Outcome of children admitted to a general highcare unit in a regional hospital in the Western Cape, South Africa

Abstract

Background. Critically ill children are often managed in non-tertiary general intensive care units admitting both adults and children, but few data are currently available regarding paediatric outcomes in these general units.

Objective. To determine the outcome of critically ill neonates and children admitted to a general high-care unit in a large regional hospital in the Western Cape, South Africa.

Methods. This was a retrospective descriptive analysis of outcome of all neonatal and paediatric (<13 years of age) patients admitted with non-surgical disease, during a 1-year period, to a general high-care unit at a large regional hospital in Worcester, South Africa. Data included demography, admission time, length of stay, diagnoses, HIV status, therapeutic interventions and outcome. The primary outcome was defined as successful discharge, transfer to a central hospital or death.

Results. There were 185 admissions, with the majority (83%) <12 months of age (median age 3.7 months; range 0 - 151 months) and a male:female ratio of 1.3:1. The majority (70%) were successfully discharged, while 24% were transferred to a tertiary paediatric intensive care unit (PICU) and only 6% died. Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (33%), birth asphyxia (16%) and complications of prematurity (16%). Nasal continuous positive airway pressure (p<0.001), ventilation (p<0.001) and HIV infection (p=0.010) were associated with transfer to a PICU in a central hospital or death.

Conclusion. The majority of children (70%) requiring admission to a general high-care unit in a regional hospital were successfully treated and discharged. These good outcomes were only achievable with a good transfer system and supportive tertiary healthcare system.