Kelly Tracy, Selden Owen, Houston Dazhanae, Meyers Derek, Kent Brenna, Kanyamuhunga Aimable
University of Virginia, Charlottesville, Virginia, USA.
University of Rwanda College of Medicine and Health Sciences, Pediatrics & Child Health Department, Kigali, Rwanda.
Ann Glob Health. 2025 Aug 26;91(1):48. doi: 10.5334/aogh.4714. eCollection 2025.
Children born in low‑ and middle‑income countries are 14 times more likely to die before reaching the age of five compared to children in high‑income countries. Pediatric Intensive Care Units (PICUs) with specialized equipment and advanced medications managed by trained clinicians have reduced mortality of children worldwide, yet countries with limited funds and scarce resources strain to meet needs of critically ill children. The aim of the study was to identify the disease burden of patients entering the PICU at the Central Hospital in Kigali, Rwanda, and the relationship between patient mortality and allocation of resources. In addition, this study focused on several factors suspected to impact the mortality rate, including the entry point into the health system, delay in admittance, and whether surgery was performed. A retrospective, cross‑sectional review of 30 medical records per year was conducted between January 2016 and December 2022, totaling 177 encounters. Demographic and clinical data were extracted and analyzed to perform descriptive and inferential statistics, including univariable and multivariable logistic regression analyses to identify factors affecting mortality. The study showed an overall mortality rate of 55% for patients admitted to the PICU. Among patients who died, the most common diagnoses were sepsis, primary respiratory failure, and congenital defects. When holding age and surgery constant, patients with a noted delay in admittance to the PICU had increased odds of mortality than those without a delay. Holding the delay in admittance constant, there was an interaction effect between age and surgery on mortality, with higher odds of mortality in newborns than in children over one month of age when surgery was performed. Careful adherence to emerging pediatric sepsis guidelines, immediate recognition, and appropriate treatment may reduce mortality. Prioritizing policies that reduce delays in treating critically ill children may improve outcomes.
与高收入国家的儿童相比，低收入和中等收入国家出生的儿童在五岁前死亡的可能性要高14倍。配备专门设备和先进药物且由训练有素的临床医生管理的儿科重症监护病房（PICUs）降低了全球儿童的死亡率，然而，资金有限且资源稀缺的国家难以满足重症儿童的需求。本研究的目的是确定卢旺达基加利中央医院进入儿科重症监护病房的患者的疾病负担，以及患者死亡率与资源分配之间的关系。此外，本研究重点关注了几个被怀疑会影响死亡率的因素，包括进入卫生系统的切入点、入院延迟以及是否进行了手术。2016年1月至2022年12月期间，对每年30份病历进行了回顾性横断面审查，共计177次就诊。提取并分析了人口统计学和临床数据，以进行描述性和推断性统计，包括单变量和多变量逻辑回归分析，以确定影响死亡率的因素。该研究显示，入住儿科重症监护病房的患者总体死亡率为55%。在死亡患者中，最常见的诊断是败血症、原发性呼吸衰竭和先天性缺陷。在年龄和手术情况不变的情况下，入住儿科重症监护病房明显延迟的患者死亡几率高于未延迟的患者。在入院延迟情况不变的情况下，年龄和手术对死亡率有交互作用，进行手术时，新生儿的死亡几率高于一个月以上的儿童。严格遵守新出现的儿科败血症指南、及时识别和适当治疗可能会降低死亡率。优先制定减少治疗重症儿童延迟的政策可能会改善治疗结果。
