Regional Variability of Admission Prevalence and Mortality of Pediatric Critical Illness in Latvia

Abstract

Objectives: There is only one pediatric intensive care unit (PICU) in Latvia, where all critically ill children <18 years are admitted from all regions of Latvia. The aim of this study is to ascertain regional differences in mortality and morbidity of critically ill children over a 5-year period. Materials and Methods: Descriptive retrospective study of children who were admitted to the PICU in Latvia from January 2012 to December 2016. Data on episodes were obtained from the Children's Clinical University Hospital electronic health records. Pediatric Index of Mortality (PIM2) was used for risk adjustment and calculation of standardized mortality ratio (SMR). The data were compared among the six regions of Latvia - Kurzeme, Latgale, Pieriga, Riga, Vidzeme, and Zemgale. Results: The analysis included 3651 intensive care episodes. The highest PICU admission prevalence was in Riga and the lowest in Latgale - 2.3 and 1.7 admissions per 1000 children per year, respectively. The highest emergency admission proportion was observed in Riga and Pieriga, while the lowest in Latgale - 52 and 38%, respectively. The average proportion of mechanically ventilated patients ranged from 24 to 29% of all admitted patients across the regions. SMR for the total population was 1.44 (95% CI: 1.17- 1.81). In two regions, Riga (1.51; 95% CI: 1.04- 2.14) and Latgale (2.21; 95% CI: 1.9- 3.76), it was significantly higher than 1. Conclusions: We noted excess mortality (SMR >1) in the population of critically ill children in Latvia, 2012-2016; in particular, in patients from two regions - Riga and Latgale.