Critical Care and Shock

The Paediatric Resuscitation Room: Demographic analysis and predictors for admittance in Intensive Care Units

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Objective: Epidemiological description of paediatric patients admitted in the resuscitation room, identify the main pathologies that lead to admittance, and analyse risk factors for intensive care admittance.

Design: A retrospective study was conducted between January 2014 and December 2017. Data regarding epidemiology, provenance, means of transport, triage evaluation, clinical status, and attitudes employed before admission and in the resuscitation room, destination, and prognosis were collected. Collected data was then compared between admitted and non-admitted patients in any intensive care unit.

Setting: Resuscitation Room of the Paediatric Emergency Department in a tertiary hospital in the north of Portugal.

Patients: All paediatric patients (newborn to 17 years and 364 days of age). Three hundred and sixty-three patients were admitted.

Measurements and results: Main causes for admission were active seizures (35%) and severe traumatic brain injuries (TBI) (18.8%). Forty-four point one percent were admitted to the intensive care unit (ICU). Multivariate analysis through binary logistic regression determined that admittance with a spinal board (p=0.012) and ventilatory support requirement (p=0.001) were independent positive risk factors for ICU admission, while being a frequent user of emergency services (p=0.016) and admission for active seizure (p=0.007) were negative risk factors. Trauma patients were the ones most likely to be admitted to the Paediatric Intensive Care Unit (PICU) (p<0.001). Among these, TBI was the most frequent cause for admission (p<0.031).

Conclusions: Active seizure and trauma are the two situations most frequently addressed, the latter with the worst prognosis. It is paramount to hold frequent training and simulation sessions for health professionals to prepare the approach to these pathologies.