Risk Factors for Paediatric Intensive Care Unit Admission and In-hospital Mortality among Paediatric Emergencies in Nigeria: A Single Centre Study.

Abstract

Background: In Nigeria, the burden of critical illness and risk factors for mortality remains poorly described. This study describes the epidemiology of patients admitted at the children's emergency ward (EW) and risk factors for Paediatric intensive care unit (PICU) admission and in-hospital mortality (IHM).

Methods: This was a retrospective study of patients admitted to the Children's EW of the University College Hospital, Ibadan, Nigeria, from 1st December 2022 to 30th November 2023. Patient's demographics, presenting clinical features and diagnosis at admission were extracted. The primary outcome was PICU admission. Secondary outcomes were duration of hospital stay and IHM.

Results: There were 649 patients; 421(64.9%) were <5 years old. Median age was 2.3 (interquartile range 0.8-7.0) years. Most common presenting features were dyspnoea [269 (41.4%)], vomiting [182 (28%)] and hypoxaemia [188 (29%)]. At presentation, 51 (7.9%) and 63 (10.3%) had altered mental status and seizures, respectively, while the most common diagnoses were sepsis [250 (39%)], malaria [192 (30%)], and pneumonia [165(26%)]. At presentation, 217 (33.5%), 110 (16.9%), 48 (7.4%), and 32 (4.9%) required oxygen, blood transfusion, fluid bolus, and inotropes, respectively. Twenty (3.1%) patients required cardiopulmonary resuscitation (CPR), and 101 (15.6%) required PICU admission. Median duration of hospital stay was 5 (interquartile range 3-9) days, while IHM was 74 (6.6%) patients. On bivariate analysis, gender, dehydration, breathlessness, dyspnoea, cyanosis, cold extremities, thready pulses and altered mental state were associated with mortality, while breathlessness, hypoxaemia, dyspnoea, dehydration, cyanosis, thready pulses, cold extremities, convulsion and altered mental status were associated with PICU admission.

Conclusion: Shock state and hypoxaemia were associated with poor outcomes in paediatric emergencies. The introduction of basic critical care services will reduce the burden of adverse outcomes.