Incidence of new morbidity in children on discharge from pediatric intensive care unit of a developing country.

Abstract

Objective: To determine the incidence of newly acquired morbidity, its categorization, and to identify the associated risk factors among children upon being discharged from the PICU. Study Design: Prospective Longitudinal Cohort study. Setting: Multidisciplinary PICU of Aga Khan University Hospital. Period: October 2022 to March 2023. Material & Methods: Patients who were readmitted to the PICU, deceased, or lost to follow-up during the study were excluded. The functional status was assessed using FSS at baseline, PICU discharge, and at 3 months to measure newly acquired morbidity and dysfunction. All data was collected on a structured proforma. Categorical variables were presented as absolute values and percentages, and continuous variables were expressed as means ± SD or medians with interquartile range or proportions as applicable and considered statistically significant level if p value is ≤ 0.05. Results: A total 96 patients were discharged alive from PICU and 85 of them were included in this study. The mean age was 5.27 ± 5.01 years. The major diagnostic categories were acute respiratory illnesses (25.89%), cardiovascular disorders (21.18%), and neurological disorders (16.47%). 43.53% of the patients underwent surgical intervention. The mean PRISM score at admission was 4.32 ± 5.84. The incidence of morbidity was 40% (34/85) at PICU discharge and 5.8% at 3 months. Longer duration of vasoactive medications, arterial catheterization, mechanical ventilation and PICU stay were associated with new morbidity in critically ill children on discharge from PICU. Conclusion: At PICU discharge, the incidence of new morbidity among critically ill pediatric patients was 40%, which reduced to 5.8% at 3 months. Patients with hemodynamic instability, longer duration of inotropic support and those on prolonged mechanical ventilation had longer PICU stay and exhibited increased risk for new morbidity development. The majority of patients (>82%) exhibited either good functional status or mild dysfunction upon discharge.