Adherence to standard admission and discharge criteria and its association with outcome of pediatric intensive care unit cases in Al-Ahrar Hospital Zagazig

Background: The effective use of pediatric intensive care unit (PICU) beds is an important issue as they are expensive and have limited resources. Adherence to well-defined admission and discharge criteria for PICU cases will be very helpful for better PICU bed utilization. Aim of the study: The aim of the present study is to evaluate of criteria of admission and discharge of all admitted and discharged patients to the PICU in Al-Ahrar Hospital, Zagazig, Egypt, in comparison to the standard criteria of admission and discharge of the American Academy of Pediatrics (AAP). Methods: This study included 125 children admitted to the PICU with different diagnoses during a six month period from July 2013 to December 2013. The recorded data of the recruited patients include demographic data, cause of referral, criteria of admission, physical examination, provisional diagnoses at admission, diagnostic studies, definite diagnoses, outcome and criteria of discharge. Pediatric index of mortality second version (PIM-2) was calculated from the collected information within one hour period from the time of admission to the PICU. Results: The admission of male children to PICU was slightly higher than females (51.2% versus 48.8%). Incompatible admission represented 18.4% of all admitted cases. Complicated gastroenteritis was the most frequent final diagnosis in our PICU (16.8%). This was followed by pneumonia (15.2%), traumatic brain injury (12%), status epilepticus (8.8%), sepsis (6.4%) and meningitis (4.8%). Overall mortality rate was 14.4% (18 out of 125). The highest mortality rate was in traumatic cases (33.3%), followed by multiple organ dysfunction syndrome (MODS) in sepsis cases (22.2%) and neurological cases (22.2%). Incompatible discharge represented 4.8% of all discharged cases. Average LOS and mean PIM-2 were significantly higher in non-survivors group than in survivors group (18.3 days and 34.1% versus 5.4 days and 2.1%, respectively). These two factors were also the only significant predictors of outcome. The optimal cutoff value of PIM-2 to predict mortality rate in the studied patients was >5% with high sensitivity and specificity (100% and 95.3%, respectively). Conclusion: PICU facilities at Al-Ahrar Hospital, Zagazig are insufficient to meet the demand. An admission score based on the PIM-2 score could assist in the selection of patients for these limited PICU facilities