Mnh Set
Reasons for admission and results in less than five years in Bugando Hospital Pediatric ICU over a year (July 2006-June 2007)
ABSTRACT
Intensive care unit or ICU, is a specialized section for a hospital that offers a comprehensive and continuous care for people who are severely ill and may benefit from treatment. The aim of this research was to determine the reason for admission and results between underfives in Pediatric Intensive Care Bugando Medical Center in July 2006 to June 2007. BMC intensive care is provided in two units, ICU and AICU. Design of the study, retrospective study of cross section.
Methodology: Data on age, ethnicity refferal, admission time, diagnosis and length of stay and the results were obtained in July 2006 to June 2007 and analyzed using Epi Info program developed by the CDC, a 2005 version. RESULTS: Of 471 patients were admitted to the ICU and 249 patients in July 2006 AICU June 2007. NICU patients: 56.6% were male and 43.4% were women. Mortality is high among women (59.3%). The overall mortality among newborns admitted to the NICU for one year from 58.1%. preterm delivery and asphyxia at birth have were the most frequent causes of admission to the ICU, 36.7% and 25.1% respectively. Others referred to heart disease congenital aspiration pneumonia, hypothermia, anemia etc70.2% and 72.4% of patients admitted because of prematurity and sepsis, respectively, died in the average length of stay was 4.73 NICU.The hours. AICU patients, 52.6% were male while 47.4% who were women. Most patients need are role models for care services intensive, while both sources admitted Reference Most patients have survived. Overall mortality was 45.4% AICU and mortality was higher in patients male sex (46.6%) compared with male patients (44.1%). Most patients were admitted during the afternoon (32.5%), while that the mortality was higher among patients admitted during the night (60.3%). malaria and pneumonia were the leading cause of admission to AICU, 27.7% and 24.1% respectively. Other causes include head injuries, congenital heart disease after surgery, sepsis, meningitis, malnutrition, diarrheal diseases, burns, poisoning, tuberculosis and pleural effusion etc94.1% of all patients admitted died of malnutrition in the length of stay APCU.The half for all patients was 60 hours.
CONCLUSION: Although the intensive care unit was established to reduce mortality among children underfives particular, the mortality rate of ICU admitted underfives BMC remains high (58.1%), but mortality is low underfives AICU (45.4%) compared with the NICU.
Introduction and literature review
Intensive care unit or unit of care intensive, is a section of a hospital that provides comprehensive and continuous care of people who are seriously ill and may benefit from treatment. It's a hospital for care of critically ill patients to a more intense level than required by other patients. Encouraged by qualified personnel, intensive care unit contains a complex range of monitors and support equipment that can sustain life in situations of after death, including respiratory distress syndrome in adults, renal failure, failure and multiorgan sepsis. The aim of the Intensive Care Unit (ICU) is simple, although the practice is complex. Health professionals working in the ICU or rotate during their training to provide any work time control and treatment of patients seven days a week. Patients are usually admitted to intensive care is likely benefiting from the level of care. ICU has been shown to benefit patients who are critically ill and medically unstable to say they have a disorder.Although threatening illness or criteria for admission to an intensive care unit is somewhat controversial, with the exception of patients who are too or too ill to receive intensive care, there are four priorities recommended that intensivists (specialists in critical care medicine) in the matter.
In general resuscitation care requires a multidisciplinary team including but not limited to intensivists (doctors who specialize in the care of a disease severe), pharmacists and medical consultants, nurses, respiratory therapists and other care of a wide range of specialties, including surgery, pediatrics and anesthesia. The ideal in the ICU with a team that represents not less than 31 different health professionals and practitioners involved in patient assessment and treatment. Intensivists administer the treatment, diagnosis, intervention and individualized attention for each patient who is recovering from a serious illness.
When patients are transferred to the intensive care unit of another hospital, prescription and treatment planning must be reviewed and new treatment plans for the state written current patient. For example, the patient is a chronic disease may worsen significantly within a few hours and can be transferred to intensive care, where staff must reevaluate orders for care.
A broad and comprehensive study, conducted in 1992 by the Intensive Care Society, in collaboration with the American Association Hospital found that 8% of licensed hospital beds in the United States have been designated for intensive care. Small hospitals with fewer than 100 general beds an intensive care unit, while large hospitals, with over 300 beds in general wards were several designated patients for intensive medical, surgical and coronary. Small hospitals often do not have a specialist full-time Certificate of intensive care medicine, while major medical centers usually employ certified intensivists.
G Arias, J Taylor and Marcin conducted a study to determine whether an association between the time admission (weekday compared with weekend and day and night) and the risk of death exists among pediatric patients included in a cohort of children admitted to a national sample of Picus in USA.They found that pediatric patients admitted to the PICU during the night were more likely to die than those who are not allowed during the day. There was no association between mortality and the day of admission (admission cons of weekend admission Monday through Friday). Here we can see that the greatest risk of death exist for some pediatric patients admitted to the PICU during evening hours.
A retrospective study Cooper S, Lyall H, Walters S et al evaluate the outcomes of children living with HIV admitted and treated in the pediatric intensive care unit of the United Kingdom found that, Sixteen (38%) children died in the ICU and 26 (62%) survived their last entry intensive. Among these, 5 died at a later date (between 1 and 32 months after leaving the PICU) and 21 survived when the statement. The most common reason for ICU admission was respiratory failure, either due to Pneumocystis carinii (45% of revenue) or other respiratory pathogens (32%). Over 80% of survivors who have good results in terms of growth and development; 6 children showed signs of spastic diplegia.There is significant mortality in children with HIV infection admitted to PICU, although many of them survive their admission, and over 80% of survivors have good results with high availability currently active ART.
Another study by Jeena PM, Wesley AG, Coovadia HM describe admission and results of disease models managed by a pediatric intensive care unit (PICU) in a developing country. Overall mortality rate was 35.44%, more 90% of children admitted were intubated and 80% required intermittent positive pressure ventilation. The average ICU stay for survivors during the period study was 13.891 days. Tetanus, septicemia and HIV-related diseases, is the longest survivor in the revival, while the accident occurred, infant apnea and asthma needed more short duration of ICU stay for survivors, 23.9% of deaths in the first 24 hours
A study Prospective Cohort Results of children's access to different tertiary pediatric intensive care in a developing country was conducted by Goh AY, Abdel-Latif Mel-A, MN Lum LC and Abu Bakar. In this study, we can say that the result of severely ill children transferred from community hospitals do not differ from that of those who develop ICU needs in the wards of a tertiary center of attention, despite being carried by non-dedicated equipment. Outcome was not affected by the lack of initial access to care intensive if the children finally received care at a tertiary level of care.
THE PROBLEM AND REASON
Patients who are admitted to the unit Seriously ill pediatric intensive care if they are not taken seriously by death can occur at any time but the team of pediatric intensive care use their skills to the utmost to reduce mortality in pediatric intensive care Underfive, but the role Results intensive care pediatric units of a BMC Pediatrics has not been well documented in comparison with other countries and therefore this study was necessary to study the real situation in our system ..
Studies have shown that pediatric patients admitted to pediatric intensive care during the night were more likely to die than those admitted only during the day. Here we can see that the greatest risk of death is there for some pediatric patients admitted to the PICU overnight (Arias G et al.) It is necessary to determine whether this observation results differences in the structure of care, process of care, or both. This study tried to associate the relationship between time of admission and BMC results in circles.
Children admitted to pediatric intensive care can be admitted directly from the community and / or perhaps those who develop requirements while neighborhoods. However, the results between the two groups has not been well established. Studies are needed to generate data the results of these two groups.
OBJECTIVES
Go large
The aim of this study was to determine the reasons for admission and results Underfives Pediatric ICU Bugando Medical Center between July 2006 June 2007.
The specific objectives were:
- To determine the modes of entry into the PICU, including age, sex, diagnosis, time income and source of reference.
- To describe patterns of disease outcomes managed APCU
- To determine the number and causes of mortality and morbidity in pediatric intensive care underfives
- To determine the length of stay from admission to discharge or death.
METHODOLOGY
Study design
A retrospective cross-sectional
The study area
The study was conducted in the intensive care unit BMC.BMC AICU is located in the city of Mwanza and serves as a reference hospital Mara, Kagera and Shinyanga and the region Mwanza. Mwanza is located south of Lake Victoria, on the southern border in Shinyanga, Mara Region in the east and Kagera in the northwest. Most people are Sukuma Mwanza, Kerewan, Zinzi and other tribes are the result of economic activities are fishing (Main), mines, small businesses, etc.
Neonatal ICU is in the building and get patients in the H2 unit preterm delivery room and the peripheral hospitals. The staff doctor (1), Resident Doctor (1) trainee (1) Nurses (10) and assists (3). It has 5 beds and 2 extra beds (KMC bedÿÿ, infusion pumps, 3, 6 Boxes drip, 1 machine light therapy, heated 5, 1 air conditioner, 2 tables, cabinets, 5 1 rocker, 1 fan, 6 monitors, electrocardiograph 1 and 2 cars.
Adult ICU is also built in H2 and get both adults and children, except children who received care in the NICU. AICU personnel are doctors (3), nurses (2), nurses (16) and staff (3). It has a large office and laboratory rooms, 12 beds, 9 represents drip, 2 ECG machines, 1 stabilizer, 1 starilizer, 1 autoclave, 1 microscope, 1 centrifugal 1 defibrillator, 3 pumps, 15 controllers, 5 fans, 1 echo machine, 1 suction machine, oxygen concentrator 1 and the other life support equipment.
Sample size
The sample size was recognized in all the NICU and two AICU underfives as documented in the records of 2,007,471 in July 2006 newborns were June admitted to intensive nursing unit and the patients were admitted AICU.
Data Collection
Table of Documents All patients under 5 years from July 2006 to June 2007 were collected and analyzed retrospectively. Information on sex, age, duration of stay, admission diagnosis and discharge or the result of death were recorded.
Ethical
The permission to perform this study was asked to MUCHS, BMC Authority and the respective section heads.
Study Limitations
- The result of the patient was transferred to the room can not be determined. Most patients may die shortly after leaving the PICU and by studying these parameters were not included in my study, which may have an effect on sample size.
- Due to the age limit of a large number of patients over five years who were admitted AICU have been omitted in my study, this may affect the size of the sample.
- Errors and / or incomplete entry in the records particularly in the NICU have affected my study, some of the objectives were not achieved due to incomplete data, as shown in the records.
Data Analysis
The data were analyzed by a version of the CDC's Epi Info and presented a table where the associations were tested mathematically.
RESULTS
1: NICU Department
Note: The total number of patients admitted to ICU during the past year is 471, however for data analysis "Total" columns and / or lines may change due to the lack of an entry or exposure and outcome variables than those found in the records NICU.
table of results can not appear
Most newborns in the intensive care unit were male. significant in the NICU deaths occurred in women and death in the intensive care unit was 58.8% overall.
Most children who developed need, while the neighborhoods and entering from home and the peripheral hospital, died in APCU. The progress of patients transferred to paeditric General Ward was not known.
Prematurity, birth asphyxia, hypothermia, sepsis and anomalies Most congenital causes of admission to the NICU. Others include malaria, resuscitation, observation, hypoglycemia, HIV = 4, low score, etc etc
Most patients remained in intensive care unit at 10 hours.
The total duration of stay for all patients during one year was 1816.32 hours. The average length of stay of each patient, regardless of the outcome (death, release or transfer to the general pediatric ward 4.73 hours.
2: AICU DEPARTMENT
Table 1, children under five years AICU admitted in July 2006-June 2007 Review of Age and sex
Most patients were aged less than 12 months. Rights are 52.6% while women was 47.4%
Most patients were admitted during the afternoon. Most patients admitted during the night dies APCU (60.3%).
Malaria and pneumonia are the most frequent causes of admission AICU.
Others understand epilepsy, tumors, bleeding disorders, Council on Foreign Relations etc.
Most patients admitted because of malnutrition is dead in AICU.
Most patients AICU remained within 24 hours.
The total time of all patients for one year is 14,941 hours.
The average length of stay of each patient, regardless of the outcome (death, discharge or transfer of general pediatrics Ward was 60 hours.
Discussion
In this study, whose data were collected retrospectively underfives income records in the intensive care unit and resuscitation for adults, infants 471 and 249 infants were admitted to NICU and AICU underfives respectively in the past one year. We find that the ICU admission was more than twice AICU However, the system record in the intensive care unit is low because there are many incomplete data, while the AICU registration system is adequate. Intensive care unit, approximately 56.6% of newborns were male and 43.4% were women. The majority (89%) were younger than 7 days. The overall mortality rate of newborns admitted to the NICU One year from 58.1%, mortality was higher among women (59.3%) is not consistent with a study by the ten Berge Jetske and circumstances of morbidity and mortality in the pediatric intensive care unit where only 87 (4.4%) of patients admitted in 1995 died. Mortality is very high compared to The same study commissioned by NMS Isangula K in which 54.1% of patients admitted died in APCU. The high percentage of deaths observed in NICUs may be due to delays services and support to life / work or their life savings inappropriate and / or shortages of doctors and nurses in the NICU.
In AICU, 52.6% were men, while that 47.4% were women. Overall mortality was 45.4% AICU, although this result is not consistent with a study of ten Berge et al Jetske the circumstances of morbidity and mortality in the pediatric intensive care unit in which only 87 (4.4%) of patients admitted in 1995 died. Mortality is low compared to the same study by SMN Isangula K in which 54.1% of patients admitted died in APCU.The can be brought to the team and the organization of services in relation AICU BMC with SMN.
In the ICU, most patients were not necessary for intensive services, particularly in the delivery room this observation Ward is the same for patients hospitalized in AICU and the two units of the majority of patients have survived regardless of the source of reference.
Overall AICU and Mortality was higher in men (46.6%) compared with male patients (44.1%). Most patients were admitted in the afternoon (32.5%) while mortality was higher among patients admitted during the night (60.3%). This result according to the same study commissioned by NMS Isangula K, which were Supported in most patients during the afternoon and most of the patients admitted during the night in mid APCU died. The results also are consistent with another study by Arias G, G Taylor and Marchin to determine whether an association between admission and the risk of death in pediatric patients are included in a cohort of children admitted to a national sample of Picus in USA.They found that patients admitted to the PICU during the night were more likely to die than those who are not allowed during the day. However, their study found no association between mortality rates and the day of admission. Here we can see that they have observed an increased risk of death in some pediatric patients admitted to the PICU during evening hours. Although in my study, I did not create the association between admission and the admission from Monday to Friday, weekends and results for children, but found that most patients were admitted during AICU after Food and most of the patients admitted at night (60.3%) died, which can be attributed to the fact that during this time, the attending physician not readily available. This study shows the time of admission have an effect on patient outcomes. However, further studies are needed to establish the true relationship between the time of admission and results.
Prematurity and birth asphyxia were the commonest causes of admission to the ICU 36.7% and 25.1% respectively. Others involved in congenital heart disease, aspiration pneumonia, hypothermia, anemia, etc, but 70.2% and 72.4% of patients hospitalized for prematurity and sepsis, respectively, died in the intensive care unit. The average length of ICU stay was 4.73 hours. In AICU, malaria and pneumonia were the predominant causes of admission AICU, 27.7% and 24.1% respectively. Other causes include head injuries, heart disease congenital, after surgery, sepsis, meningitis, malnutrition, diarrheal diseases, burns, poisoning, tuberculosis / pleural effusion etc. About 94.1% of all patients admitted because of malnutrition APCU died. The average length of stay in AICU was 60 hours, equivalent to 2.5 days. The study Jeena PM, Wesley AG, Coovadia HM admission and to describe trends of the results of disease management in a pediatric intensive care unit (care PICU) in a developing country. The overall mortality rate was 35.44% The average length of stay in the ICU for survivors in the study period was 13.891 days. Tetanus, septicemia, and AIDS-related illnesses need to stay longer in the ICU to survive, while the accident occurred, apnea of newborn born and asthma requires the least time spent in intensive care each survivor. In the same study of mortality is 54.1% MTF APCU all. The average length of stay of each patient, regardless of the outcome (death, discharge or transfer to the general pediatric unit was 114.5 hours, equivalent to 4.8 days. Severo, pneumonia, sepsis and meningitis are the most causes of admission to APCU MNH.Other involved causes PCP, oral candidiasis, intoxication, liver failure, congenital anomalies multiple, malaria etc, the short duration of stay of BMC may be due to disease patterns and service organization, and BMC patients receiving areas lake area, while MTF receives patients from all corners of Tanzania and in most cases "complicated patients.
Conclusions and recommendations
This study shows differences with studies in other contexts. This may be due to geographical, social, cultural and economic differences in these parameters were the studies conducted. However, the UCI has been created to reduce mortality among children underfives particular mortality rate among those admitted to the intensive care unit AICU underfives remain high (58.1%) and BMC 45.1%, respectively. That there is a general need to improve life-saving health and care in the NICU AICU in terms of equipment and regular updating of knowledge of doctors and nurses in the treatment of children who need emergency care. However, patient care and the system of records in the intensive care unit should be considered to reduce mortality and improve record keeping in this department. Further studies are needed to produce knowledge about how patients special care underfives BMC can provide maximum.
References.
- GM Althabe Cardigni, Vassallo JC, Allende D, Berrueta M, M Codermatz, J Córdoba, S Castilian, Jabornisky R, Y Marrone, Orsi MC, Rodriguez G, Varon J, Schnitzler E, H Tamusch, Torres JM, L. Vega die in the intensive care unit: collaborative multicenter study about to give up a life-sustaining treatment in intensive care units Argentina children. Pediatr Crit Care Med 2003, 4:164-9.
- Arias Y, Taylor DS, Marcin JP: Association between evening income and higher rates of mortality in the pediatric intensive care unit.Pediatrics 2004, 113: E530-4.
- Van der Wal ME, LN Renfurm, Van Vught AJ, RJ Gemke: Circumstances of death in the hospital children.Eur J Pediatr 1999, 158:560-5.
- Cooper S, Lyall H, Walters S, G Tudor-Williams, P Habibi of Munter C, Britto J, Nadel S: Children with immune deficiency syndrome virus admitted to a pediatric intensive care in the United Kingdom 10-year period.Eur 1999,168:504-9 J Pediatr.
- Jeena PM Wesley AG, Coovadia HM: admission patterns and outcomes in the pediatric intensive care unit in South Africa during a period of 25 years (1971-1995): PMID: 10051O84.
- Isangula K: reasons for admission and in outcomes between Underfives APCU of Muhimbili National Hospital, April-June 2007. (Unpublished)
- Goh AY, Abdel-A-Latifmel, Lum LC, Abu Bakar, MN: Outcome of children with access to different tertiary pediatric unit of intensive care in a developing country, a prospective cohort study of pediatric 2004:235-8
About the Author
Dr.Kahabi Isangula
Zonal HIV/AIDS and Malaria Coordinator
WORLD VISION TANZANIA
