An assessment of critically ill children admitted to a general high-care unit in a regional hospital in Western Cape, South Africa

Abstract

Background. Many critically ill children in South Africa (SA) are cared for by general paediatricians in regional hospitals. Limited data are available on the outcomes of these admissions.

Objective. To describe the profile and outcomes of children admitted to a general high-care unit (HCU) in a regional hospital in Western Cape, SA.

Methods. This was a retrospective descriptive study of all children admitted to the HCU of the George Regional Hospital during a 1-year period (2016). Demographic data, HIV status, anthropometric data, immunisation status, diagnoses, medical interventions, length of stay, outcome and referral data to the tertiary paediatric intensive care unit (PICU) were collected. The paediatric index of mortality 3 (PIM3) score and standardised mortality ratio (SMR) were calculated.

Results. Approximately a third (n=144/468) of admissions were children. Most (70%) were admitted after  hours. Half were younger than 9 months (range 3 days - 149 months). Respiratory and inotropic support were needed in 65% and 45% of the cases, respectively. A fifth of the children were transferred to the PICU. Twelve children (8.5%) died, with most deaths (n=9/12) occurring at regional level. The cumulative PIM3 score was 9.049 (95% confidence interval (CI) 6.430 - 11.668), with the associated SMR calculated as 1.326 (95% CI 1.028 - 1.866).

Conclusion. Critically ill children accounted for a third of HCU admissions, with most needing specialised medical intervention. Most children were successfully discharged, suggesting that a good outcome was possible owing to effective channels of communication and transport to a tertiary PICU.