Critical illness related to community acquired pneumonia, its epidemiology and outcomes in a pediatric intensive care unit of Pakistan

Background To determine the epidemiology and outcomes in critically ill children admitted with severe community acquired pneumonia (CAP) and to identify risk factors associated with mortality in a pediatric intensive care unit (PICU) Methods Retrospective review of medical records of all children (age 1 month to 18 years) admitted to PICU with CAP from January 2013 to March 2018 was done. Patients admitted in last 2 weeks before current illness and those with bronchiolitis (based on clinical diagnosis) were excluded. Data were collected on a structured proforma and included demographic, clinical data, comorbidities, therapeutic information, laboratory data, and outcome data. Results were presented as mean with SD and frequency with percentages. Factors associated with mortality were analyzed, using logistic regression for both univariate and multivariate analyses. Results A total of 187 children with severe CAP were identified, 53.5% (n = 100) were <1 year of age and 65.2% (n = 122) were male, 32.6% (n = 61) were underweight, and 24.6% (n = 46) were stunted. A total of 94% (175) required mechanical ventilation. Mortality among the cohort was 20.3% (n = 38) with median length of mechanical ventilation 4 (2-8) days, and median length of PICU stay was 6 (4-12) days. PRISM score >10 on admission, presence of systemic illness, empyema, and length of PICU stay 14 (+/- 2) days were associated with increased mortality among critically ill children admitted with CAP (p < .05). Conclusions Severe illness on presentation, presence of systemic illness and empyema are associated with increased mortality in children admitted to the PICU with severe CAP.

Automated summary

This study retrospectively analyzed the epidemiology and outcomes of 187 critically ill children with severe CAP admitted to the PICU in recent years. The results showed that severe illness on presentation, presence of systemic illness, and empyema were associated with increased mortality among children admitted to the PICU with severe CAP.