• E Clarence and P M Jeena.
• Department of Paediatrics, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa. eclarence@gmail.com.
• S. Afr. Med. J. 2022 Nov 1; 112 (11): 871878871-878.

BackgroundPaediatric intensive care, a valuable resource that improves the outcomes of critically ill children, is often scarce.ObjectiveTo evaluate the need for paediatric intensive care beds and compare the outcomes of admitted and non-admitted deserving cases.MethodsA prospective evaluation of all bed requests, in terms of need for intensive care and outcomes of those admitted and not admitted to a paediatric intensive care unit (PICU), was performed between July 2017 and June 2018. Factors for refusal and for poor outcomes were evaluated.ResultsOf the 811 bed requests, 32.6% (n=264, p<0.001) were denied access. Of the 231 deserving cases who were denied access, 85.7% (n=198) were due to unavailability of a PICU bed. Patients not admitted to PICU had a twofold increased risk of dying compared with those admitted (34.4% v. 15.5% respectively, p<0.001), even though the patient characteristics of both groups were similar (age, gender and nutritional status). In those admitted, risk factors for mortality were requiring transfusion of blood and platelets (56.0%, p<0.001), requiring two or more inotropes (52.5%, p<0.001), instability on admission (41.3%, p<0.001), prior cardiac arrest (32.0%, p=0.021), severe acute malnutrition (26.9%, p=0.043), fungal infection (22.2%, p=0.004) and emergency admission (18.0%, p<0.001). In those not admitted, prior cardiac arrest (100%, p<0.001) and emergency referral (42.3%, p<0.001) were associated with adverse outcomes.ConclusionThe need for PICU beds exceeds availability, with a consequent twofold increase in mortality among cases not admitted to PICU. Paediatric critical care services have increased at appropriate sites of need following completion of this study.

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