EARLY DEATH IN A PEDIATRIC INTENSIVE CARE UNIT OF PAKISTAN: A DESCRIPTIVE ANALYSIS

MR IQBAL; U SAMAN; M WAQAS; M FAREED; AU HAQUE

doi:10.54112/pjicm.v5i02.121

Authors

MR IQBAL Pediatric ICU Sindh Institute of Child Health and Neonatology Karachi, Sindh, Pakistan
U SAMAN Department of Pediatrics at Aga Khan University Hospital Karachi, Pakistan
M WAQAS Pediatric ICU Sindh Institute of Child Health and Neonatology Karachi, Sindh, Pakistan
M FAREED Pediatric ICU Sindh Institute of Child Health and Neonatology Karachi, Sindh, Pakistan
AU HAQUE Pediatric ICU Sindh Institute of Child Health and Neonatology Karachi, Sindh, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i02.121

Keywords:

Critically-Ill, Death, Children, PICU Multi-Organ Dysfunction

Abstract

Background: Mortality statistics from pediatric intensive care units (PICU) are widely available. Early Death (ED) is defined as death occurring within 24 hours of ICU admission. Few clinical reports on ED are available from the adult ICU. There is a paucity of data on ED available from the PICU. Objective: The objective of the study is to assess the frequency of Early Deaths and describe the patient's clinical-demographic characteristics who died within the first 24 hours of PICU admission. Study Design: A descriptive, cross-sectional study. Setting: A closed multidisciplinary Pediatric Intensive Care Unit of a public-sector Children's Hospital. Duration: One year; From January 1 to December 31, 2024. Methods: A total of 225 children (age 1 month to 15 years) who expired within 24 hours of admission to the PICU of the Children's Hospital of Korangi, Karachi, were eligible. Data were extracted from electronic medical records and chart reviews, including patients' demographic characteristics, pertinent clinical variables, selected labs and imaging, pediatric sequential organ dysfunction (p-SOFA) score, and received ICU-specific intervention. Descriptive statistics were applied. Results: The overall mortality rate was 8.72% (666) of all admissions (n=5814), and 33.78% (225) of all deaths were ED. The median age was 12 months (IQR 6-24 months), and 55% were male. Almost half of the patients (48.5%) were in a terminally ill state. The most common abnormal critical clinical parameters were hypoxia (88%, n=198), hypotension (88%, n=198), and decreased level of consciousness (89.8%, n=202). The mean p-SOFA was 10.6±4. Septic shock, cardiac diseases, and multi-organ failure were the most common diagnoses at the time of death. Vasoactive drugs and mechanical ventilation were used in 99.6% (n=224) and 82.7% (n=186), respectively. The mean time from PICU admission to death was 10.5±9.8 hours. Conclusion: We found the frequency of early deaths was more than one-third of all deaths in the PICU (33.78%). Nearly half of them were futile. Septic shock, cardiac illnesses, and multiorgan failure were the common diagnoses. More comprehensive studies are needed on early deaths from PICUs for critical analysis.

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