Abstract
Background. Paediatric intensive care, a valuable resource that improves the outcomes of critically ill children, is often scarce.
Objective. To evaluate the need for paediatric intensive care beds and compare the outcomes of admitted and non-admitted deserving cases.
Methods. A prospective evaluation of all bed requests, in terms of need for intensive care and outcomes of those admitted and not admitted to a paediatric intensive care unit (PICU), was performed between July 2017 and June 2018. Factors for refusal and for poor outcomes were evaluated.
Results. Of the 811 bed requests, 32.6% (n=264, p<0.001) were denied access. Of the 231 deserving cases who were denied access, 85.7% (n=198) were due to unavailability of a PICU bed. Patients not admitted to PICU had a twofold increased risk of dying compared with those admitted (34.4% v. 15.5% respectively, p<0.001), even though the patient characteristics of both groups were similar (age, gender and nutritional status). In those admitted, risk factors for mortality were requiring transfusion of blood and platelets (56.0%, p<0.001), requiring two or more inotropes (52.5%, p<0.001), instability on admission (41.3%, p<0.001), prior cardiac arrest (32.0%, p=0.021), severe acute malnutrition (26.9%, p=0.043), fungal infection (22.2%, p=0.004) and emergency admission (18.0%, p<0.001). In those not admitted, prior cardiac arrest (100%, p<0.001) and emergency referral (42.3%, p<0.001) were associated with adverse outcomes.
Conclusion. The need for PICU beds exceeds availability, with a consequent twofold increase in mortality among cases not admitted to PICU. Paediatric critical care services have increased at appropriate sites of need following completion of this study.
Publisher
South African Medical Association NPC
Reference39 articles.
1. Naidoo K, Singh J, Lalloo U. A critical analysis of ICU/HC beds in South Africa: 2008 - 2009. S Afr Med J 2013;103(10):751-753. https://doi.org/10.7196%2Fsamj.6415
2. Rhodes A, Moreno RP. Intensive care provision: A global problem. Rev Bras Ter Intensiva 2012;24(4):322-325. https://doi.org/10.1590/S0103-507X2012000400005
3. Vukoja M, Riviello E, Gavrilovic S, et al. A survey on critical care resources and practices in low- and middle-income countries. Glob Heart 2014;9(3):337-342.e331-335. https://doi.org/10.1016/j. gheart.2014.08.002
4. Siaw-Frimpong M, Touray S, Sefa N. Capacity of intensive care units in Ghana. J Crit Care 2021;61:76- 81. https://doi.org/10.1016/j.jcrc.2020.10.009
5. Horak RV, Griffin JF, Brown AM, et al. Growth and changing characteristics of pediatric intensive care 2001 - 2016. Crit Care Med 2019;47(8):1135-1142. https://doi.org/10.1097%2Fccm.0000000000003863 6. Bamford LJ, McKerrow NH, Barron P, Aung Y. Child mortality in South Africa: Fewer deaths, but better data are needed. S Afr Med J 2018;108(3 Suppl 1):S25-S32. https://doi.org/10.7196/samj.2017.
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