Table 1. Demographics, acute referral timeline and clinical outcomes for the cohort of children.
| DEMOGRAPHICS | Medical (n = 239) | Trauma (n = 43) | Total (n = 282) |
|---|---|---|---|
| Gender: Male | 137(57.3%) | 27(62.8%) | 164(58.2%) |
| Age of Child Median (months) (IQR) | 4.8(2.2–20.2) | 63.5(23.5–63.5) | 7.8(2.5–33.6) |
| <1 month | 30(12 6%) | 0(0 0%) | 30(10 6%) |
| 1 month to 1 year | 132(55 2%) | 5(11 6%) | 137(48 6%) |
| 1 year to 5 years | 55(23 0%) | 16(37 2%) | 71(25 2%) |
| >5 years | 22(9 2%) | 22(51 2%) | 44(15 6%) |
| Distance from Health Facility | |||
| Nearest facility (km) Median(IQR) | 2 0(0 8–4 0) | 1 0(0 5–2 0) | 2 0(0 5–3 0) |
| Nearest 24 hour facility (km) Median(IQR) | 6 0(3 0–12 0) | 7 0(2 0–15 0) | 6 0(2 5–13 0) |
| Diagnosis | |||
| Traumaa | - | 43(100.0%) | 43(15.3%) |
| cardiacb | 30(12.6%) | - | 30(10.6%) |
| gastroenteritis | 13(5.4%) | - | 13(4.6%) |
| neurological-meningitis/epilepsyc | 20(8.4%) | - | 20(7.1%) |
| respiratory diseased | 102(42.7%) | - | 102(36.2%) |
| sepsis/ septic shocke | 42(17.6%) | - | 42(14.9%) |
| otherf | 32(13.4%) | - | 32(11.3%) |
| Expected weight for age (z-score)g | (n = 227) | (n = 32) | (n = 259) |
| z < -3 | 67(29 5%) | 0(0 0%) | 67(25 9%) |
| -3 < z < -2 | 30(13 2%) | 0(0 0%) | 30(11 6%) |
| z > -2 | 130(57 3%) | 32(100%) | 162(62 5%) |
| Length of pathway all children (Median (IQR)) | (n = 239) | (n = 43) | (n = 282) |
| Onset of illness to first presentation (days) | 2 (0–3.0) | 0 (0.0–0.0) | 1 (0.0–3.0) |
| First presentation to RCWMCH arrival (hours) | 4.4 (1.9–9.2) | 1.9 (1.0–5.2) | 4.2 (1.7–8.9) |
| First presentation to PICU admission (hours) | 13.8 (7.3–46.0) | 9.8 (6.3–16.0) | 12.3 (6.9–39.6) |
| RCWMCH arrival to PICU admission (hours)h | 5.0 (2.4–15.9) | 5.5 (3.1–8.1) | 5.0 (2.5–12.9) |
| EMS activation to destination facility (minutes)i | (n = 237) | (n = 55) | (n = 292) |
| 86.0 (56.0–124.0) | 80.0 (48.0–128.0) | 86.0 (54.0–124.0) | |
| Clinical Outcomes for PICU Admissions only | Medical (n = 218) | Trauma (n = 34) | Total (n = 252) |
| Outcome at 30 days | |||
| Death in/after PICU | 26(11.9%) | 2(5.9%) | 28(11.1%) |
| Discharge home | 150(68.8%) | 13(38.2%) | 163(64.7%) |
| Remain inpatient | 42(19.3%) | 19(55.9%) | 61(24.2%) |
| Median (IQR) | Median (IQR) | Median (IQR) | |
| Risk of mortalityj (PIM2%) | 6.9(1.8–18.2) | 7.6(4.6–12.6) | 6.9(2.0–16.6) |
| PICU Length of stay (hours) | 73.6 (43.0–159.4) | 94.5 (43.6–218.7) | 76.9 (43.0–164.0) |
| Total RCWMCH Length of stay (days) | 10.5(7.0–20.0) | 15.0(9.8–25.8) | 11.0 (7.0–21.0) |
IQR inter quartile range; RCWMCH Red Cross War Memorial Children’s Hospital; PICU paediatric intensive care unit; EMS emergency medical services
a trauma: road traffic accidents(28), burns (8) and other (7) non road traffic accident injury
b cardiac: congenital heart disease (17) and myocarditis/ cardiomyopathy (13)
c neurology includes meningitis (14), epilepsy(3);
d respiratory: infective (pneumonia/bronchiolitis) (82); obstructive airway/croup/asthma (13)
e sepsis/ septic shock: neonatal (18), older infants/ children (24)
f other includes: surgical (12),death unknown causes (7), overdose (3), drowning (2), renal failure, diabetic keto-acidosis, hepatic failure
g z-score—WHO Global Database on Child Growth and Malnutrition (data incomplete–no age/ weight z score for > 10 year olds)
h 32 patients went directly to PICU on arrival at RCWMCH (all had been previously accepted by PICU with a bed reserved for them); medical(31), trauma (1)
i EMS was not utilized by all cases but some cases had more than one EMS transfer
j on admission to PICU PIM2 score–Paediatric Index of Mortality [21]