Epidemiology of paediatric intensive care unit admissions, deaths and organ donation candidacy: A single-centre audit.
10.47102/annals-acadmedsg.2024247
- Author:
John Zhong Heng LOW
1
;
Joel Kian Boon LIM
1
;
Herng Lee TAN
2
;
Rudimar Martinez FERNANDEZ
2
;
Samsudin Bin NORDIN
3
;
Yee Hui MOK
1
;
Judith Ju-Ming WONG
1
Author Information
1. Duke-NUS Medical School, Singapore.
2. Respiratory Therapy Service, Division of Allied Health Specialties, KK Women's and Children's Hospital, Singapore.
3. National Organ Transplant Unit, Ministry of Health, Singapore.
- Publication Type:Journal Article
- Keywords:
PICU;
children;
mortality;
organ donation;
organ transplant;
paediatric intensive care units;
paediatrics
- MeSH:
Humans;
Male;
Female;
Tissue and Organ Procurement/statistics & numerical data*;
Intensive Care Units, Pediatric/statistics & numerical data*;
Child, Preschool;
Child;
Infant;
Singapore/epidemiology*;
Risk Factors;
Patient Admission/statistics & numerical data*;
Hospital Mortality;
Adolescent;
Medical Audit;
Comorbidity;
Clinical Audit
- From:Annals of the Academy of Medicine, Singapore
2024;54(1):17-26
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:There are limited reports on the epidemiology of paediatric intensive care unit (PICU) admissions, deaths and organ donation candidacy. We aimed to describe PICU admission characteristics and outcomes, determine risk factors for mortality, and perform an independent assessment of missed organ donation opportunities.
METHOD:We adopted a clinical audit design recruiting consecutive patients admitted to a single-centre multidisciplinary PICU from June 2020 to December 2023. Clinical characteristics and outcomes of survivors and non-survivors were described. Multivariable regression was performed to identify independent risk factors for mortality. Organ donation candidacy was evaluated by an independent team based on the criteria by Singapore's National Organ Transplant Unit.
RESULTS:There were 1766 PICU admissions with mean age ± standard deviation of 5.9 ± 6.0 years. Surgical admissions accounted for 707/1766 (40%), while the most common medical admission category was respiratory (416/1766; 23.6%). The majority of 983/1766 (55.7%) had a chronic comorbidity and 312/1766 (17.6%) were dependent on at least 1 medical technology device. Mortality occurred in 99/1766 (5.6%). After adjusting for elective admissions and admission category; comorbidity with adjusted odds ratio (aOR) 95% confidence interval (CI) 3.03 (1.54-5.96); higher Pediatric Index of Mortality 3 (PIM 3) score with aOR 1.06 (95% CI 1.04-1.08); and functional status scale with aOR 1.07 (95% CI 1.00-1.13) were associated with mortality. Among non-survivors, organ donor candidacy was 21/99 (21.2%) but successful organ donation occurred in only 2/99 (2.0%).
CONCLUSION:In this single-centre audit, comorbidities, PIM 3 score and functional impairment were associated with mortality. Efforts are needed to improve paediatric organ donation rates.
