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Identifier 000454740
Title Επιδημιολογικά δεδομένα και διαχρονικές τάσεις νοσηλευόμενων παιδιών σε Πανεπιστημιακή ΜΕΘ : 9-ετής εμπειρία
Alternative Title Epidemiology and trends of children admitted to an Academic Pediatric intensive care unit
Author Δημοπούλου, Βάγια
Thesis advisor Ηλία, Σταυρούλα
Reviewer Μριασούλης, Γεώργιος
Ραϊσάκη, Μαρία
Abstract Background: Pediatric critical care has evolved over the past 3 decades, mainly with the evolution of technology and subspecialties. The doctors who staff a Pediatric Intensive Care Unit (PICU) are experienced specialized intensivists in children and the nursing staff working in a PICU has expertise and special knowledge on the subject. The provision of care in all PICUs, versatile general or specialized, aim at the best and most efficient treatment of seriously ill pediatric patients and at dealing with critical situations, which often appear unexpectedly. Objective. : The purpose of this study is to collect the epidemiological data of pediatric patients who were hospitalized in a University Children's ICU, to study the longitudinal trends and to correlate them with outcome indicators. Methods. The study was conducted in the PICU of the University General Hospital of Heraklion. Data were collected retrospectively from electronic health records of patients hospitalized between May 2014 and December 2022. Demographics, clinical information, therapeutic interventions, in-hospital complications, length of hospital stay, final diagnosis and patient outcome indicators were recorded. Results: For the studied period of time, 1332 patients were hospitalized in the PAGNI Children's ICU, while complete data were found for 1250 patients. Median age was 5.7 years (IQR 1.6;11.75), boys were 769 (61.5%), PIM-III clinical severity index was -2.5 (-4.2; -0.8), comorbidity was 543 (43.4%), while hospitalized 14 cases of Covid-19. 957 (76.6%) patients were pathological cases, while 293 (23.4%) were surgical, with 128/293 (43.7%) being trauma or accident. Planned admissions were 408 (32.6%) [307/408 (75.2%) pathological cases, 101/308 (24.8%) surgical cases]; medical versus surgical patients differed in terms of reason for admission, age and length of stay (p<0.001). Emergency admissions were 842 (67.4%) [650/842 (77.2%) pathological cases, 192/842 (22.8%) surgical cases]. The average length of hospitalization did not significantly vary over time and ranged from 4.4 to 9.3 days. Disease severity varied over time (p<0.001), with patients who died having a greater severity of illness (p<0.001). Mechanical ventilation was applied to 398 (47.3%) patients, with a statistically significant difference over time (p=0.044). Emergency admissions differed significantly from planned admissions in terms of reason for admission, clinical severity, GCS, use of catheters, administration of antibiotics, ICU and hospital length of stay, and mortality (all p<0.001), but not for age, BMI and gender. Crude mortality was estimated at 5.7% (N=48/842) and remained stable over time with a range of 2.5%–6.9%. It was significantly related to comorbidity and the presence of cerebral edema (all, p<0.001). Independent factors associated with mortality were clinical severity, shock and low GCS at admission (p<0.001). Disease severity, comorbidity, respiratory failure, and low GCS were good predictors of mortality (all p<0.001). Of the surviving patients, 421 (50%) had a very good outcome and recovery, 315 (37.4%) were discharged from the NICU receiving some chronic treatment, such as chronic drug therapy (N=160), feeding through indwelling catheters (N= 88), oxygen therapy (N=145), ventilator support (N=25 via tracheostomy, N=6 with non-invasive mechanical ventilation). Conclusion: The present study is the first description of longitudinal trends and 9-year epidemiological data of pediatric patients admitted to the PICU in Greece. The planned admissions constitute a sufficient number of patients, which justifies the development of a specific infrastructure and the exclusive employment of specialized nursing and medical staff. The significant majority of patients admitted to the ICU were on an emergency basis. Over time, the average length of hospital stay and mortality remained stable. Mortality was related to clinical severity, shock, impaired level of consciousness and underlying complex co- morbidity. Surviving patients had high rates of morbidity and this signals the need for the development of ongoing follow up facilities with early recognition and holistic treatment of physical and psychosocial problems.
Language Greek
Subject PICU
ΜΕΘ παίδων
Issue date 2023-04-05
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
Permanent Link https://elocus.lib.uoc.gr//dlib/b/0/3/metadata-dlib-1682405473-492319-22234.tkl Bookmark and Share
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