Outcome of pediatric intensive care at six centers in Mexico and Ecuador.
Crit Care Med
; 25(9): 1462-7, 1997 Sep.
Article
in En
| MEDLINE
| ID: mdl-9295818
ABSTRACT
OBJECTIVE:
To improve understanding of the causes of morbidity and mortality among critically ill children in the countries studied.DESIGN:
Survey of hospital records between 1992 and 1994.SETTING:
Six pediatric intensive care units (ICUs) (four ICUs in Mexico City and two ICUs in Ecuador). PATIENTS Consecutive patients (n = 1,061) admitted to the units studied.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
The mortality rate for low-risk patients (pediatric Risk of Mortality [PRISM] score of < or = 10, n = 701) was more than four times the rate predicted by the PRISM score (8.1% vs. 1.8%, p < .001), with an additional 11.3% of this group incurring major morbidity. The mortality rate for moderate-risk patients (PRISM scores of 11 to 20, n = 232) was more than twice predicted (28% vs. 12%, p < .001). For low-risk patients, death was significantly associated with tracheal intubation, central venous cannulation, pneumonia, age of < 2 months, use of more than two antibiotics, and nonsurgical diagnosis (after controlling for PRISM score). Central venous cannulation and tracheal intubation in the lower-risk groups were performed more commonly in units in Mexico than in one comparison unit in the United States (p < .001).CONCLUSIONS:
For six pediatric ICUs in Mexico and Ecuador, mortality was significantly higher than predicted among lower-risk patients. Tracheal intubation, central catheters, pneumonia, sepsis, and nonsurgical status were associated with poor outcome for low-risk groups. We speculate that reducing the use of invasive central catheters and endotracheal intubation for lower-risk patients, coupled with improved infection control, could lower mortality rates in the population studied.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Severity of Illness Index
/
Intensive Care Units, Pediatric
/
Outcome Assessment, Health Care
/
Hospital Mortality
/
Critical Illness
Type of study:
Clinical_trials
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Child, preschool
/
Humans
/
Infant
Country/Region as subject:
America do sul
/
Ecuador
/
Mexico
Language:
En
Journal:
Crit Care Med
Year:
1997
Document type:
Article
Affiliation country:
United States