Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 7  |  Issue : 4  |  Page : 500-503

Profile of patients admitted to pediatric intensive care unit, Cairo University Hospital: 1-year study


The Pediatric Department, Kasr El Aini Faculty of Medicine, Cairo University Mounira Children Hospital (Abou EL Reesh), Cairo University, Cairo, Egypt

Date of Submission25-May-2014
Date of Acceptance06-Jul-2014
Date of Web Publication28-Nov-2014

Correspondence Address:
Hanaa I Rady
Assistant Professor, 5, Gameat El Doual El Arabia street, Mohandessin, Cairo 12411
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-7934.145680

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  Abstract 

Introduction
Care of the critically ill patients is resource-intensive, and 15-20% of hospital budgets are spent in the ICUs.
Objectives
This study aimed to analyze the epidemiologic patterns of pediatric critically ill patients presenting to the pediatric intensive care unit (PICU) and the etiologies of PICU admission of different age groups.
Materials and methods
This descriptive study of all children aged less than 14 years presenting with critical illnesses to the PICU was conducted in a tertiary medical Hospital, in Cairo, from 2011 to 2012. All patients transferred to the PICU were included without distinction. Demographic data of critically ill children admitted to the PICU were analyzed. Etiologies of the PICU admissions were analyzed by various age groups.
Results
There were 532 critically ill children admitted to the PICU. Respiratory system diseases, foreign body inhalation removal, and encephalopathy were the predominant etiologies of admission 49.6, 11.9, and 11.5%, respectively. Mortality rate was the highest in infants below 1 year of age (43.9%). Predominant length of ICU stay was around 7 days.
Conclusion
The present study shows the etiologies of pediatric patients admitted to ICUs. The epidemiologic analysis of patients admitted to PICU can serve as basis for developing dedicated protocols for critical care and redistributing the ICUs' resources.

Keywords: critical illness, epidemiology, intensive care unit, respiratory diseases


How to cite this article:
Rady HI. Profile of patients admitted to pediatric intensive care unit, Cairo University Hospital: 1-year study. Ain-Shams J Anaesthesiol 2014;7:500-3

How to cite this URL:
Rady HI. Profile of patients admitted to pediatric intensive care unit, Cairo University Hospital: 1-year study. Ain-Shams J Anaesthesiol [serial online] 2014 [cited 2019 Sep 17];7:500-3. Available from: http://www.asja.eg.net/text.asp?2014/7/4/500/145680


  Introduction Top


In the past two decades, improvements in life-sustaining technologies resulted in an increase in the number of ICUs. Care of the critically ill patients is resource-intensive, and 15-20% of hospital budgets are spent in the ICUs. The focus on the quality and safety of medical care is increasing because of the high cost of healthcare and potential for harm [1-3]. There are many evaluations of mortality and incidence of complications, such as nosocomial infections in the ICUs, with an increased emphasis on the quality improvement efforts and evaluation of outcomes [4,5].

In 1991, a survey conducted in the USA revealed that 8% of hospital beds are ICU beds, 10-12 beds per unit for adult ICU and 21 beds per unit for neonatal ICU. The occupancy rate was 84% and the category of ICU was either medical ICU (36%) or mixed (22%) [6].

The aim of this study was to establish a profile for patients admitted to PICU of a university-based tertiary pediatric hospital, describing the demographics of patients, diagnosis, and outcome. This would allow identifying the magnitude of each illness that needed intensive care and redistribution of resources.


  Materials and methods Top


Study design

It was a descriptive study conducted over 1 year, from January 2012 to January 2013, including all patients admitted to pediatric intensive care unit (PICU) of Abolreesh Children Hospital, Cairo University.

Study settings

This PICU contains 15 beds divided as: four servos, eight beds, and three cubicles for isolation. It contains 20 ventilators (conventional and high-frequency ventilation), syringe and infusion pumps, monitor for each patient, defibrillation machine, portable X-ray machine, and plasma and hemodiafiltration machine. All indicated patients from 1 month to 15 years of age are admitted to this unit. The PICU is staffed 24/7 by a team of highly skilled pediatric intensivists. The team of this unit per 24 h is composed of two residents (PICU residents are signor residents who spend at least 6 months in the general ward and passed the first part Msc, familiar with the use of mechanical ventilator and managing critically ill cases), one assistant lecturer (resident who finished 3 years training in the pediatric department, 4 months of which in PICU, and passed both parts of Msc), one lecturer (PICU assistant lecturer after passing the MD exam), and seven nurses and nurse aids. The patients are either referred from the emergency department or from other hospitals.

Data collection

Data were extracted from the patient's files filled by resident. Extracted data included the following:

(1) Demographic characteristics: age, sex, and admission date.

(2) Clinical characteristics: provisional diagnosis and outcome.

(3) Patients with previously diagnosed chronic conditions were noted.

(4) The outcome including length of stay (LOS), referral to general ward, or death was also noted.

Data analysis

Data were tabulated and analyzed using frequency and percentage. Nominal data were compared using the χ2 tests. P values less than 0.05 were considered significant. Microsoft Office Excel version 2007 and statistical package for social science, version 17.0, (IBM) were used in the process.


  Results Top


During the year of the study, the total number of patients admitted to this PICU was 532.

[Table 1] shows demographics of patients admitted to PICU, including their distribution according to age, sex, date of admission, LOS, and fate. Children (1-5 years of age) were the largest age group admitted to PICU (n = 238). November and December were the most common months of admission (n = 58 and 57, respectively). Mortality rate was 33.1% and half the patients (53%) stayed an average of 1 week (n = 282).

[Table 2] describes the etiologies of admission to the PICU and their relationshipz with the outcome (P = 0.0001). Children representing with pneumonias (n = 264) and foreign body (FB) inhalation (n = 63) represented the highest admission etiology, followed by encephalopathy (n = 61). All patients with stridor were discharged, followed by FB inhalation (95.2%) and Guillain-Barré syndrome (94.4%). All patients who presented with postarrest died, followed by liver cell failure (66.7%) and heart failure with pneumonia (61.5%).
Table 1 Demographics of patients admitted to pediatric intensive care

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Table 2 Relationship between the etiologies of admission to the pediatric intensive care and outcome (P = 0.0001)

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[Table 3] shows the relationship between admission etiologies and the age group of patients (P = 0.0001) and their LOS (P = 0.007). Pneumonias and encephalopathy were more prevalent in infants below 1 year of age (n = 129 and 32, respectively); FB inhalation was more common among children 1-5 years of age (n = 45), whereas uncontrolled hypertension was more common among age group 1-5 years and above 5 years (n = 3 for both groups). Regarding LOS, 282 patients stayed around 7 days. Those who stayed less than 1 day were mostly the postbronchoscope FB removal (n = 26).
Table 3 Relationship between admission etiologies and age groups and length of stay

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Regarding the relationship between the different age groups and the LOS, 50% (8/16) of those who stayed more than 30 days were aged below 1 year. Children aged 1-5 years stayed on an average 1-7 days (P = 0.69) ([Table 4]).

Mortality rate was the highest in infants below 1 year of age (43.9%), and survival was nearly similar in those aged 1-5 years and above 5 years, 76.4 and 70.3%, respectively, (P = 0.0001) as shown in [Table 4].
Table 4 Relationship between age groups and length of stay and outcome

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  Discussion Top


Critically ill infants, children, and adolescents up to age 14 years receive constant care, sophisticated monitoring, and specialized therapies in our PICU at El Monira Children Hospital, Cairo University.

We noticed that children younger than 5 years of age were the vulnerable age group representing the majority of admitted patients to PICU. Winter (November and December) was the season of the highest PICU admission reflecting the possibility of droplet infection predominance (respiratory manifestations).

In this study, 53% of patients stayed an average of 7 days and mortality rate was 33.1%. In a study conducted in South Africa [7], LOS in PICU was 13.8 days (mortality rate 35.44%), whereas in a study conducted in Birmingham LOS was 4.2 days (103 h). [8] However, in other previous studies, we found that the mortality rates varied from 17 to 24.3% [9,10].

According to the etiologic analysis in this study, diseases of the respiratory system (pneumonias, FB inhalation removal) and encephalopathy were both the major etiologies in patients with ICU admission. The result is similar to a previous study in which disease of the respiratory system was the major cause [11,12] but is not comparable with another study in which the major etiology was disease of the cardiovascular system [9].

Among all age groups, still pneumonias were the leading cause of PICU admission. Children with FB inhalation (postbronchoscope FB removal) usually stayed less than 1 week, which indicates the good prognosis of those cases when managed without delay.

Mortality rate was the highest among infants below 1 year of age (43.9%); similar results were noticed by El-Nawawy study [13] in which nonsurvivors compared with survivors were significantly younger (12 vs. 23 months).


  Conclusion Top


Epidemiologic analysis of the pattern of patients admitted to PICU shows different etiologies for admission; on the top were respiratory system diseases. New protocols have to be provided to care givers in a trial to improve the outcome of infants' illness and to decrease the LOS of patients with pneumonias.


  Acknowledgements Top


 
  References Top

1.
Curtis JR, Cook DJ, Wall RJ, Angus DC, Bion J, Kacmarek R, et al. Intensive care unit quality improvement: a 'how-to' guide for the interdisciplinary team. Crit Care Med 2006; 34:2111-2118.  Back to cited text no. 1
    
2.
Garland A. Improving the ICU: parts 1 and 2. Chest 2005; 127:2151-2179.  Back to cited text no. 2
[PUBMED]    
3.
Luce JM, Rubenfeld GD. Can health care costs be reduced by limiting intensive care at the end of life? Am J Respir Crit care Med 2002; 165:750-754.  Back to cited text no. 3
    
4.
Mehta A, Rosenthal VD, Mehta Y, Chakravarthy M, Todi SK, Sen N, et al. Device associated nosocomial infection rates in intensive care units of seven Indian cities: findings of the international noscomial infection control consortium (INICC) J Hosp Infect 2007; 67:168-174.  Back to cited text no. 4
    
5.
Chelluri LP. Quality and performance improvement in critical care. Indian J Crit Care Med 2008; 12:67-76.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Batiha A. Critical care delivery in ICU. Crit Care Med 2001; 29:2007-2019.  Back to cited text no. 6
    
7.
Jeena PM, Wesley AG, Coovadia HM. Admission patterns and outcomes in a paediatric intensive care unit in South Africa over a 25-year period (1971-1995). Intensive Care Med 1999; 25:88-94.  Back to cited text no. 7
    
8.
Pearson G, Barry P, Timmins C, Stickley J, Hocking M. Changes in the profile of paediatric intensive care associated with centralisation. Intensive Care Med 2001; 27:1670-1673.  Back to cited text no. 8
    
9.
Taori RN, Lahiri KR, Tullu MS. Performance of PRISM (Pediatric Risk of Mortality) score and PIM (Pediatric Index of Mortality) score in a tertiary care pediatric ICU. Indian J Pediatr 2010; 77:267-271.  Back to cited text no. 9
    
10.
Kanter RK, Edge WE, Caldwell CR, et al. Pediatric mortality probability estimated from pre-ICU severity of illness. Pediatrics 1997; 99:59-63.  Back to cited text no. 10
    
11.
Tilford JM, Roberson PK, Lensing S, et al. Differences in pediatric ICU mortality risk over time. Crit Care Med 1998; 26:1737-1743.  Back to cited text no. 11
    
12.
Yang WC, Lin YR, Zhao LL, Wu YK, Chang YJ, et al. Epidemiology of pediatric critically-ill patients presenting to the pediatric emergency department. Klin Padiatr 2013; 225; 18-23.  Back to cited text no. 12
    
13.
El-Nawawy A. Evaluation of the outcome of patients admitted to the pediatric intensive care unit in Alexandria using the pediatric risk of mortality (PRISM) score. J Trop Pediatr 2003; 49:109-114.  Back to cited text no. 13
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


This article has been cited by
1 Burden of respiratory illnesses in pediatric intensive care unit and predictors of mortality: Experience from a low resource country
Chhaya Divecha,Milind S. Tullu,Satish Chaudhary
Pediatric Pulmonology. 2019;
[Pubmed] | [DOI]



 

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