Potentially Preventable Mortality in the Pediatric Intensive Care Unit: Findings from a Retrospective Mortality Analysis

Abstract

The goal of this study was to estimate the proportion and causes of potentially preventable mortality among critically ill children admitted to the pediatric intensive care unit (PICU). Methods The medical records of all patients who died in the PICU (age range: one month to 16 years) between January 2014 and December 2015 were evaluated by two independent reviewers to determine whether there had been any delayed recognition of deteriorating conditions, delayed interventions, unintentional/unanticipated harm, medication errors, adverse reactions to transfusions, and hospitalacquired infections that could have resulted in unanticipated death. Preventability was labeled on a 6-point scale. Results During the study period, 92 of 690 patients did not survive [median age: 60 months, interquartile range (IQR): 114]. The median Pediatric Risk of Mortality (PRISM) III score was 17 (IQR: 6). Major diagnostic categories included sepsis (n = 29, 35%), central nervous system diseases (n = 16, 17%), oncological/hematological diseases (n = 6, 6%), cardiac diseases (n = 4, 4%), and miscellaneous conditions. None of the deaths had definitive or strong evidence of preventability. Four (4.3%) patients were in category 4 (i.e., possibly preventable, >50/50 chance), 15 (16.3%) in category 3 (possibly preventable, <50/50 chance), 28 (30.4%) had some evidence of preventability, and 45 (49.0%) were labeled as definitely not preventable. Late identification (diagnostic error) of the worsening condition in four (21.0%) patients, slow intervention in six (31.6.0%), and hospital-acquired infections in 10 (52.6%) were found to be related to potentially preventable mortality. Conclusions Preventable diagnostic errors and nosocomial infections (NIs) are major contributors to preventable mortality. Structured mortality analysis provides actionable information for future preventive strategies. Improvement in care processes, including clinical decision support systems, could help reduce preventable mortality rates.

The Correlation of Platelet Indices; Platelet Count, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and Platelet-Large Cell Ratio (P-LCR) with Mortality in Patients Admitted to PICU

“…The mortality rate during the one-year study period was 10.42 %. Studies have reported a wide range of mortality rates in PICUs of Pakistan (11.9 to 35%), 12 which is comparable to India, 13 but very high compared to approximately 3% in the USA. 2 Infants were the largest sub-group (45.68%) in the mortality group.…”

Elective Tracheostomy in Critically Ill Children: A 10-Year Single-Center Experience From a Lower-Middle Income Country

“…We collected data through a study questionnaire using inpatient medical records by two independent reviewers with a similar protocol as described in a previously published study from our center [ 13 ]. Data collection included demographic details (age, gender, weight, height) as well as clinical details including diagnostic categories, indications for tracheostomy, the day of admission when tracheostomy was done, Pediatric Risk of Mortality (PRISM III) score, and outcome data (duration of mechanical ventilation, hospital length of stay [LOS], intensive care unit LOS, and complications of tracheostomy) [ 14 ].…”

“…We collected data through a study questionnaire using inpatient medical records by two independent reviewers with a similar protocol as described in a previously published study from our center [13]. The most common indications for elective tracheostomy ( Table 2) were PMV (n=24, 50%) and extubation failure (n=9, 18.7%).…”

Novel data visualization and risk analytic algorithm in a low-middle income country

“…3 Furthermore, healthcare providers are scarce and due to continuous brain drain are less well-trained in LMICs. 4,5 Even in one of the better intensive care units like ours, the mortality rates remain very high; with the majority of reasons being preventable such as late presentation, delayed recognition of the deteriorating condition, and delayed intervention. 5 PICUs are scarce resources in Pakistan.…”

“…4,5 Even in one of the better intensive care units like ours, the mortality rates remain very high; with the majority of reasons being preventable such as late presentation, delayed recognition of the deteriorating condition, and delayed intervention. 5 PICUs are scarce resources in Pakistan. According to a survey done in 2023, there were only 53 PICUs all over Pakistan with a total 667 beds, equating to 0.7 bed for every 100,000 children.6 Within these units, there are only 20 trained paediatric intensivists.…”