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Profile and outcomes of critically ill children in a lower middle-income country
  1. Muhammad Irfan Habib1,
  2. Khalid Mehmood A Khan2
  1. 1Department of Clinical, Child Life Foundation, Karachi, Pakistan
  2. 2Department of Medicine, National Institute of Child Health, Karachi, Pakistan
  1. Correspondence to Dr Muhammad Irfan Habib, Department of Clinical, Child Life Foundation, B-82, Block-W, Allama Iqbal Town, North Nazimabad, Karachi, Pakistan; dr.irfanhabib{at}gmail.com

Abstract

Objective To determine the clinical profile and outcome of critically ill children presenting to a paediatric ED in a lower middle-income country.

Methods We performed a retrospective analysis of children (<14 years) presenting to the ED of the National Institute of Child Health, Karachi, between January and December 2014 who were assigned to acuity 1 (requiring immediate life-saving interventions) according to the Emergency Severity Index. Data included demographic variables, presenting complaints, interventions and outcomes in the ED.

Results There were 172 162 visits during the year. Of these, 13 551 (8%) were level 1. 64% of level 1 patients were transported to the ED without ambulance service. Neonates (0–28 days) constituted 48% of level 1 children; their most frequent presenting complaints were respiratory symptoms, followed by fever and reluctance to feed. Above the neonatal age group, the most common presenting complaints were gastrointestinal symptoms (with signs of hypoperfusion), followed by seizures, reluctance to feed and respiratory symptoms. 64% of children of >28 days presenting were malnourished. Interventions included cardiopulmonary resuscitation, application of bubble continuous positive airway pressure and endotracheal intubation. Overall mortality was 13%; 63% of all deaths were in the neonatal age group.

Conclusion Children with the highest triage acuity represent 8% of all visits to a paediatric ED. In this group, neonates account for nearly half of all the children, and more than half of all the deaths among critically ill children came in ED. A large proportion of high-acuity children are malnourished.

  • paediatric resuscitation
  • emergency department
  • death/mortality
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Footnotes

  • Contributors MIH and KMK developed the initial draft and analysis plan. MIH and KMK were involved in data analysis and interpretation. MIH and KMK provided critical review of the draft as well as in overall design and implementation of draft. Both authors approved of the final draft.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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