Outcome of children with different accessibility to tertiary pediatric intensive care in a developing country – a prospective cohort study

Goh, Adrian; Abdel-Latif, Mohamed E; Lum, Lucy Chai-See; Abu-Bakar, Mohd Nazir

doi:10.1007/s00134-002-1534-9

Cited by 18 publications

(16 citation statements)

References 21 publications

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“…Hatherill et al [12] reported a high incidence of transfer-related adverse events during transfers to Cape Town's Red Cross War Memorial Children's Hospital PICU, as did Goh et al [6] in Malayasia. Our objective was to describe the journey of a critically ill child from referral to arrival at tertiary care, and to identify modifiable factors that could improve outcomes during the resuscitation and transfer process.…”

Section: Articlementioning

confidence: 85%

“…The practice of centralising paediatric intensive care services, specifically, has been associated with lower mortality rates and costs. [3][4][5][6] These intensive care units are able to provide high-quality care due to their familiarity with the management of seriously ill children. [7] Children admitted to PICUs in SA have been shown to differ substantially from those in developed countries, tending to be younger and requiring management of infective illnesses.…”

Section: Articlementioning

confidence: 99%

“…International studies vary with regard to the incidence of adverse events in transfer, from 87.5% with nonspecialised teams [6] to 4% with retrieval teams. [15] The paucity of adverse events reported coupled with the high proportion of both PICU and ward patients falling into the emergency and very urgent groups by TEWS scoring suggests a lack of insight in those undertaking these transfers.…”

Section: In-transit Carementioning

confidence: 99%

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A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa

Royal

McKerrow

2015

S Afr J CH

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Background.Obtaining care for an acutely ill child in specialised paediatric services relies on referral from lower-level facilities. In South Africa, it is common practice for acutely ill children to be transported far distances by non-specialist teams with limited equipment, knowledge and skills. Objectives. To describe the transfer of these children and to determine whether they deteriorate from the time of referral to the time of arrival at a tertiary centre. Furthermore, we sought to identify modifiable factors that might improve outcomes during resuscitation and transfer. Methods. The study was a retrospective review of emergency referrals of children aged 1 month -12 years to Grey's Hospital paediatric ward or paediatric intensive care unit (PICU), from lower-level facilities in KwaZulu-Natal between January and June 2012. In conjunction with an assessment by the receiving clinician at Grey's Hospital, Triage Early Warning Signs (TEWS) scores were obtained during telephonic referral and compared with the TEWS score on arrival in order to determine if a deterioration had occurred. Results. A total of 57 PICU referrals and 79 ward referrals were analysed. The mortality rate prior to transportation was 8.8%. Mean transfer distance was 131 km and mean transfer time 9 hours. Advanced life support teams undertook transportation in 76.7% of PICU and 25% of ward transfers and few adverse events were reported in transfer logs. However, 31.5% of PICU and 11.3% of ward referrals required immediate resuscitation on arrival. When the TEWS scoring system was applied 78.5% of PICU and 30.4% of ward referrals fell into the 'very urgent' and 'emergency' categories. Conclusion. Pretransport and in-transit care failed to stabilise children and this may reflect lack of skill of attending healthcare workers, transport delays or illness progression. Interventions to improve resuscitation and transfer are needed, and the use of retrieval teams should be investigated.

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Section: Articlementioning

confidence: 85%

Section: Articlementioning

confidence: 99%

Section: In-transit Carementioning

confidence: 99%

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A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa

Royal

McKerrow

2015

S Afr J CH

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“…Table V compares various studies on patient admissions to PICUs in developed and developing countries based on the diagnoses (excluding neonates, and trauma and postoperative patients) (2,4,5,7,(9)(10)(11)(12) Children with cardiac disorders, which include cardiac surgical and transplant patients, form the largest group by admission diagnosis in paediatric ICUs in high-income nations (13) -the United Kingdom, Australia and New Zealand (36%-51%). (2,5) Admission diagnosis in our study population is comparable to those of other middle-income nations (14) such as South Africa, India, Spain and Argentina, where respiratory (32%-52%), central nervous system (CNS) and cardiac disorders, and septicaemia predominate (p = 0.87).…”

Section: Discussionmentioning

confidence: 99%

“…(4,6,7,10) Our hospital caters to a mainly rural and resource-limited population in North Borneo, Malaysia. (14) The study by Goh et al (9) from University Malaya Medical Centre, Kuala Lumpur, …”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and mortality risk prediction in critically ill children in Malaysian Borneo

Ganesan

Thomas²,

Ng³

et al. 2014

smedj

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METHODSWe prospectively collected demographic and clinical data on paediatric medical patients admitted to the PICU of Sabah Women's and Children's Hospital in Kota Kinabalu, Sabah, Malaysia. The PIM2 risk score for mortality was tabulated. RESULTSOf the 131 patients who met the inclusion criteria, data was available for 115 patients. The mean age of the patients was 2.6 ± 3.8 years, with 79% of the cohort aged less than five years. Patients were mainly of Kadazan (38%) and Bajau (30%) descent, and 26% of patients were non-citizens. Leading diagnoses on admission were respiratory (37%), neurological (18%) and infectious (17%) disorders. Out of the 29 patients who died, 23 (79%) were Malaysians and the main mortality diagnostic categories were respiratory disorder (22%), septicaemia (22%), haemato-oncological disease (17%) and neurological disorder (13%). Calculated standardised mortality ratios (SMRs) were not significantly > 1 for any patient category for variables such as age and admission diagnosis. However, infants less than two years old with comorbidities were significantly worse (SMR 2.61, 95% confidence interval 1.02-6.66). CONCLUSIONThe patient profile at our centre was similar to that reported from other PICUs in Asia. The PIM2 score is a useful mortality risk prediction model for our population.

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Pediatric Critical Care: A Global View

Argent

Kissoon

2014

Pediatric Critical Care Medicine

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Outcome of children with different accessibility to tertiary pediatric intensive care in a developing country – a prospective cohort study

Cited by 18 publications

References 21 publications

A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa

A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa

Clinical characteristics and mortality risk prediction in critically ill children in Malaysian Borneo

Pediatric Critical Care: A Global View

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