• M Earle, O Martinez Natera, A Zaslavsky, E Quinones, H Carrillo, E Garcia Gonzalez, A Torres, M P Marquez, J Garcia-Montes, I Zavala, R Garcia-Davila, and I D Todres.
• Division of Pediatric Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
• Crit. Care Med. 1997 Sep 1;25(9):1462-7.

ObjectiveTo improve understanding of the causes of morbidity and mortality among critically ill children in the countries studied.DesignSurvey of hospital records between 1992 and 1994.SettingSix pediatric intensive care units (ICUs) (four ICUs in Mexico City and two ICUs in Ecuador).PatientsConsecutive patients (n = 1,061) admitted to the units studied.InterventionsNone.Measurements And Main ResultsThe mortality rate for low-risk patients (pediatric Risk of Mortality [PRISM] score of < or = 10, n = 701) was more than four times the rate predicted by the PRISM score (8.1% vs. 1.8%, p < .001), with an additional 11.3% of this group incurring major morbidity. The mortality rate for moderate-risk patients (PRISM scores of 11 to 20, n = 232) was more than twice predicted (28% vs. 12%, p < .001). For low-risk patients, death was significantly associated with tracheal intubation, central venous cannulation, pneumonia, age of < 2 months, use of more than two antibiotics, and nonsurgical diagnosis (after controlling for PRISM score). Central venous cannulation and tracheal intubation in the lower-risk groups were performed more commonly in units in Mexico than in one comparison unit in the United States (p < .001).ConclusionsFor six pediatric ICUs in Mexico and Ecuador, mortality was significantly higher than predicted among lower-risk patients. Tracheal intubation, central catheters, pneumonia, sepsis, and nonsurgical status were associated with poor outcome for low-risk groups. We speculate that reducing the use of invasive central catheters and endotracheal intubation for lower-risk patients, coupled with improved infection control, could lower mortality rates in the population studied.

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