Rosine Nyirasafari1, Mark H Corden2, Angélique Charlie Karambizi3, Jean Claude Kabayiza4, Jean Damascene Makuza5, Rex Wong6, Michael F Canarie7. 1. a Department of Pediatrics and Child Health , Ministry of Health, Rwamagana Provincial Hospital , Rwamagana , Rwanda. 2. b Division of Hospital Medicine , Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA. 3. c Department of Paediatrics and Child Health , Kigali University Teaching Hospital , Kigali , Rwanda. 4. d School of Medicine and Pharmacy, College of Medicine and Health Sciences , University of Rwanda , Butare , Rwanda. 5. e STIs Care and Treatment Senior Office, HIV and STIs Division, Rwanda Biomedical Centre , Kigali , Rwanda. 6. f Yale University Global Health Leadership Institute , New Haven , CT , USA. 7. g Department of Pediatrics, Division of Critical Care , Yale University School of Medicine , New Haven , CT , USA.
Abstract
BACKGROUND: The enormous burden of critical illness in resource-limited settings has led to a growing interest in paediatric critical care in these regions. However, published data on the practice of critical care and patient outcomes in these settings are scant. OBJECTIVE: This study sought to identify risk factors associated with mortality in the newly established Paediatric Intensive Care Unit (PICU) at Kigali University Teaching Hospital (KUTH) in Rwanda and test the predictive ability of a newly devised mortality risk score, the modified PRISM (MP) score. METHODS: All admissions to the PICU at KUTH from October 2012 to October 2014 were included. Demographic and physiological data on each patient were gathered and each was assigned a MP score. This prospective cross-sectional study examined the association between the characteristics and physiological status of these patients and mortality. Using logistic regression, factors associated with mortality in the PICU were analysed. RESULTS: A total of 213 children were admitted to the PICU during the study period. Three patients were excluded because of missing data. Of this total, 59% were male, 25% were neonates and nearly 60% were moderately to severely malnourished. The overall mortality rate was 50%. On bivariate analysis, factors associated with increased mortality were male sex, use of vasoactive medications, a MP score ≥ 5, a discharge diagnosis of septic shock, and malnutrition on admission. On multivariate analysis, only the use of vasoactive drugs [odds ratio (OR) 12.24, 95% confidence interval (CI) 4.4-35.4, p < 0.001] and MP score ≥ 5 (OR 16.1, CI 6.3-40.8, p < 0.001) were associated with mortality. CONCLUSION: The observed mortality rate was in the range reported in other resource-limited settings. The initial attempt to create and implement a risk of mortality tool for this setting determined a score that could identify those patients at higher risk of mortality. In PICUs in resource-limited settings, the gathering of data and use of severity of illness tools could improve care in a number of ways.
BACKGROUND: The enormous burden of critical illness in resource-limited settings has led to a growing interest in paediatric critical care in these regions. However, published data on the practice of critical care and patient outcomes in these settings are scant. OBJECTIVE: This study sought to identify risk factors associated with mortality in the newly established Paediatric Intensive Care Unit (PICU) at Kigali University Teaching Hospital (KUTH) in Rwanda and test the predictive ability of a newly devised mortality risk score, the modified PRISM (MP) score. METHODS: All admissions to the PICU at KUTH from October 2012 to October 2014 were included. Demographic and physiological data on each patient were gathered and each was assigned a MP score. This prospective cross-sectional study examined the association between the characteristics and physiological status of these patients and mortality. Using logistic regression, factors associated with mortality in the PICU were analysed. RESULTS: A total of 213 children were admitted to the PICU during the study period. Three patients were excluded because of missing data. Of this total, 59% were male, 25% were neonates and nearly 60% were moderately to severely malnourished. The overall mortality rate was 50%. On bivariate analysis, factors associated with increased mortality were male sex, use of vasoactive medications, a MP score ≥ 5, a discharge diagnosis of septic shock, and malnutrition on admission. On multivariate analysis, only the use of vasoactive drugs [odds ratio (OR) 12.24, 95% confidence interval (CI) 4.4-35.4, p < 0.001] and MP score ≥ 5 (OR 16.1, CI 6.3-40.8, p < 0.001) were associated with mortality. CONCLUSION: The observed mortality rate was in the range reported in other resource-limited settings. The initial attempt to create and implement a risk of mortality tool for this setting determined a score that could identify those patients at higher risk of mortality. In PICUs in resource-limited settings, the gathering of data and use of severity of illness tools could improve care in a number of ways.
Entities:
Keywords:
Critical care; MP, modified PRISM; Mechanical ventilation; PCC, paediatric critical care; PICU, paediatric critical care unit; PRISM, paediatric risk of mortality; Resource-limited settings; SOI, severity of illness; Sepsis
Authors: Osama E Bekhit; Shereen A Mohamed; Remon M Yousef; Hoiyda A AbdelRasol; Nirvana A Khalaf; Fatma Salah Journal: Sci Rep Date: 2019-04-12 Impact factor: 4.379
Authors: Corrado Cancedda; Phil Cotton; Joseph Shema; Stephen Rulisa; Robert Riviello; Lisa V Adams; Paul E Farmer; Jeanne N Kagwiza; Patrick Kyamanywa; Donatilla Mukamana; Chrispinus Mumena; David K Tumusiime; Lydie Mukashyaka; Esperance Ndenga; Theogene Twagirumugabe; Kaitesi B Mukara; Vincent Dusabejambo; Timothy D Walker; Emmy Nkusi; Lisa Bazzett-Matabele; Alex Butera; Belson Rugwizangoga; Jean Claude Kabayiza; Simon Kanyandekwe; Louise Kalisa; Faustin Ntirenganya; Jeffrey Dixson; Tanya Rogo; Natalie McCall; Mark Corden; Rex Wong; Madeleine Mukeshimana; Agnes Gatarayiha; Egide Kayonga Ntagungira; Attila Yaman; Juliet Musabeyezu; Anne Sliney; Tej Nuthulaganti; Meredith Kernan; Peter Okwi; Joseph Rhatigan; Jane Barrow; Kim Wilson; Adam C Levine; Rebecca Reece; Michael Koster; Rachel T Moresky; Jennifer E O'Flaherty; Paul E Palumbo; Rashna Ginwalla; Cynthia A Binanay; Nathan Thielman; Michael Relf; Rodney Wright; Mary Hill; Deborah Chyun; Robin T Klar; Linda L McCreary; Tonda L Hughes; Marik Moen; Valli Meeks; Beth Barrows; Marcel E Durieux; Craig D McClain; Amy Bunts; Forrest J Calland; Bethany Hedt-Gauthier; Danny Milner; Giuseppe Raviola; Stacy E Smith; Meenu Tuteja; Urania Magriples; Asghar Rastegar; Linda Arnold; Ira Magaziner; Agnes Binagwaho Journal: Int J Health Policy Manag Date: 2018-11-01