Mortality Pattern and Risk Factors in Pediatric ICU: A Retrospective Study at Mukalla Maternal and Childhood Hospital in Yemen (2021-2024).

Abstract

Background: The pediatric intensive care unit (PICU) plays a crucial role in managing critically ill children requiring advanced airway, respiratory, and hemodynamic support. Reducing the mortality rate is one of the primary objectives in every ICU. However, data regarding mortality and associated risk factors from low-resource countries remain insufficient. The aim of our study was to describe the mortality pattern, and to evaluate risk factors associated with mortality in the PICU at Mukalla Maternity and Childhood Hospital.

Methods: This retrospective study analyzed the admission records for children aged over 1 month to 15 years from the PICU over four years (1st January 2021 to 31st December 2024). The information retrieved included gender, age, place of residence, body weight, nutritional status, vaccination status, clinical presentations on admission, temperature, level of consciousness, presence of co-morbidities, the lag time between illness onset and hospital admission, date of admission, date of discharge, referring source, readmission frequency, diagnosis, need for mechanical ventilation, and condition at discharge (survived /deceased).

Results: Out of the 790 patients admitted to the PICU, 716 were included in the study. The three most common disease categories among admissions were respiratory diseases (29.5%), central nervous system diseases (27.1%), and gastrointestinal diseases (11%). The overall mortality rate was 38.1%. Among deceased patients, 57.9% were severely undernourished, 38.5% were unvaccinated, and 63.4% had associated co-morbidities. The most common causes of death were pneumonia (26%), meningoencephalitis (17.2%), and sepsis/septic shock (9.2%). Independent risk factors of PICU mortality included length of PICU stay [AOR 0.129, p < 0.001], need for mechanical ventilation [AOR 68.6, p < 0.001], cardiovascular diseases [AOR 3.1, p = 0.003], hypothermia [AOR 7.1, p = 0.014], convulsions [AOR 0.375, p = 0.001], disturbance of consciousness [AOR 2.1, p = 0.002], and hepatosplenomegaly [AOR 15.7, p = 0.024].

Conclusion: The mortality in our PICU is high and is associated with several independent factors. Recognizing these risk factors will facilitate the identification of critical cases, enable the prioritization of resources, and support the implementation of essential modifications.