Incidence and predictors of mortality among children admitted to the pediatric intensive care unit at the University of Gondar comprehensive specialized hospital, northwest Ethiopia: A prospective observational cohort study

Abstract

Background Pediatric intensive care unit (PICU) tremendously improves the success of saving patients having potentially life-threatening illness. An accurate estimate of lives saved through pediatric critical care intervention is important to evaluate the quality of the health care system. Data on pediatric critical care in developing countries remain scarce yet is much needed to improve clinical practices and outcomes. This study aimed to determine the incidence and predictors of mortality in the pediatric intensive care unit in the study setting.Method An institution based prospective cohort study was conducted from February 2018 to July 2019. We collected data by interview, chart and registration book review. Life table was used to estimate the cumulative survival of patients and Log rank test was used to compare survival curves between different categories of the explanatory variables. Survival trend over the follow up time was described using the Kaplan Meier graph. Bivariate and multivariate Cox proportional hazard model were used to identify predictors.Result Based on the 10 th version of international classifications of disease (ICD) of WHO, neurologic disorders (22.7%) infectious disease (18.8%) and environmental hazards (11.8%) account for the top three diagnoses. The median observation time was 3 days with IQR of 1 to 6 days. Of the total of 313 participants, 102 (32.6%) died during the follow-up time. This gives the incidence of mortality of 6.9 deaths per 100 person day observation. Caregivers’ occupation of government-employed (AHR=0.35, 95%CI: 0.14, 0.89), weekend admission (AHR=1.63, 95%CI: 1.02, 2.62), critical illness (AHR=1.79, 95%CI: 1.13, 2.85) Mechanical ventilation AHR=2.36,95%CI: 1.39, 4.01)and PIM2 score (AHR=1.53, 95%CI: 1.36, 1.72) were predictors of mortality in the pediatric ICU.Conclusion Neurologic disorder was the leading causes of admission followed by infectious diseases, and environmental hazards. Rate of mortality was high and admission over weekends, caregivers' occupation, mechanical ventilation, critical illness diagnosis, and higher PIM2 scores were found to be significant and independent predictors of mortality at the PICU. This suggests that ICU medical equipment, diagnostics, and interventions should be available up to the standard. Intensivist and full staffing around the clock has to be available in the PICU.

Predictors of mortality and loss to follow up among children with malignancies in a resource constraint community in Nigeria

“…[9][10][11][12]14,15,24 The occurrence of high in-hospital mortality in this study is comparable to reports from other studies conducted in Nigeria, some parts of Africa and South America. [9][10][11][12][13][14][15][16]22 Like in these studies, majority of the subjects in our study presented late, with most (82.9%) of them presenting after a month to more than 3 months of occurrence of the first noticeable symptom and 68.6% having metastatic disease at presentation. In well-resourced countries, a good number of children less than 15 years of age are said to commence treatment less than a month from the onset of symptoms.…”

“…High rates of mortality have been variously reported by studies conducted in Nigeria and beyond, and have been attributed to late presentation and diagnosis, limited treatment options, lack of manpower, specialized facilities and palliative support, with the burden of treatment mainly born by the caregivers. [9][10][11][12][13][14][15][16][17][18] In wellresourced countries with better management techniques, newer, more potent drugs and adjuvant therapies, the outcome has been encouraging with about 7-8 out of every 10 children with cancer achieving cure. [19][20][21] Long term follow up of cancer cases is also a challenge in resource constraint settings like ours.…”