The unmet need for critical care at a quaternary paediatric intensive care unit in South Africa
S. Afr. med. j
; 112(11): 871-877, 2022. tables
Artículo
en Inglés
| AIM (África)
| ID: biblio-1399380
Biblioteca responsable:
CG1.1
ABSTRACT
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
Texto completo:
Disponible
Contexto en salud:
ODS3 - Salud y Bienestar
/
ODS3 - Meta 3.2 Evitar muertes en recién nacidos y niños menores de 5 años
Problema de salud:
Meta 3.2: Evitar muertes en recién nacidos y niños menores de 5 años
/
Nutrición
Base de datos:
AIM (África)
Asunto principal:
Prevención Cuaternaria
/
Pediatría Integrativa
Tipo de estudio:
Factores de riesgo
Límite:
Humanos
Idioma:
Inglés
Revista:
S. Afr. med. j
Año:
2022
Tipo del documento:
Artículo
Institución/País de afiliación:
Department of Paediatrics, Inkosi Albert Luthuli Central Hospital, Durban/ZA