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

• Published in: BMJ open Vol. 10; no. 10; p. e036746
• Main Authors: Teshager, Nahom Worku, Amare, Ashenafi Tazebew, Tamirat, Koku Sisay
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 16-10-2020; BMJ Publishing Group
• Series: Original research
• Subjects: Adolescent; Caregivers; Child; Child mortality; Cohort analysis; Comorbidity; Convulsions & seizures; Critical care; Data collection; Emergency medical care; Ethiopia - epidemiology; Female; Hospital Mortality; Hospitals; Humans; Illnesses; Immunization; Incidence; Infant; Intensive Care; Intensive Care Units, Pediatric; Laboratories; Low income groups; Male; Malnutrition; Mortality; Nutritional status; Observational studies; Pediatrics; Prospective Studies; Respiratory distress syndrome; Retrospective Studies; Sepsis; Sociodemographics; Survival analysis; Ventilators; Ethiopia; accident & emergency medicine; paediatric intensive & critical care; intensive & critical care
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-036746

ObjectiveTo determine the incidence and predictors of mortality among children admitted to the paediatric intensive care unit (PICU) at the University of Gondar comprehensive specialised hospital, northwest Ethiopia.DesignA single-centre prospective observational cohort study.ParticipantsA total of 313 children admitted to the ICU of the University of Gondar comprehensive specialised hospital during a one-and-a-half-year period.MeasurementsData were collected using standard case record form, physical examination and patient document review. Clinical characteristics such as systolic blood pressure, pupillary light reflex, oxygen saturation and need for mechanical ventilation (MV) were assessed and documented within the first hour of admission and entered into an electronic application to calculate the modified Pediatric Index of Mortality 2 (PIM 2) Score. We fitted the Cox proportional hazards model to identify predictors of mortality.ResultThe median age at admission was 48 months with IQR: 12–122, 28.1% were infants and adolescents accounted for 21.4%. Of the total patients studied, 59.7% were males. The median observation time was 3 days with (IQR: 1–6). One hundred and two (32.6%) children died during the follow-up time, and the incidence of mortality was 6.9 deaths per 100 person-day observation. Weekend admission (adjusted HR (AHR)=1.63, 95% CI: 1.02 to 2.62), critical illness diagnoses (AHR=1.79, 95% CI: 1.13 to 2.85), need for MV (AHR=2.36, 95% CI: 1.39 to 4.01) and modified PIM 2 Score (AHR=1.53, 95% CI: 1.36 to 1.72) were the predictors of mortality.ConclusionThe rate of mortality in the PICU was high, admission over weekends, need for MV, critical illness diagnoses and higher PIM 2 scores were significant and independent predictors of mortality.