Admission patterns and outcomes in a paediatric intensive care unit in South Africa over a 25-year period (1971-1995).

OBJECTIVE: To describe admission and outcome patterns of diseases managed at a paediatric intensive care unit (PICU) in a developing country between 1971 and 1995, in order to provide data which will assist in improving the management of diseases and the rational allocation of health resources.

METHOD: This study is based on data collated from annual audits conducted by the head of the PICU, King Edward VIII Hospital, Durban, South Africa. This unit serves a childhood population of about 3-4 million aged from 0-12 years.

RESULTS: The proportion of children admitted to the ICU as a percentage of the general paediatric admission has increased from 1.5% in 1971 to 7% in 1995. During this period, 7580 children were admitted to the unit, an average of 303 cases per annum. The overall mortality rate was 35.44% (range 29.9 to 45.4%); over 90% of the children admitted were intubated and 80% required intermittent positive pressure ventilation. Common childhood vaccine preventable infections have declined substantially and have been replaced by HIV related syndromes, lower respiratory tract infections, metabolic disorders, septicaemia and hyaline membrane disease. The mean duration of ICU stay per survivor over the study period 1991-1995 was 13.891 days. Tetanus, septicaemia and HIV related diseases required the longest ICU stay per survivor (>20 days), while accidental injuries, neonatal apnoea and asthma required the shortest duration of ICU stay per survivor (<6 days); 23.9% of all deaths occurred in the first 24 h.

CONCLUSION: The profile of diseases in children admitted to this PICU has changed considerably over 25 years. Some of these changes can be attributed to the shift in emphasis to primary health care, especially higher vaccination coverage rates. Profitable utilisation of limited ICU facilities would probably be enhanced by the use of outcome measures such as mortality and mean number of ICU days of stay per survivor.