Lilongwe, Malawi
Abstract
Abstract
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.
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Pediatrics, Perinatology, and Child Health
Cited by
3 articles.
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