Demographic profile and outcome analysis of pediatric intensive care patients

Abstract

Background: Demographic profile and outcome can vary in pediatric intensive care unit (PICU) patients. The aim of our study was to analyze demographic profile and outcome in a Greek PICU.

Methods: Prospective observational study.

Data collected: demographic profile; co morbidities; source and diagnosis at admission; Pediatric Risk of Mortality (PRISM III-24); Glasgow Coma Scale (GCS, pediatric); Injury Severity Score (ISS); procedures; treatment; mechanical ventilation (MV); MV days; length of stay (LOS) and the outcome at PICU discharge.

Statistical analysis: Student's t-test; Mann-Whitney U test; Kruskall-Wallis test; χ(2) criterion with relative risk (RR) estimation; Cox regression analysis; as appropriate. Values are mean ± SD, p < 0.05.

Results: 300 patients (196 boys/104 girls), aged 54.26 ± 49.93 months, were admitted due to respiratory failure (22.3%), head trauma (15.3%), seizures (13.7%), coma (9.7%), postoperative care (7.7%), polytrauma (7%), accidents (5.3%), sepsis-septic shock (5.3%), cardiovascular diseases (4.7%), metabolic diseases (3.3%), multiple organ failure syndrome (3%) and miscellaneous diseases (2.7%). PRISM III-24 score was 8.97 ± 7.79 and predicted mortality rate was 11.16% ± 18.65. MV rate was 67.3% (58.3% at admission) for 6.54 ± 14.45 days, LOS 8.85 ± 23.28 days and actual PICU mortality rate 9.7%. Patients who died had statistically worse severity scores. Significant mortality risk factors were inotropic use, PRISM III-24 > 8, MV, arterial and central venous catheterization, nosocomial infections, complications, and cancer. COX regression analysis showed that PRISM III-24 score and inotropic use were independent predictors of mortality.

Conclusions: Demographic profile followed similar patterns to relevant studies while there were major differences in case mix and the severity of the disease. Mortality rate (9.7%) was relatively high but better than predicted and in accordance with the characteristics of our population.

Keywords: mortality; mortality risk factors; pediatric intensive care unit; pediatric risk of mortality PRISM III-24.

Figure 1. Mortality across diagnostic categories. No deaths occurred during stay in the unit in postoperative care, accidents and miscellaneous diseases patients

Figure 2. Severity scores in patients who died and survived. Differences were always statistically significant (p=0.000). GCS, Glasgow coma scale; ISS, injury severity score; PRISM, pediatric risk of mortality

Figure 3. Survival curve (n=300, deaths 29) into two PRISM III-24 categories using Cox proportional hazards model. Relative risk of mortality when PRISM III-24 > 8 was 14.54 (95% CI 4.30-46.95). PRISM, pediatric risk of mortality

Figure 4. Survival curve (n=300; deaths 29) according to inotropic use using Cox proportional hazards model. Relative risk of mortality in the presence of inotropic use was 64.38 (95% CI 15.80-262.36)