Admission pattern, treatment outcomes, and associated factors for children admitted to pediatric intensive care unit of Tikur Anbessa specialized hospital, 2021: a retrospective cross-sectional study

Abstract

Background Assessement of the pattern of admission and treatment outcomes of critically ill pediatrics admitted to pediatric intensive care units (PICU) in developing countries is crucial. In these countries with resource limitations, it may help to identify priorities for resource mobilization that may improve patient service quality. The PICU mortality rate varies globally, depending on the facilities of the intensive care unit, availability of experties, and admission patterns. This study assessed the admission pattern, treatment outcomes, and associated factors for children admitted to the PICU. Methods A retrospective cross-sectional study was implemented on 406 randomly selected pediatrics patients admitted to the PICU of Tikur Anbessa Specialized Hospital from 1-Oct-2018 to 30-Sept-2020. The data were collected with a pretested questionnaire. A normality curve was used to check for data the distribution. Both bivariable and multivariable analyses were used to see association of variables. A variable with a p-value of < 0.2 in the bivariable model was a candidate for multivariate analysis. The strength of association was shown by an adjusted odds ratio (AOR) with a 95% Confidence interval (CI), and a p-value of < 0.05 was considered statistically significant. Frequency, percentage,and tables were used to present the data. Results A total of 361 (89% response rate) patient charts were studied, 197 (54.6%) were male, and 164(45.4%) were female. The most common pattern for admission was a septic shock (27.14%), whereas the least common pattern was Asthma 9(2.50%). The mortality rate at the pediatric intensive care unit was 43.8%. Moreover, mechanical ventilation need (AOR = 11.2, 95%CI (4.3–28.9), P < 0.001), need for inotropic agents (AOR = 10.7, 95%CI (4.1–27.8), P < 0.001), comorbidity (AOR =8.4, 95%CI (3.5–20.5), P < 0.001), length of PICU stay from 2 to 7 days (AOR = 7.3, 95%CI (1.7–30.6), P = 0.007) and severe GCS (< 8) (AOR = 10.5, 95%CI (3.8–29.1), P < 0.001) were independent clinical outcome predictors (mortality). Conclusion The mortality rate at the PICU was 43.8%. Septic shock, and meningitis were the common cause of death and the largest death has happened in less than 7 days of admission.

Factors Associated with the Outcome of a Pediatric Patients Admitted to Intensive Care Unit in Resource-Limited Setup: Cross-Sectional Study

“…The majority of the children admitted to this study (86.1%) were over the age of two. This finding is consistent with previous research in Ethiopia 25 , 26 and Mozambique. 16 A similar study in India found a different result than ours, in which more than 50.7% of the participants were infants.…”

“…This result is in line with other PICU studies that have been conducted in Ethiopia and have found mortality rates between 40% and 44%. 13,26 The death rate was 2%, 2.1%, and 4.5%, respectively, in similar studies conducted in India, Singapore, and Switzerland, but the findings were different. 27,28,30 Given that most families live in rural areas of the country with inadequate infrastructure and that most arrive at hospitals with advanced stages of illness after consulting traditional healers before going there, the disparity in mortality rates may be the result of a delay in seeking medical attention by the families of the children.…”

“…28 On top of that septic shock (27.14%) and respiratory disorders (20.9%) were the most prevalent causes, according to this study’s findings, which differ from those of similar studies conducted in Ethiopia at various points in time. 26 , 29 According to a research done in India, cardiovascular illness accounted for 41.1% of admissions. 27 Due to poor health seeking habits and the nation’s low socioeconomic status, the bulk of admissions for post-operative care may be explained by patients seeking care later in the course of their illness when complications require surgical interventions.…”

Predictors of Outcome in an Egyptian Pediatric Intensive Care Unit

“…An Egyptian study reported that the incidence of MODS in patients with severe sepsis and septic shock reached up to 68.9% [22] . The MODS was reported to be the most common cause of deaths in an Ethiopian PICU [3] .…”

“…Pediatric intensive care services have been significantly increased in the poor countries since the start of the new century [2] . Nevertheless, many PICUs in the low-middle income countries (LMICs) lack organizational details [3] . Many units are still deficient in properly-trained medical staff, adequate nurse-topatients ratios, proper tools, monitoring capacity or ancillary assistance [4] .…”