Paediatric critical care needs assessment in a tertiary facility in a developing country

Abstract

Introduction and Aim: There is a great burden of critically ill children in developing countries where paediatric critical care is still in its early stages. The actual burden of critically ill children is necessary for healthcare planning however, in Nigeria the magnitude is unknown. In order to provide the basic paediatric intensive care services which will likely reduce mortality and improve patient outcomes, the specific burden and need for various aspects of paediatric critical care services must be quantified. This study set out to determine the volume, specific critical care needs and outcomes of critically ill paediatric emergencies in the UCH.

Methods: It was a prospective study of all consecutive patients admitted into the children’s emergency ward over a three-month period. Data on clinical state on admission and the need or otherwise for critical care using the paediatric assessment triangle (PAT) were documented.

Results: There were 391 admissions during the study period, of which 130 were critically ill. They had one or more of the following; respiratory distress 93(28.3%), respiratory failure 35 (19.0%), shock 65(50%), central nervous system/metabolic derangements 64 (49.2%). Eighty-nine (68.5%) of the critically ill were under-5s. The diagnoses commonly associated with critical illness were malaria, 59 (45.4%), septicaemia, 18, (13.8%) and meningitis 17 (13. 1%). Four of the critically ill children (2.8%) were admitted into the general ICU and 33 (25.4%) died within 48hours of presentation.

Conclusion: There is a huge burden of critical care needs among children presenting to the children’s emergency ward, which remains largely unmet. There is an urgent need to address paediatric critical care services in order to improve child survival.