Frequency and outcome of infectious disease admissions to a pediatric intensive care unit

Abstract

This prospective clinical study was designed to assess patients with primary infectious disease (ID) necessitating admission to a pediatric intensive care unit (PICU), to identify morbidity and mortality risk factors, and to better define this subpopulation of critically ill children and compare them with patients who had a noninfectious disease (NID). All patients (N = 1,151) admitted to a multidisciplinary, university-affiliated, 20-bed PICU from January through December 1988 were studied. The patients were classified as having either ID or NID as the primary indication for PICU admission. Other variables assessed included age, sex, requirement for mechanical ventilatory support, and severity of illness at admission as determined by Pediatric Risk of Mortality (PRISM) score. Of the 1,151 patients admitted, 187 (16%) had ID. Patients with ID had significantly higher PRISM scores than NID patients, but mortality rates were not significantly different between the NID group (9%) and the ID group (11%). The ID and NID groups showed no significant difference with regard to sex, number of days in the ICU, or number of days of mechanical ventilatory support. Patients with ID were significantly younger than those without. Although the highest mortality overall was in neonates, there was no difference in mortality rate for this age group between ID and NID. Fifty-five (30%) of the 187 ID patients had a diagnosis of sepsis syndrome on admission, and had significantly higher PRISM scores and mortality than patients with other ID. We concluded that patients admitted to our PICU with a diagnosis of infectious disease were significantly younger and had higher severity of illness scores than patients admitted with a diagnosis of noninfectious disease. The most frequent cause of death in both groups was multisystem organ failure. Patients with sepsis syndrome showed showed no significant difference in overall mortality, but their PRISM scores and mortality rate were significantly greater than those of the other ID patients.