Clinical profile and outcome of PICU in a tertiary care hospital in south India
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Context (Background): This study is done at PICU of Coimbatore Medical College, studied clinical profile and outcome of PICU candidates.
AIM: To study the clinical profile and outcome of children admitted in PICU. Secondary objective is to correlate age, sex,
disease with poor outcome. Settings and design: descriptive study, conducted in PICU of Coimbatore medical college.
Methods: It is a descriptive study, conducted over a period of 3 months from October 2015 to December 2015. Studied all children admitted with PICU admission criteria from 2 months to 12 years of age group. None excluded. All cases admitted in paediatric department are scrutinized and according to the institutional PICU admission criteria, the candidates for PICU are selected. All cases admitted in PICU and treated as per the protocol. The clinical profile such as age, sex, history, co morbid conditions, condition on arrival, provisional diagnosis at arrival is noted. The duration of hospitalization and outcome is recorded with final diagnosis. The results are tabulated in SPSS software and analysed using chi square test for variables.
Results: Total cases admitted during study period were 1372. Among which 793 were boys and remaining girls. Out of which 396 (boys girls221, girls 175) who fulfilled the inclusion criteria were admitted in PICU and treated. There were a total of 396 admissions to the PICU Mean age was 48.35 months. Male to female ratio was 1.26:1. Diagnoses included Respiratory (25.25%), Cardiac (03.78%), Neurological (16.16%), Infectious (26.26%), Toxin/ Envenomation (07.82%), Renal (02.27%), Haematology (08.83%), GIT (06.06%), Hepatology (01.51%), Nutritional (01.26%), Metabolic (00.25%), Multiple Congenital Anomalies (00.25%), Allergic (00.25%). 82 children (20.68%) required mechanical ventilation. Average duration of ventilation was 5.24 days. 22.5% of non survivors had multi organ failure. Average length of PICU stay was 4.52 +/- 2.6 days. Complications commonly encountered were IV site thrombo phlebitis (12%), atelectasis (2.25%), accidental extubation (4%), and pneumothorax (0.8%). Incidence of nosocomial infections was 12.24%. 27 died (boys 13, girls 14) with a mortality rate of 07.07%. The mean age of deaths was 1.76 years (boys 2.63years, girls 0.96 years) with 70.3% of deaths occurring under one years of age (excluding neonates) and 85.18% of deaths occurring in under five years. 25.92% of deaths occurred within 24 hours of admission and 11.11% deaths had prolonged stay (>12days).
Conclusion: Respiratory illnesses were common cause of PICU admissions. As expected, Dengue like illnesses was also common. Maximum deaths were due to CNS infections. 2 deaths attributed to VHF with DIVC. Incidence of nosocomial infections was somewhat high. Interestingly, more boys got admitted to the PICU as compared to girls. More studies are required to assess the overall outcomes of critically ill children in India.
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