Survival Status and Predictors of Mortality Among Pediatric Patients Admitted to Intensive Care Unit at a University Teaching Hospital in Southeastern Ethiopia: Insights from a Prospective Cohort Study
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Abstract Background: Pediatric mortality rates in intensive care units (ICUs) are much higher in developing countries compared to high-income nations. Although advancements in pediatric intensive care have improved outcomes worldwide, resource-limited settings still face significant challenges. The high burden of disease and mortality from preventable illnesses further complicate patient outcomes in these under-resourced ICUs. In Ethiopia, there is limited published data on pediatric ICU outcomes and their influencing factors. This study aimed to assess survival status and identify predictors of mortality among pediatric patients admitted to the ICU at Asella Referral and Teaching Hospital. Methods: An Institutional-based prospective cohort study was conducted in the ICU, involving 305 pediatric patients admitted between September 2023 and November 2024. We consecutively recruited eligible patients and followed them until they were either censored or died. Kaplan Meier was used to compare patient survival experiences and Cox regression analyses were used to identify independent predictors of ICU mortality. The strength of associations was measured using hazard ratios, and statistical significance was determined at a P-value of <0.05. Results: In this cohort, A total of 129/305 patients died during the follow-up time, yielding an overall mortality of 42.3%. The mortality incidence was 7.1 deaths per 100 person-days of observation (95% CI: 5.86–8.32 deaths per 100 person-days), with a median survival time of 10 days. The independent predictors of ICU mortality include: Lack of health insurance (AHR: 2.03; 95% CI: 1.22–3.39; P = .007), Presence of multi-organ dysfunction (AHR: 1.73; 95% CI: 1.09–2.73; P = .019), Elevated creatinine levels (AHR: 1.82; 95% CI: 1.13–2.93; P = .013), Hemoglobin levels below 10 g/dL (AHR: 1.73; 95% CI: 1.15–2.60; P = .008), and Higher PIM 2 scores (AHR: 1.58; 95% CI: 1.03–2.43; P = .038). Conclusion: The study found a concerningly high mortality rate among pediatric patients in the ICU. Key predictors of ICU mortality included elevated creatinine levels, higher PIM 2 scores, hemoglobin levels below 10 g/dL, lack of health insurance, and the presence of multi-organ dysfunction. These findings underscore the urgent need for early intervention strategies targeting these risk factors, particularly in high-risk patients, to enhance outcomes in pediatric critical care and significantly reduce ICU mortality rates.
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Survival Status and Predictors of Mortality Among Pediatric Patients Admitted to Intensive Care Unit at a University Teaching Hospital in Southeastern Ethiopia: Insights from a Prospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Survival Status and Predictors of Mortality Among Pediatric Patients Admitted to Intensive Care Unit at a University Teaching Hospital in Southeastern Ethiopia: Insights from a Prospective Cohort Study Mesfin Wubishet, Solomon Gelaye, Tahir Aman, Betre Shimelis This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5868295/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background: Pediatric mortality rates in intensive care units (ICUs) are much higher in developing countries compared to high-income nations. Although advancements in pediatric intensive care have improved outcomes worldwide, resource-limited settings still face significant challenges. The high burden of disease and mortality from preventable illnesses further complicate patient outcomes in these under-resourced ICUs. In Ethiopia, there is limited published data on pediatric ICU outcomes and their influencing factors. This study aimed to assess survival status and identify predictors of mortality among pediatric patients admitted to the ICU at Asella Referral and Teaching Hospital. Methods: An Institutional-based prospective cohort study was conducted in the ICU, involving 305 pediatric patients admitted between September 2023 and November 2024. We consecutively recruited eligible patients and followed them until they were either censored or died. Kaplan Meier was used to compare patient survival experiences and Cox regression analyses were used to identify independent predictors of ICU mortality. The strength of associations was measured using hazard ratios, and statistical significance was determined at a P-value of <0.05. Results: In this cohort, A total of 129/305 patients died during the follow-up time, yielding an overall mortality of 42.3%. The mortality incidence was 7.1 deaths per 100 person-days of observation (95% CI: 5.86–8.32 deaths per 100 person-days), with a median survival time of 10 days. The independent predictors of ICU mortality include: Lack of health insurance (AHR: 2.03; 95% CI: 1.22–3.39; P = .007), Presence of multi-organ dysfunction (AHR: 1.73; 95% CI: 1.09–2.73; P = .019), Elevated creatinine levels (AHR: 1.82; 95% CI: 1.13–2.93; P = .013), Hemoglobin levels below 10 g/dL (AHR: 1.73; 95% CI: 1.15–2.60; P = .008), and Higher PIM 2 scores (AHR: 1.58; 95% CI: 1.03–2.43; P = .038). Conclusion: The study found a concerningly high mortality rate among pediatric patients in the ICU. Key predictors of ICU mortality included elevated creatinine levels, higher PIM 2 scores, hemoglobin levels below 10 g/dL, lack of health insurance, and the presence of multi-organ dysfunction. These findings underscore the urgent need for early intervention strategies targeting these risk factors, particularly in high-risk patients, to enhance outcomes in pediatric critical care and significantly reduce ICU mortality rates. Survival status Predictors Mortality PICU Southeast Ethiopia Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Intensive care is a multidisciplinary and interprofessional specialty focused on managing patients with serious organ dysfunction. The pediatric intensive care unit (PICU) is a specialized setting that delivers comprehensive medical and nursing care to critically ill children. The primary goal of the PICU is to closely monitor and treat these severely ill patients, who are at high risk of mortality(1). According to the World Health Organization (WHO), acute pediatric critical illness is defined as “any severe problem with the airway, breathing, or circulation, or acute deterioration of conscious state; which includes apnea, upper airway obstruction, hypoxemia, central cyanosis, severe respiratory distress, total inability to feed, shock, severe dehydration, active bleeding requiring transfusion, unconsciousness, or seizures”. Children experiencing these critical issues are often admitted to the intensive care unit (ICU), where they need advanced support for their organ function, hemodynamics, and airway management(2). Despite significant progress in reducing child mortality globally, the rates remain unacceptably high, with substantial disparities in survival chances across regions(3). According to a 2022 World Health Organization (WHO) report, most pediatric deaths in developing countries are caused by preventable and treatable illnesses, provided timely and optimized care is available(4). Over the past decades, high-income countries have achieved significantly lower pediatric mortality and morbidity rates following PICU admissions, largely due to advancements in medical care (5). In contrast, pediatric critical care services in low-income countries, particularly in Sub-Saharan Africa (SSA), are often insufficient, contributing to high child mortality rates. These regions struggle with varying levels of infrastructure required for effective critical care, leading to challenging patient outcomes in resource-limited settings (6,7). The pediatric mortality rate in ICUs varies significantly between developed and developing countries, with particularly high rates observed in low-income countries (8–12), compared to high-income countries(13–15). In 2020, SSA recorded the world's highest under-five mortality rate, accounting for 53% of all under-five deaths globally(3). Ethiopia ranked among the top five countries in the region with the highest under-five mortality, reporting 59 deaths per 1,000 live births (3,16). According to available evidence, the PICU is where the highest number of deaths occurs in most hospitals in Ethiopia. Studies conducted in the country have reported overall mortality rates for patients admitted to the PICU were 32.6%, 39.8%, and 28.6% with the most common causes of death being infections, cardiovascular, and respiratory disease, respectively (11,17,18). Pediatric ICUs play a critical role in saving the lives of children with acute life-threatening conditions, particularly in developing countries with high numbers of critically ill patients. However, data on the organization and outcomes of pediatric ICUs in low-income countries like Ethiopia are limited. This gap in information hinders efforts to improve practices and enhance patient outcomes. Most research on ICU mortality predictors comes from high-income countries and relies on clinical and laboratory indices that may not be accessible in resource-limited settings. Furthermore, existing studies are often retrospective and cross-sectional, failing to explore broader epidemiological and sociodemographic factors or to consider essential parameters, which further limits their relevance to resource-limited contexts (8,11,18–20). Identifying mortality risk factors among children admitted to the PICU is crucial for optimizing resource allocation and improving outcomes, especially in resource-limited settings like ours. In southeastern Ethiopia, there is a notable lack of research on the factors affecting pediatric ICU outcomes. This cohort study aims to assess survival outcomes and identify mortality predictors among pediatric patients admitted to the ICU at ARTH in southeastern Ethiopia. The findings will provide valuable insights into the causes of mortality, enabling the development of targeted strategies to enhance survival rates for high-risk patients. By addressing these knowledge gaps and improving the ability to predict patient outcomes, this research has the potential to advance pediatric critical care practices in resource-constrained environments. Objectives of the study To determine the survival status and predictors of mortality among pediatric patients admitted to the intensive care unit at ATRH, Southeast Ethiopia, 2024. Methods and Materials Study design, period, and setting An institutional-based prospective cohort study was conducted among pediatric patients admitted to the ICU at Asella Referral and Teaching Hospital from September 2023 to November 2024. Asella Referral and Teaching Hospital (ARTH) is located in Asella City, southeast Ethiopia, and serves a population of over 3.5 million people. The hospital has more than 400 beds, including 6 dedicated ICU beds. The Department of Pediatrics and Child Health at ARTH includes various wards, totaling 103 beds across multiple units, such as the emergency unit, neonatal ICU, general ICU, High Dependency Unit (HDU), and general pediatric wards. The organizational detail of the ICU in this hospital is lacking. The ICU itself has a capacity of six beds, equipped with mechanical ventilators and patient hemodynamic monitoring systems. The unit is staffed by general pediatricians, anesthesiologists, pediatric residents, medical interns, and skilled ICU nurses, maintaining a nurse-to-patient ratio of 1:1. However, pediatric intensivists, respiratory therapists, and dietitians are not currently available at the facility. Source and study population. All pediatric patients admitted to the ICUs at ARTH constituted our source population. The study population consisted of pediatric patients who were admitted to the ICU during the study period and met the inclusion criteria. Eligibility criteria All pediatric patients aged 1 month to 14 years who were admitted to the ICU during the study period and whose parents provided consent were included in the study. Exclusion criteria include pediatric patients who died upon arrival or within two hours of admission, surgical patients admitted solely for recovery purposes, and patients whose parents did not consent to participation. Study variables Dependent variable: Time to death (In ICU mortality) Independent variables: The sociodemographic characteristics include age, gender, residence, and the caregiver's educational status and occupation. The clinical characteristics of the patient encompass duration of illness before admission, reason for admission, Source of admission, frequency of admission, admission vital signs, Mental status, nutritional status, vaccination status, presence of comorbid illness, organ dysfunction, and intervention during ICU stay and before admission, PIM2 score, length of ICU stay, Health insurance status and complications after ICU admission. Sample size determination and sampling procedures The sample size (n) was determined using a single population proportion formula with the following assumptions: level of confidence (α) was taken as 0.05; Zα/2 = 1.96, a 5% margin of error (d = 0.05), and proportion of mortality 28.6% was taken from a study conducted at selected tertiary care hospitals in Ethiopia(21). The initial sample size was 314; after adding a 10% contingency, the final sample size was calculated to be 345. During the study period, a total of 323 pediatric patients were admitted to the ICU. We collected data from 305 patients who met the inclusion criteria. All pediatric patients admitted to the ICU during the study period and meeting the inclusion criteria were conveniently enrolled until the target sample size was achieved. Information about the study was provided to parents or guardians and informed written consent was obtained before recruitment. Data collection tools and procedure To ensure content validity, the data collection tool was adapted through a systematic review of related literature and modifications to capture data. Additionally, patient charts were reviewed according to the study’s objectives(11,17–19,22–25). The data collectors were trained pediatric residents and medical interns, who were also part of the patient care team and supervised by the principal investigator. After obtaining consent from the caretakers, the study participants were recruited at the time of their admission by the data collectors. They were closely monitored throughout their stay at the facility, with documentation of all significant clinical events until either they were censored or passed away. Key clinical characteristics such as systolic blood pressure (SBP), pupillary light reflex, oxygen saturation, and the need for mechanical ventilation (MV) were assessed within the first hour of admission and recorded in an electronic application to calculate the Pediatric Index of Mortality 2 (PIM2) score (26). We collected sociodemographic data and medical history through interviews with caregivers. Patient data, including admission diagnosis, laboratory indices, and the clinical course during the hospital stay, were documented prospectively until the study participant died or was censored. We utilized the WHO International Classification of Diseases, 10th edition (ICD-10) to assign disease categories, and only the primary diagnoses, the major reason for the patient’s current admission, were taken as the final diagnosis for ICD-10 assignment in patients having multiple diagnoses (27). Data quality assurance To assure data quality, the questionnaire was first prepared in English and then translated into the local languages (Afan Oromo, and Amharic) by language experts and fluent speakers of both languages, and it was translated back into English to check its consistency. A pretest was conducted on 5% of the sample at Adama Medical College before the actual data collection to assess the consistency and validity of the structured data collection format. One day of Training on the study objective and how to review the documents per the data extraction format was given to data collectors. The collected data were double-checked by the data collectors and principal investigator before the data entry for completeness, accuracy, and clarity. Residents and interns were updated once every 4 weeks on the proper recording of the appropriate conditions in line with the WHO ICD-10 system. Data processing and analysis Data were manually checked for completeness before being entered into Epi-data Manager version 4.6 and then into SPSS version 27 for statistical and survival analysis. Descriptive analysis was performed to recap baseline characteristics, and results were presented by the text, tables, and figures. Kaplan-Meier curves were computed to compare the survival status of patients. Bi-variable analysis was conducted, and variables having a P -value <.25 were considered candidates for the multi-variable regression. A multi-variable Cox proportional hazard model was performed to identify the independent predictors of ICU mortality. The hazard ratio was used to assess the strength of the association and variables with a P -value of .05 were considered statistically significant. Operational definition Survival status : The outcome of a pediatric patient admitted to ICU either event or censored. Event (death): is defined as a patient who died in the ICU during treatment. Censored: refers to patients who were survived /discharged alive from the PICU or those with no event of interest. Loss to follow-up : Patients who were referred to another hospital or discharged against medical advice without knowing their outcome. Length of ICU stays (LOS): Was a period in hours, days, or months the patients stayed in ICU from admission time to discharge time. MODS: refers to a potentially reversible physiologic derangement in two or more organ systems criteria. ICU Mortality: was calculated as the number of deaths of patients given particular diagnoses divided by the total number of patients with that diagnosis. Comorbidity: A concurrent disease with the final diagnosis during hospitalization. Complications at ICU : Diseases developed during a stay in the ICU which is not reported upon admission. Results During the study period, 325 pediatric patients were admitted, of which 305 met the inclusion criteria and were included in the final analysis. Among the enrolled patients, 18 were subsequently excluded for the following reasons: four were under one month of age, nine died within two hours of ICU admission, and five had parents who declined to provide consent, as illustrated in the study flow diagram (Fig. 1 ). Socio-demographic characteristics of study participants The study included 305 patients, of whom 186 (61%) were male, resulting in a female-to-male ratio of 1:1.6. The mean age of patients admitted to the ICU was 27.6 months (± 24.8 months). Nearly half of the participants, 152 (49.8%), were infants, while 21 (6.9%) were adolescents. Most patients, 215 (70.5%), lived in rural areas, and over half, 175 (57.4%), were primarily engaged in farming. Parents were the primary caregivers for most patients, accounting for 296 (97%), though about 61 (20%) of these caregivers lacked formal education. Of the patients, 88 (28.9%) were classified as severely malnourished (WFL < 3 Z-score). Regarding vaccination, 149 (48.9%) were fully vaccinated. Additionally, 65 patients (21.3%) had comorbid illnesses, and 194 (63.6%) did not have health insurance coverage (Table 1 ). Table 1 Socio-Demographic Characteristics of Pediatric Patients Admitted to the ICU at ARTH, Southeast Ethiopia, 2024 (N = 305). Variable Category Event (n = 129) Censored (n = 176) Total (N = 305) n (%) n (%) n (%) Age in months 1–12 83(54.6) 69(45.4) 152 (49.8) 13–60 31(29.8) 73(70.2) 104 (34.1) 61–120 5(17.9) 23(82.1) 28 (9.2) 121–168 10(47.6) 11(52.4) 21 (6.9) Sex Male 78(41.9) 108(58.1) 186 (61.0) Female 51(42.9) 68(57.1) 119 (39.0) Residence Urban 32(35.6) 58(64.4) 90 (29.5) Rural 97(45.1) 118(54.9) 215 (70.5) Primary caregiver Parents 124(41.9) 172(58.1) 296 (97.0) Grandparents 5(55.6) 4(44.4) 9 (3.0) Caregiver’s Education Level No formal education 39(63.9) 22(36.1) 61 (20.0) Elementary school ( 1 – 8 ) 49(37.1) 83(62.9) 132 (43.3) Secondary school ( 9 – 12 ) 21(28.0) 54(72.0) 75 (24.6) College/University 20(54.1) 17(45.9) 37 (12.1) Caregiver’s occupation Farmer 83(47.4) 92(52.6) 175 (57.4) Employee (Govt./ private) 22(44.9) 27(55.1) 49 (16.1) Merchant 13(23.2) 43(76.8) 56 (18.4) Daily laborer 11(44.0) 14(56.0) 25 (8.2) Frequency admission First admission 121(41.4) 171(58.6) 292(95.7) Readmission (⩾2) 8 (61.5) 5(38.5) 13(4.3) Co-morbidity Yes 38(58.5) 27(41.5) 65 (21.3) NO 91(37.9) 149(62.1) 240 (78.7) Vaccination status Fully vaccinated 42(28.2) 107(71.8) 149 (48.9) Partially vaccinated 61(51.7) 57(48.3) 118 (38.7) Not vaccinated 26(68.4) 12(31.6) 38 (12.5) Nutritional status Normal 49(26.5) 136(73.5) 185 (60.7) MAM 15(46.9) 17(53.1) 32 (10.5) SAM 65(73.9) 23(26.1) 88 (28.9) Health insurance Insured 24(21.6) 87(78.4) 111 (36.4) No insurance 105(54.1) 89(45.9) 194 (63.6) Clinical characteristics of study participants The majority of PICU admissions were from the emergency department,192 (63.0%), followed by pediatrics wards,71 (23.3%), and referrals from other facilities 18 (5.9%). Among the patients, 251 (82.3%) were admitted due to medical conditions. Co-morbid illnesses were present in approximately one-fifth of the patients, totaling 65 (21.3%). Additionally, nearly half of the patients, 148 (48.5%), exhibited Multi-Organ Dysfunction Syndrome (MODS). Elevated creatinine levels were noted in 66 patients (21.6%), and 135 patients (44.3%) were anemic, with hemoglobin levels below 11 g/dL. The majority of patients, 266 (87.2%), received fluid resuscitation before their admission to the ICU. Upon arrival, severe impairment of consciousness was noted in 87 patients (28.5%), and 256 patients (83.9%) had oxygen saturation levels below 90%. The mean PIM-2 score was 8.6 ± 6.54, with 156 patients (51.1%) scoring below 5. Mechanical ventilation was required for 87.2% of the patients. During their stay in the ICU, complications occurred in 80 patients (26.2%), with the most common being hospital-acquired infections (30%), followed by aspiration pneumonia (28.8%) ( Table 2 ). Table 2 Clinical Characteristics of Pediatric Patients Admitted to the ICU at ARTH in Southeast Ethiopia, 2024 (N = 305). Variable Category Event (n = 129) Censored (n = 176) Total (N = 305) n (%) n (%) n (%) Patient Category Medical patient 107 (42.6) 144 (57.4) 251(82.3) Surgical patient 22 (40.7) 32 (59.3) 54 (17.7) Admission source Pediatric EOPD 85 (44.3) 107 (55.7) 192 ( 63 ) Referral from Other facilities 5 (27.8) 13 (72.2) 18 (5.9) Surgical/OR 8 (33.3) 16 (66.7) 24 (7.9) Pediatric ward 31 (43.7) 40 (56.3) 71 (23.3) Duration of illness 8 87 (39.9) 131 (60.1) 218 (71.5) ≤ 8 42 (48.3) 45 (51.7) 87 (28.5) Oxygen saturation (%) < 90 114 (44.5) 142 (55.5) 256 (83.9) 90 to 100 15 (30.6) 34 (69.4) 49 (16.1) MODS Yes 93 (62.8) 55 (37.2) 148 (48.5) No 36 (22.9) 121 (77.1) 157 (51.5) Creatinine level (mg/dl) Normal 69 (28.9) 170 (71.1) 239 (78.4) Elevated 60 (90.9) 6 (9.1) 66 (21.6) Hemoglobin (g/dl) 5 90 (60.4) 59 (39.6) 149 (48.9) ≤ 5 39 ( 25 ) 117 (75) 156 (51.1) Mechanical ventilator Yes 124 (46.6) 142 (53.4) 266 (87.2) No 5 (12.8) 34 (87.2) 39 (12.8) In-ICU complications Yes 34 (42.5) 46 (57.5) 80 (26.2) No 95 (42.2) 130 (57.8) 225 (73.8) Length of ICU stay (in days) < 2 47 (65.3) 25 (34.7) 72 (23.6) 2–7 65 (40.9) 94 (59.1) 159 (52.1) 7–14 13 (23.2) 43 (76.8) 56 (18.4) 14–28 4 (22.2) 14 (77.8) 18 (5.9) Reason for admission and the type of treatment given during the ICU stay. Severe pneumonia with impending respiratory failure was the most common reason for ICU admission, accounting for 90 cases (29.5%), followed by septic shock (40 cases, 13.1%) and complicated meningitis (29 cases, 9.5%) (Table 3 ). Nearly all patients, 301(98.7%), were treated with antibiotics, and most, 289(94.8%), required respiratory support, such as oxygen therapy. Other frequently administered treatments included fluid resuscitation 148 (48.5%), Steroids 135 (44.3%), and nutritional treatments 132(43.3%). Inotropic support was provided to nearly one-third of the patients (Fig. 2 ). Mechanical ventilation was needed for most patients 266 (87.2%), with 255 (95.9%) undergoing intubation. However, 11 patients (4.1%) could not be intubated due to the unavailability of mechanical ventilators. The duration of ventilator support ranged from 1 to 22 days, with an average of 7.34 days. The ICU length of stay ranged from 4 hours to 28 days, with an average stay of 6 days. Table 3 Reason for Admission to the ICU Among Pediatric Patients in ARTH, Southeast Ethiopia, 2024 (n = 305). Variables Frequency (%) Event (n = 129) n (%) Censored (n = 176) n (%) Severe Pneumonia 90 (29.5) 40 (44.4) 50 (55.6) Septic Shock 40 (13.1) 29 (72.5) 11 (27.5) Complicated meningitis 29 (9.5) 12 (41.4) 17 (58.6) post-operative patient 25 (8.2) 11 ( 44 ) 14( 56 ) PARDS 20 (6.6) 10 ( 50 ) 10 ( 50 ) Bronchiolitis 15 (4.9) 3 ( 20 ) 12 (80) Gullian-Barre syndrome 12 (3.9) 3 ( 25 ) 9 (75) Traumatic Brain Injury (TBI) 12 (3.9) 5 (41.7) 7 (58.3) Status epilepticus 9 (3.0) 4 (44.4) 5 (55.6) Disseminated tuberculosis 8 (2.6) 0 (0) 8 (100) Severe Asthma 7 (2.3) 1 (14.3) 6 (85.7) Congestive heart failure 6 (2.0) 2 (33.3) 4 (66.7) Upper airway obstruction 6 (2.0) 0 (0) 6 (100) Severe DKA 4 (1.3) 2 ( 50 ) 2 ( 50 ) Cardiogenic shock 2 (0.7) 2 (100) 0(0) Miscellaneous conditions 20 (6.6) 5 ( 25 ) 15 (75) Survival status and incidence of In-ICU mortality among Pediatric Patients During the study period, 129 pediatric patients (42.3%) died in the ICU, while 176 patients (57.7%) were censored. Among the censored patients, 131 (43%) were discharged alive, 38 (12.5%) were left against medical advice, and seven (2.3%) were referred to other facilities (Fig. 3 ). In this study, patients were monitored for a period ranging from 4 hours to 28 days, with a median ICU stay of 5 days (IQR: 2–7 days). Over the study period, there were 1,821 person-day observations, equivalent to 60.8 person-months. Among the 305 participants, 129 (42.3%) died during the follow-up period, resulting in an incidence rate of ICU mortality of 7.1 deaths per 100 person-days (95% CI: 5.86–8.32 deaths per 100 person-days). The median survival time for all patients was 10 days. Of the patients who died, the majority 112 (86.8%) died within the first 7 days, 13 patients (10.1%) died between 7 and 14 days, and the remaining deaths occurred after 2 weeks of ICU admission. The primary causes of death were multiorgan failure (40.3%), respiratory failure (33.3%), cardiopulmonary failure (10.1%), brain herniation (9.3%), and cardiac arrest (7%) (Fig. 4 ). The comparison of survival functions among different mortality predictors in pediatric ICU patients was evaluated. Patients with organ dysfunction had a median survival of 6.0 days (95% CI: 5.34–6.66), compared to 19.0 days (95% CI: 7.54–30.46) for those without organ dysfunction (log-rank P < .001). Patients with elevated creatinine levels had a median survival of 19.0 days (95% CI: 11.56–26.85), while those with normal creatinine levels had a median survival of 4.0 days (95% CI: 3.48–5.31) (log-rank P < .001). Additionally, patients diagnosed with anemia had a median survival of 6.0 days (95% CI: 5.33–6.67), whereas those without anemia had a median survival of 19.0 days (95% CI: 11.45–26.55) (log-rank P = .001) (Table 4 ). Baseline differences between the patient strata were analyzed using the log-rank (χ²) test, and the equality of hazards was assessed for the explanatory variables. Kaplan-Meier survival curves were plotted for organ dysfunction (P = .019), and Hemoglobin level (P = .008), all of which showed significant differences (Figs. 5– 6 ). Table 4 The mean and median survival times, along with the corresponding 95% CI, among various predictors of mortality in pediatric patients admitted to the ICU at ARTH, 2024 (N = 305). Variable Category Mean survival time (95% CI) Median survival time (95% CI) Health insurance Insured 20.70(17.93,23.46) 21.0(19.32,25.41) No insurance 8.52(7.12,9.92) 7.0(6.23,7.77) Organ dysfunction Yes 8.74(7.15,10.34) 6.0(5.34,6.66) No 18.22(14.51,21.92) 19.0(7.54,30.46) Creatinine (mg/dl) Normal 17.46(15.19,19.73) 19.0(11.56, 26.85) Elevated 5.06(3.90,6.23) 4.0(3.48,5.31) Hemoglobin (g/dl) 5 8.52 (7.12, 9.92) 6.00 (5.25, 6.75) ≤ 5 17.76 (14.94, 20.58) 19.00 (12.19, 25.81) Predictors of mortality among pediatric patients admitted to ICU The Cox proportional hazards model was used to identify factors associated with mortality within the ICU. In the univariate analysis, variables with a p-value less than 0.25 were identified as potential predictors for inclusion in the multivariable analysis. In a multivariate Cox proportional hazards regression model, health insurance status, multi-organ dysfunction, creatinine levels, hemoglobin levels, and PIM-2 scores were identified as predictors of mortality. The mortality hazard was twofold higher for patients without health insurance coverage during their ICU stay (AHR: 2.03; 95% CI: 1.22, 3.39; P = .007) compared to those with health insurance. Additionally, the risk of mortality was 1.7 times higher in patients with organ dysfunction (AHR: 1.73; 95% CI: 1.09–2.73; P = .019) and 1.8 times higher in patients with elevated creatinine levels (AHR: 1.82; 95% CI: 1.13–2.93; P = .013) compared to their counterparts. Anemia was associated with a 1.7-fold increased risk of mortality (AHR: 1.73; 95% CI: 1.15–2.60; P = .008), while patients with a PIM2 score above five had a 1.6 times higher mortality risk (AHR: 1.58; 95% CI: 1.03–2.43; P = .038) than those with a score below five ( Table 5 ). Table 5 Bivariate and multivariable Cox proportional hazard regression analysis for mortality predictors among pediatric patients admitted to the ICU at ARTH, southeast Ethiopia, 2024(N = 305). Variable Category Survival status CHR (95%CI) AHR (95%CI) P-value Event n (%) Censored n (%) Age in months 1–12 83(54.6) 69(45.4) 1 1 .065 13–60 31(29.8) 73(70.2) .49(0.33, 0.75) 0.67 (0.42, 1.08) 61–120 5(17.9) 23(82.1) .27(0.11, 0.68) 0.75 (0.27, 2.08) 121–168 10(47.6) 11(52.4) .93(0.48, 1.80) 1.87 (0.81,4.32) Residence Urban 32(35.6) 58(64.4) 1 1 .113 Rural 97(45.1) 118(54.9) 1.32(0.89, 1.97) 1.42 (0.92, 2.18) Co-morbidity Yes 38(58.5) 27(41.5) 1.66 (1.14, 2.43) 1.39 (0.89, 2.15) .144 No 91(37.9) 149(62.1) 1 1 Health insurance Insured 24(21.6) 87(78.4) 1 1 .007 No insurance 105(54.1) 89(45.9) 3.41 (2.16, 5.36) 2.03 (1.22, 3.39) * Nutritional status Normal 49(26.5) 136(73.5) 1 1 .169 MAM 15(46.9) 17(53.1) 1.74 (0.97, 3.10) 1.42 (0.76, 2.64) SAM 65(73.9) 23(26.1) 3.16 (2.18, 4.58) 1.53 (0.97, 2.41) Duration of illness < 6 days 78 (36.8) 134 (63.2) 1 1 .306 ≥ 6 days 51 (54.8) 42 (45.2) .76(0.53, 1.08) 0.81 (0.55, 1.21) Need mechanical ventilation Yes 124 (46.6) 142 (53.4) 2.89 (1.18, 7.08) 2.05 (0.77, 5.46) .152 No 5 (12.8) 34 (87.2) 1 1 Organ dysfunction Yes 93 (62.8) 55 (37.2) 3.14(2.14, 4.62) 1.73 (1.09, 2.73) * .019 No 36 (22.9) 121 (77.1) 1 1 Creatinine (mg/dl) Normal 69 (28.9) 170 (71.1) 1 1 .013 Elevated 60 (90.9) 6 (9.1) 4.37(3.08, 6.20) 1.82 (1.13, 2.93) * Hemoglobin (g/dl) 5 90 (60.4) 59 (39.6) 2.86(1.95, 4.18) 1.58 (1.03, 2.43) * .038 ≤ 5 39 ( 25 ) 117 (75) 1 1 Vaccination status Fully vaccinated 42(28.2) 107(71.8) 1 1 .382 Partially vaccinated 61(51.7) 57(48.3) 2.12(1.43, 3.14) 1.12 (0.66, 1.92) Not vaccinated 26(68.4) 12(31.6) 2.89(1.77, 4.73) 0.76 (0.39, 1.46) GCS at admission > 8 87 (39.9) 131 (60.1) 1 1 .062 ≤ 8 42 (48.3) 45 (51.7) 1.11 (0.77, 1.61) 0.67 (0.43, 1.02) Keys: AHR , adjusted hazard ratio; CHR , crude hazard ratio; CI , confidence interval; GCS , Glasgow coma scale; ICU , intensive care unit; MV , mechanical ventilation; PIM2 , pediatric index of mortality 2; 1 , reference group; *Shows statistical significance at a p- value < 0.05. Bold variables with significant association. Discussion This prospective cohort study aimed to assess the survival status and identify mortality predictors among pediatric patients admitted to the intensive care units at ARTH. Notably, it represents the first reported prospective cohort analysis of pediatric ICU admissions in Southeast Ethiopia. The study highlights a high mortality rate and identifies several key predictors of mortality, including lack of health insurance coverage, presence of organ dysfunction, elevated creatinine levels, hemoglobin levels below 10 g/dL, and a modified PIM2 score greater than five. These findings provide valuable insights for clinicians and healthcare planners, enabling evidence-based medical practice in resource-limited settings and facilitating prognosis-tailored care and efficient resource allocation. According to this study, the overall in-ICU mortality among pediatric patients was 42.3%, with an incidence of 7.1 deaths per 100 person-day observations. This finding is consistent with mortality rates from studies conducted in Ethiopia: Addis Ababa at 43.8%(11), Wolayita at 41.7%(24), and Jimma at 40%(28). Additionally, a study from Tanzania reported a mortality rate of 41.1%(29). However, these rates are lower than those found in other studies from low-income countries, such as a cohort study in Tanzania that reported a mortality rate of (49.8%) (12), and studies from Malawi (54.3%)(25), Rwanda (50%)(10), and Egypt (50.49%)(30). The differences in mortality rates among pediatric patients can be attributed to variations in study locations and settings, a scarcity of trained staff, and a lack of available resources(19). The in-ICU pediatric mortality rate in this study was higher than in recent Ethiopian studies, such as Ayder Referral Hospital (8.5%)(8), Gondar (32%)(17), Northwest Ethiopia (23.6%)(31), tertiary care hospitals in Ethiopia (28.6%)(18), and a systematic review that reported (28.5%)(32). This variation may arise from differences in sample sizes, study designs, resource limitations, the absence of a dedicated pediatric intensive care unit (ICU), which leads to pediatric and adult patients being managed together in a general ICU, and the lack of trained pediatric intensivists in the current study's setting. Additionally, inadequate transportation for critically ill children often leads to delayed arrivals and poor outcomes. The shortage of trained pediatric intensivists may also contribute to the high mortality rates in the pediatric ICU in our setting, which aligns with previous findings that indicate higher ICU mortality rates in locations without intensivist support(33). Furthermore, When we compare the proportion of mortality in PICUs in the present study with other lower-income countries, the mortality rate in our PICU is higher than the mortality rates in studies done in India (10.58%)(34), Nepal 12.6%(35), Pakistan 12.9%(36), rural North India 13.40%(37), South Africa (15.6%)(38), Iran16.5%(39), and Mozambique (25%)(40). The observed disparity could potentially be attributed to variations in economic status between the two study areas, which influence the availability and utilization of medical technology and consequently impact patient outcomes, and the hospital's role as a tertiary center receiving delayed referrals from distant locations, which may result in delayed admission and poor clinical outcomes(41). Many families, living in rural areas with limited infrastructure, often seek traditional healers before accessing medical care, leading to advanced stages of illness upon arrival. Additional contributing factors include a weak referral system, a shortage of skilled medical professionals, and inadequate PICU infection prevention and control practices. Furthermore, the lack of a high-dependency unit in the study area could be one of the factors contributing to the higher rate of ICU mortality. In our study, we found that organ dysfunction was an independent predictor of ICU mortality among pediatric patients. Our rate of MODS was 48.5%, which is significantly higher than the rates reported in studies from Ethiopia (30.7%) (17), India(7.6%) (42) and Egypt(41.3%) (43). This discrepancy may be attributed to delayed admission to the PICU and limited early resuscitation practices in our setting, both of which are crucial for preventing organ failure. This study revealed that Children admitted with organ dysfunction had a mortality risk of 1.7 times higher than those without organ dysfunction (P = .019). Similar findings have been reported in previous studies, including data from a U.S. database on children admitted to various PICUs (44), a cohort study conducted in Tanzania (12) and a cross-sectional study at a tertiary hospital in Ethiopia(45). This can be explained by the idea that organ dysfunction indicates the severity and advanced stage of an illness, resulting in either immediate mortality or the presence of sequelae that increase the long-term risk of mortality. Among the various tools for assessing disease severity at baseline, the PIM 2 score does not require extensive laboratory investigations and is unaffected by subsequent interventions. Since it is scored within one hour of admission, it enables early identification of illness severity, facilitating timely stratification of children for necessary interventions and providing essential information for counseling caregivers (46,47). In this study, we used a modified version of the PIM 2 score due to the unavailability of an arterial blood gas analyzer in our ICU during the study period. This scoring system has been validated and widely used in PICUs worldwide (48,49). Patients with a modified PIM 2 score greater than five had a 1.6 times higher mortality risk than those with a low score, demonstrating its sensitivity in predicting outcomes. This finding aligns with earlier studies(17,37,50). However, the higher mortality rate observed in our study compared to predictions by the modified PIM 2 score highlights the poor quality of intensive care in our setting. Focusing care on patients with high modified PIM 2 scores, using the tool to predict outcomes, and directing resources to those most in need could improve critical care outcomes in low-income settings. In our study, 66 patients (21.6%) had elevated creatinine levels at admission, this finding was comparable with the study done in Egypt which reports 23.7%, However, our AKI incidence was much lower than the 56% reported in an Egyptian study, which included only 60 patients(51). Differences in disease severity, coexisting conditions, and study populations may explain this discrepancy. This study found that elevated creatinine levels were an independent risk factor for mortality. These findings align with a major international study on AKI in children and young adults in ICUs, which identified severe AKI as an independent risk factor for death by day 28 after adjusting for covariates(52). Additionally, Our result is consistent with the recent prospective study done in Egypt children with acute kidney injury were 11.6 times at increased risk of mortality(53), and in another multi-center cohort study done in Canada AKI was associated with increased mortality (adjusted odds ratio (OR) 3.7 (54). Our result is consistent with a study done by Samuels et al. (55). The reason could be an increased creatinine level indicates a kidney injury resulting in a loss of function in which metabolism is greatly affected, which leads to electrolyte imbalance and metabolic acidosis that greatly impacts mortality(56). In addition, patients with compromised kidney function noted increased creatinine levels might have associated comorbid conditions and sepsis, which could reduce the likelihood of survival(54,57). Anemia was common in this study cohort at ICU admission of 135 patients (44.3%) and was also associated with a significantly increased relative risk of death. This finding was in line with a Pediatric Cohort study done in Malawi which showed hemoglobin < 10 g/dl was associated with increased ICU mortality(25). Anemia is a known driver of ICU morbidity and mortality worldwide. Children in sub-Saharan Africa are at increased risk for anemia independent of their critical illness, secondary to overlapping tropical infectious diseases, poverty, and malnutrition(58–60). In sub-Saharan Africa, 12–29% of hospitalized children are severely anemic, with an in-hospital case fatality rate of between 8% and 17%(61). In our cohort, the etiology of anemia at ICU admission is unknown. Recurrent laboratory assessments are not common in this low-resource hospital setting. Given the relatively low prevalence of HIV (4.0%) and malaria (29.4%), these conditions did not likely contribute meaningfully to mortality. With the large proportion of post-surgical ICU admissions (39%), acute traumatic and surgical losses likely contributed to some proportion of the observed anemia. This suggests anemia may be a modifiable risk factor for ICU mortality in this cohort. Future research must focus on elucidating the etiology of this condition to determine the best treatment and prevention course. In our study, only 36.4% of the children had mothers with health insurance, significantly lower than the 97.7% reported in a study from Nigeria (62). This discrepancy highlights the low health insurance coverage in the study area. Children with health insurance were found to be twice as likely to survive compared to those without, a finding consistent with a cohort study conducted in Tanzania (63). This suggests that inadequate healthcare access, likely due to mothers lacking health insurance, contributes to higher child mortality rates. Children with health insurance benefit from improved healthcare access. Moreover, the country's efforts to adopt universal health coverage through relevant legislation are expected to enhance access to care and reduce mortality rates (62). The higher mortality rates in the Intensive Care Unit require immediate attention. Research indicates that well-equipped PICUs with trained intensivists and professionals improve outcomes. Therefore, we recommend that planners and hospital administrators address staffing and equipment shortages in the ICU of Asella Referral and Teaching Hospital. Strengths and limitations of the study This prospective cohort study employed survival analysis, a robust statistical method, to identify predictors of mortality. However, the calculation of the PIM 2 score was based on only nine out of the eleven parameters, as an arterial blood gas analyzer was unavailable in the ICU during the study period. The study also did not comprehensively assess the availability of medical equipment or the quality of ICU care, nor did it explore how these factors might influence patient survival using standard parameters. Furthermore, the study excluded patients who died within the first two hours of admission, which could have led to an underestimation of the overall mortality rate. Accurately determining the primary cause of death in children with multiple diagnoses also presented challenges. Conclusion and Recommendation The study revealed a higher incidence of in-ICU mortality among pediatric patients compared to the previous studies. Significant predictors of ICU mortality included elevated creatinine levels, higher PIM 2 scores, hemoglobin levels below 10 g/dL, lack of health insurance, and the presence of multi-organ dysfunction. Early recognition, resuscitation, and timely transfer of critically ill patients are essential for preventing and improving outcomes in cases of multi-organ dysfunction syndrome (MODS). Close monitoring and meticulous care are particularly important for patients with higher Pediatric Index of Mortality 2 (PIM 2) scores. The modified PIM 2 score can be a valuable tool for prioritizing care for high-risk patients, ensuring resources are allocated to those most in need, and providing appropriate guidance to their caregivers. To address the impact of low health insurance coverage on child mortality, targeted initiatives should focus on increasing enrollment among caregivers. This can include implementing community-based health insurance programs, offering subsidies for low-income families, and conducting awareness campaigns to highlight the benefits of health insurance. Additionally, policies and programs should be developed to ensure equitable access to health insurance, reducing financial barriers to critical healthcare services for children. Abbreviations AGN: Acute Glomerulonephritis; AHR: Adjusted Hazard Ratio, AKI: Acute Kidney Injury, ARDS: Acute Respiratory Distress Syndrome; ARTH; Asella Referral and Teaching Hospital CHR: Crude Hazard Ratio, CI: Confidence Intervals, GCS: Glasgow Coma Scale HAP: Hospital Acquired Pneumonia, CD: International Classifications of Disease, ICU: Intensive Care Unit, IQR: Interquartile Range, IR: Incidence Rate, LAMA: Left Against Medical Advice, LOS: Length of Hospital stay, MAM: Moderate Acute Malnutrition, MODS: Multiple Organ Dysfunction Syndrome, MV: Mechanical Ventilation, PICU: Pediatric Intensive Care Unit, PIM2: Pediatrics Index of Mortality 2, SAM: Severe acute Malnutrition, SSA: Sub-Saharan Africa TBI: Traumatic Brain Injury; USA : United States of America, WHO: World Health Organization Declarations Acknowledgment The authors extend their sincere gratitude to the data collectors and hospital staff for their invaluable support and assistance during the data collection process. Authors’ contributions MW; contributed to the conception and design of the study, proposal development, data collection, analysis, review, and preparation of the manuscript. SG, TA, and BS; contributed to conception and design; contributed to acquisition, analysis, and interpretation; drafted manuscript; critically revised manuscript. All authors read and approved the final version of the manuscript for publication, and agreed to be accountable for all aspects of the work. Ethical approval and consent to participate Ethical approval was obtained from the Ethical Review Committee (ERC) of Arsi University College of Health Science under [Protocol No. A/CHS/RC/120/2290/15] . Informed, written, and signed consent was obtained from hospital administrators before the data collection. Anonymity was maintained by using identification numbers instead of patient names. Additionally, all extracted data were kept confidential and not used for any other purpose than the stated objective, and all methods were carried out per ethical guidelines. Consent for publication Not applicable Declaration of Competing Interests The authors declared no potential conflicts of interest concerning the research authorship, and/or publication of this article. Funding The author(s) received no financial support for the research authorship, and/or publication of this article. Availability of data and Sharing Statement The data that support the findings of this study are available from the corresponding author upon reasonable request. ORCID iDs Mesfin Wubishet; https://orcid.org/0009-0004-8758-9424 References Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz J V., Dorman T, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care [Internet]. 2017;37:270–6. 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Curr Opin Crit Care [Internet]. 2017 Dec 1 [cited 2024 Dec 29];23(6):447–56. Available from: https://journals.lww.com/co-criticalcare/fulltext/2017/12000/acute_kidney_injury_in_trauma_patients.2.aspx English M, Ahmed M, Ngando C, Berkley J, Ross A. Blood transfusion for severe anaemia in children in a Kenyan hospital. Lancet (London, England) [Internet]. 2002 Feb 9 [cited 2024 Dec 28];359(9305):494–5. Available from: https://pubmed.ncbi.nlm.nih.gov/11853798/ Koram KA, Owusu-Agyei S, Utz G, Binka FN, Baird JK, Hoffman SL, et al. Severe anemia in young children after high and low malaria transmission seasons in the Kassena-Nankana district of northern Ghana. Am J Trop Med Hyg [Internet]. 2000 [cited 2024 Dec 28];62(6):670–4. Available from: https://pubmed.ncbi.nlm.nih.gov/11304052/ Calis JCJ, Phiri KS, Faragher EB, Brabin BJ, Bates I, Cuevas LE, et al. Severe anemia in Malawian children. Malawi Med J [Internet]. 2016 Feb 28 [cited 2024 Dec 28];28(3):99–107. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa072727 Lackritz EM, Campbell CC, Ruebush TK, Hightower AW, Wakube W, Were JBO. Effect of blood transfusion on survival among children in a Kenyan hospital. Lancet (London, England) [Internet]. 1992 Aug 29 [cited 2024 Dec 28];340(8818):524–8. Available from: https://pubmed.ncbi.nlm.nih.gov/1354285/ Imo CK, De Wet-Billings N, Isiugo-Abanihe UC. The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study. Arch Public Heal [Internet]. 2022;80(1):1–12. Available from: https://doi.org/10.1186/s13690-022-00968-2 Damian DK, Furia FF, Leyna G. Predictors of mortality among children at a tertiary hospital in Tanzania: a cohort study. Egypt Pediatr Assoc Gaz [Internet]. 2024;72(1). Available from: https://doi.org/10.1186/s43054-024-00271-5 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5868295","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":406907129,"identity":"c7597822-e2f7-41ab-ab3f-8c2c6d4963dd","order_by":0,"name":"Mesfin Wubishet","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYLACxgYGBn5mxsYHH4AcNnZitUi2Nx82nAHSwkysFoMzx9KkeUA8Qlp029ufSfPuOGzXcCPHTNrm1zZ5PmYGxg8fc3BrMTtzxkya98zh5MYZOcbWuX23DduYGZglZ27Do+VGDttt3rbbycwSOYa3c3tuMwK1sDHz4tNy//kzsBY2iRwDacue2/aEtdxgMANpsePhOZYkzfDjdiJhLWdyzH/OPfM/QYIdGMi9DbeT25gZm/H75fjxxwZvd6TZ2x8GRuWPP7dt57c3H/zwEY8WGEhsAJGMbWCygbB6ILCHUH+IUjwKRsEoGAUjDAAAklVXLYUrFEAAAAAASUVORK5CYII=","orcid":"","institution":"Department of Pediatrics, Arsi University College of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mesfin","middleName":"","lastName":"Wubishet","suffix":""},{"id":406907130,"identity":"17655aec-5141-488e-8c63-ffd57c3a9a10","order_by":1,"name":"Solomon Gelaye","email":"","orcid":"","institution":"Department of Pediatrics, Arsi University College of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Solomon","middleName":"","lastName":"Gelaye","suffix":""},{"id":406907131,"identity":"1b594b81-a780-4174-bd59-c6ec8e13718e","order_by":2,"name":"Tahir Aman","email":"","orcid":"","institution":"Department of Anesthesia, Arsi University College of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Tahir","middleName":"","lastName":"Aman","suffix":""},{"id":406907132,"identity":"a0bbbe87-49eb-4643-90c2-0991a47e31ee","order_by":3,"name":"Betre Shimelis","email":"","orcid":"","institution":"Department of Pediatrics, Haramaya University College of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Betre","middleName":"","lastName":"Shimelis","suffix":""}],"badges":[],"createdAt":"2025-01-20 19:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5868295/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5868295/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74960598,"identity":"29cdc912-f1af-4206-a272-a311bd978095","added_by":"auto","created_at":"2025-01-28 18:52:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41039,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart showing enrollment of study participants.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5868295/v1/35d82a55502561dcaa06af55.png"},{"id":74960596,"identity":"aef103de-475b-4c3e-8507-e4e8416b752f","added_by":"auto","created_at":"2025-01-28 18:52:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20867,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eDistribution of treatment types administered during ICU stays for pediatric patients admitted to the ICU of ARTH in Southeast Ethiopia, 2024 (N=305).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5868295/v1/63dd4646eca5dff6f5357d05.png"},{"id":74960604,"identity":"e4322e88-ec09-481b-a605-ed0363a69fd8","added_by":"auto","created_at":"2025-01-28 18:52:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":53807,"visible":true,"origin":"","legend":"\u003cp\u003eOutcome at discharge among pediatric patients admitted to the ICU at ARTH, 2024 (N=305).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5868295/v1/2146f8b54d27d0c3584fdf8b.png"},{"id":74961561,"identity":"57cdb36c-64be-401c-a954-0419c85d25cc","added_by":"auto","created_at":"2025-01-28 19:00:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":31166,"visible":true,"origin":"","legend":"\u003cp\u003eImmediate causes of death among patients admitted to the ICU at ARTH in Southeast Ethiopia, 2024 (N=305).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5868295/v1/1aa79d8f6ee99a311dc54a7b.png"},{"id":74960606,"identity":"2b96e264-7c0c-407c-98a4-b59ac576fea8","added_by":"auto","created_at":"2025-01-28 18:52:10","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":143707,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier Survival Curve estimates of Pediatric patients admitted to ICU With and Without Organ Dysfunction. \u003cstrong\u003eLog-rank test\u003c/strong\u003e, \u003cem\u003eP \u003c/em\u003evalue \u0026lt; 0.001\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5868295/v1/7be771e134af8a459f91ac60.png"},{"id":74960610,"identity":"e477b549-7ab3-4fec-9bf8-b0c7ace3af3a","added_by":"auto","created_at":"2025-01-28 18:52:10","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":151418,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier Survival Curve estimates of Pediatric patients admitted to ICU With and without anemia. \u003cstrong\u003eLog-rank test\u003c/strong\u003e, \u003cem\u003eP \u003c/em\u003evalue = 0.001.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5868295/v1/5dedb41677e593caa39fa8e6.png"},{"id":74961938,"identity":"bd8a9ea7-48c0-4450-8219-4748103b5a25","added_by":"auto","created_at":"2025-01-28 19:08:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1844153,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5868295/v1/0b6a6971-b0db-4a0b-b359-2c7b03e6d1e9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Survival Status and Predictors of Mortality Among Pediatric Patients Admitted to Intensive Care Unit at a University Teaching Hospital in Southeastern Ethiopia: Insights from a Prospective Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntensive care is a multidisciplinary and interprofessional specialty focused on managing patients with serious organ dysfunction. The pediatric intensive care unit (PICU) is a specialized setting that delivers comprehensive medical and nursing care to critically ill children. The primary goal of the PICU is to closely monitor and treat these severely ill patients, who are at high risk of mortality(1). According to the World Health Organization (WHO), acute pediatric critical illness is defined as \u0026ldquo;any severe problem with the airway, breathing, or circulation, or acute deterioration of conscious state; which includes apnea, upper airway obstruction, hypoxemia, central cyanosis, severe respiratory distress, total inability to feed, shock, severe dehydration, active bleeding requiring transfusion, unconsciousness, or seizures\u0026rdquo;. \u0026nbsp;Children experiencing these critical issues are often admitted to the intensive care unit (ICU), where they need advanced support for their organ function, hemodynamics, and airway management(2).\u003c/p\u003e\n\u003cp\u003eDespite significant progress in reducing child mortality globally, the rates remain unacceptably high, with substantial disparities in survival chances across regions(3). According to a 2022 World Health Organization (WHO) report, most pediatric deaths in developing countries are caused by preventable and treatable illnesses, provided timely and optimized care is available(4). Over the past decades, high-income countries have achieved significantly lower pediatric mortality and morbidity rates following PICU admissions, largely due to advancements in medical care (5). \u0026nbsp;In contrast, pediatric critical care services in low-income countries, particularly in Sub-Saharan Africa (SSA), are often insufficient, contributing to high child mortality rates. These regions struggle with varying levels of infrastructure required for effective critical care, leading to challenging patient outcomes in resource-limited settings (6,7).\u003c/p\u003e\n\u003cp\u003eThe pediatric mortality rate in ICUs varies significantly between developed and developing countries, with particularly high rates observed in low-income countries (8\u0026ndash;12), compared to high-income countries(13\u0026ndash;15). In 2020, SSA recorded the world\u0026apos;s highest under-five mortality rate, accounting for 53% of all under-five deaths globally(3). Ethiopia ranked among the top five countries in the region with the highest under-five mortality, reporting 59 deaths per 1,000 live births (3,16). According to available evidence, the PICU is where the highest number of deaths occurs in most hospitals in Ethiopia. Studies conducted in the country have reported overall mortality rates for patients admitted to the PICU were 32.6%, 39.8%, and 28.6% with the most common causes of death being infections, cardiovascular, and respiratory disease, respectively (11,17,18). Pediatric ICUs play a critical role in saving the lives of children with acute life-threatening conditions, particularly in developing countries with high numbers of critically ill patients. However, data on the organization and outcomes of pediatric ICUs in low-income countries like Ethiopia are limited. This gap in information hinders efforts to improve practices and enhance patient outcomes. Most research on ICU mortality predictors comes from high-income countries and relies on clinical and laboratory indices that may not be accessible in resource-limited settings. Furthermore, existing studies are often retrospective and cross-sectional, failing to explore broader epidemiological and sociodemographic factors or to consider essential parameters, which further limits their relevance to resource-limited contexts (8,11,18\u0026ndash;20).\u003c/p\u003e\n\u003cp\u003eIdentifying mortality risk factors among children admitted to the PICU is crucial for optimizing resource allocation and improving outcomes, especially in resource-limited settings like ours. In southeastern Ethiopia, there is a notable lack of research on the factors affecting pediatric ICU outcomes. This cohort study aims to assess survival outcomes and identify mortality predictors among pediatric patients admitted to the ICU at ARTH in southeastern Ethiopia. The findings will provide valuable insights into the causes of mortality, enabling the development of targeted strategies to enhance survival rates for high-risk patients. By addressing these knowledge gaps and improving the ability to predict patient outcomes, this research has the potential to advance pediatric critical care practices in resource-constrained environments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Objectives of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTo determine the survival status and predictors of mortality among pediatric patients admitted to the intensive care unit at ATRH, Southeast Ethiopia, 2024.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Methods and Materials ","content":"\u003ch2\u003eStudy design, period, and setting\u003c/h2\u003e\n\u003cp\u003eAn institutional-based prospective cohort study was conducted among pediatric patients admitted to the ICU at Asella Referral and Teaching Hospital from September 2023 to November 2024. Asella Referral and Teaching Hospital (ARTH) is located in Asella City, southeast Ethiopia, and serves a population of over 3.5 million people. The hospital has more than 400 beds, including 6 dedicated ICU beds. The Department of Pediatrics and Child Health at ARTH includes various wards, totaling 103 beds across multiple units, such as the emergency unit, neonatal ICU, general ICU, High Dependency Unit (HDU), and general pediatric wards. The organizational detail of the ICU in this hospital is lacking. The ICU itself has a capacity of six beds, equipped with mechanical ventilators and patient hemodynamic monitoring systems. The unit is staffed by general pediatricians, anesthesiologists, pediatric residents, medical interns, and skilled ICU nurses, maintaining a nurse-to-patient ratio of 1:1. However, pediatric intensivists, respiratory therapists, and dietitians are not currently available at the facility.\u003c/p\u003e\n\u003ch2\u003eSource and study population.\u003c/h2\u003e\n\u003cp\u003eAll pediatric patients admitted to the ICUs at ARTH constituted our source population. The study population consisted of pediatric patients who were admitted to the ICU during the study period and met the inclusion criteria.\u003c/p\u003e\n\u003ch2\u003eEligibility criteria\u003c/h2\u003e\n\u003cp\u003eAll pediatric patients aged 1 month to 14 years who were admitted to the ICU during the study period and whose parents provided consent were included in the study. Exclusion criteria include pediatric patients who died upon arrival or within two hours of admission, surgical patients admitted solely for recovery purposes, and patients whose parents did not consent to participation.\u003c/p\u003e\n\u003ch2\u003eStudy variables\u003c/h2\u003e\n\u003ch3\u003eDependent variable: Time to death\u0026nbsp;(In ICU mortality)\u003c/h3\u003e\n\u003cp\u003eIndependent variables: The sociodemographic characteristics include age, gender, residence, and the caregiver\u0026apos;s educational status and occupation. The clinical characteristics of the patient encompass duration of illness before admission, reason for admission, Source of admission, frequency of admission, admission vital signs, Mental status, nutritional status, vaccination status, presence of comorbid illness, organ dysfunction, and intervention during ICU stay and before admission, PIM2 score, length of ICU stay, Health insurance status and complications after ICU admission.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eSample size determination and sampling procedures\u003c/h2\u003e\n\u003cp\u003eThe sample size (n) was determined using a single population proportion formula with the following assumptions: level of confidence (\u0026alpha;) was taken as 0.05; Z\u0026alpha;/2 = 1.96, a 5% margin of error (d = 0.05), and proportion of mortality 28.6% was taken from a study conducted at selected tertiary care hospitals in Ethiopia(21).\u0026nbsp;The initial sample size was 314; after adding a 10% contingency, the final sample size was calculated to be 345. During the study period, a total of 323 pediatric patients were admitted to the ICU. We collected data from 305 patients who met the inclusion criteria. \u0026nbsp;All pediatric patients admitted to the ICU during the study period and meeting the inclusion criteria were conveniently enrolled until the target sample size was achieved. Information about the study was provided to parents or guardians and informed written consent was obtained before recruitment.\u003c/p\u003e\n\u003ch2\u003eData collection tools and procedure\u003c/h2\u003e\n\u003cp\u003eTo ensure content validity, the data collection tool was adapted through a systematic review of related literature and modifications to capture data. Additionally, patient charts were reviewed according to the study\u0026rsquo;s objectives(11,17\u0026ndash;19,22\u0026ndash;25). The data collectors were trained pediatric residents and medical interns, who were also part of the patient care team and supervised by the principal investigator. After obtaining consent from the caretakers, the study participants were recruited at the time of their admission by the data collectors. They were closely monitored throughout their stay at the facility, with documentation of all significant clinical events until either they were censored or passed away. Key clinical characteristics such as systolic blood pressure (SBP), pupillary light reflex, oxygen saturation, and the need for mechanical ventilation (MV) were assessed within the first hour of admission and recorded in an electronic application to calculate the Pediatric Index of Mortality 2 (PIM2) score (26).\u0026nbsp;We collected sociodemographic data and medical history through interviews with caregivers. Patient data, including admission diagnosis, laboratory indices, and the clinical course during the hospital stay, were documented prospectively until the study participant died or was censored. We utilized the WHO International Classification of Diseases, 10th edition (ICD-10) to assign disease categories, and only the primary diagnoses, the major reason for the patient\u0026rsquo;s current admission, were taken as the final diagnosis for ICD-10 assignment in patients having multiple diagnoses\u0026nbsp;(27).\u003c/p\u003e\n\u003ch2\u003eData quality assurance\u003c/h2\u003e\n\u003cp\u003eTo assure data quality, the questionnaire was first prepared in English and then translated into the local languages (Afan Oromo, and Amharic) by language experts and fluent speakers of both languages, and it was translated back into English to check its consistency. A pretest was conducted on 5% of the sample at Adama Medical College before the actual data collection to assess the consistency and validity of the structured data collection format.\u0026nbsp;One day of Training on the study objective and how to review the documents per the data extraction format was given to data collectors. The collected data were double-checked by the data collectors and principal investigator before the data entry for completeness, accuracy, and clarity. Residents and interns were updated once every 4 weeks on the proper recording of the appropriate conditions in line with the WHO ICD-10 system.\u003c/p\u003e\n\u003ch2\u003eData processing and analysis\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eData were manually checked for completeness before being entered into Epi-data Manager version 4.6 and then into SPSS version 27 for statistical and survival analysis. Descriptive analysis was performed to recap baseline characteristics, and results were presented by the text, tables, and figures. Kaplan-Meier curves were computed to compare the survival status of patients. Bi-variable analysis was conducted, and variables having a \u003cem\u003eP\u003c/em\u003e-value \u0026lt;.25 were considered candidates for the multi-variable regression. A multi-variable Cox proportional hazard model was performed to identify the independent predictors of ICU mortality. The hazard ratio was used to assess the strength of the association and variables with a \u003cem\u003eP\u003c/em\u003e-value of .05 were considered statistically significant.\u003c/p\u003e\n\u003ch2\u003eOperational definition\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;Survival status\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The outcome of a pediatric patient admitted to ICU either event or censored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEvent (death):\u003c/em\u003e\u003c/strong\u003e is defined as a patient who died in the ICU during treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCensored:\u003c/em\u003e\u003c/strong\u003e refers to patients who were survived /discharged alive from the PICU or those with no event of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLoss to follow-up\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Patients who were referred to another hospital or discharged against medical advice without knowing their outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLength of ICU stays (LOS):\u003c/em\u003e\u003c/strong\u003e Was a period in hours, days, or months the patients stayed in ICU from admission time to discharge time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMODS:\u003c/em\u003e\u003c/strong\u003e refers to a potentially reversible physiologic derangement in two or more organ systems criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eICU Mortality:\u003c/em\u003e\u003c/strong\u003e was calculated as the number of deaths of patients given particular diagnoses divided by the total number of patients with that diagnosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eComorbidity:\u003c/em\u003e\u003c/strong\u003e A concurrent disease with the final diagnosis during hospitalization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eComplications at ICU\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Diseases developed during a stay in the ICU which is not reported upon admission.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, 325 pediatric patients were admitted, of which 305 met the inclusion criteria and were included in the final analysis. Among the enrolled patients, 18 were subsequently excluded for the following reasons: four were under one month of age, nine died within two hours of ICU admission, and five had parents who declined to provide consent, as illustrated in the study flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics of study participants\u003c/h2\u003e \u003cp\u003eThe study included 305 patients, of whom 186 (61%) were male, resulting in a female-to-male ratio of 1:1.6. The mean age of patients admitted to the ICU was 27.6 months (\u0026plusmn;\u0026thinsp;24.8 months). Nearly half of the participants, 152 (49.8%), were infants, while 21 (6.9%) were adolescents. Most patients, 215 (70.5%), lived in rural areas, and over half, 175 (57.4%), were primarily engaged in farming. Parents were the primary caregivers for most patients, accounting for 296 (97%), though about 61 (20%) of these caregivers lacked formal education. Of the patients, 88 (28.9%) were classified as severely malnourished (WFL\u0026thinsp;\u0026lt;\u0026thinsp;3 Z-score). Regarding vaccination, 149 (48.9%) were fully vaccinated. Additionally, 65 patients (21.3%) had comorbid illnesses, and 194 (63.6%) did not have health insurance coverage (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Characteristics of Pediatric Patients Admitted to the ICU at ARTH, Southeast Ethiopia, 2024 (N\u0026thinsp;=\u0026thinsp;305).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEvent (n\u0026thinsp;=\u0026thinsp;129)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCensored (n\u0026thinsp;=\u0026thinsp;176)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;305)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge in months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83(54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69(45.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e152 (49.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73(70.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e104 (34.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61\u0026ndash;120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(82.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (9.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121\u0026ndash;168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (6.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78(41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108(58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e186 (61.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e119 (39.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(64.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90 (29.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97(45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118(54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e215 (70.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrimary caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124(41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e172(58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e296 (97.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrandparents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCaregiver\u0026rsquo;s Education Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(63.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (20.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElementary school (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(37.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83(62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e132 (43.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary school (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54(72.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75 (24.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege/University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (12.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCaregiver\u0026rsquo;s occupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83(47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92(52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e175 (57.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployee (Govt./\u003c/p\u003e \u003cp\u003eprivate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27(55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (16.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43(76.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (18.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(56.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (8.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFrequency admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121(41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e171(58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e292(95.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReadmission (⩾2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCo-morbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27(41.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (21.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149(62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e240 (78.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVaccination status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFully vaccinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107(71.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e149 (48.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartially vaccinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61(51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57(48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e118 (38.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot vaccinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNutritional status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136(73.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e185 (60.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(46.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (10.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSAM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(73.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88 (28.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHealth insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87(78.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e111 (36.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105(54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89(45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e194 (63.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eClinical characteristics of study participants\u003c/h2\u003e \u003cp\u003eThe majority of PICU admissions were from the emergency department,192 (63.0%), followed by pediatrics wards,71 (23.3%), and referrals from other facilities 18 (5.9%). Among the patients, 251 (82.3%) were admitted due to medical conditions. Co-morbid illnesses were present in approximately one-fifth of the patients, totaling 65 (21.3%). Additionally, nearly half of the patients, 148 (48.5%), exhibited Multi-Organ Dysfunction Syndrome (MODS).\u003c/p\u003e \u003cp\u003eElevated creatinine levels were noted in 66 patients (21.6%), and 135 patients (44.3%) were anemic, with hemoglobin levels below 11 g/dL. The majority of patients, 266 (87.2%), received fluid resuscitation before their admission to the ICU. Upon arrival, severe impairment of consciousness was noted in 87 patients (28.5%), and 256 patients (83.9%) had oxygen saturation levels below 90%. The mean PIM-2 score was 8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54, with 156 patients (51.1%) scoring below 5. Mechanical ventilation was required for 87.2% of the patients. During their stay in the ICU, complications occurred in 80 patients (26.2%), with the most common being hospital-acquired infections (30%), followed by aspiration pneumonia (28.8%) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Characteristics of Pediatric Patients Admitted to the ICU at ARTH in Southeast Ethiopia, 2024 (N\u0026thinsp;=\u0026thinsp;305).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEvent (n\u0026thinsp;=\u0026thinsp;129)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCensored (n\u0026thinsp;=\u0026thinsp;176)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;305)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePatient Category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e251(82.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (59.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54 (17.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAdmission source\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatric EOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107 (55.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e192 (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReferral from Other facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (5.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical/OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (7.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatric ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71 (23.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134 (63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e212 (69.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93 (30.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131 (60.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e218 (71.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87 (28.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOxygen saturation (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (44.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 (55.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e256 (83.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 to 100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (69.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (16.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMODS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e148 (48.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121 (77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e157 (51.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCreatinine level (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170 (71.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e239 (78.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElevated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66 (21.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHemoglobin (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e135 (44.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118 (69.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e170 (55.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFluid Resuscitation Before ICU Admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e147 (48.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113 (71.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e158 (51.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePIM2 score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e149 (48.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e156 (51.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMechanical ventilator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124 (46.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 (53.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e266 (87.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (87.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (12.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIn-ICU complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80 (26.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e130 (57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e225 (73.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eLength of ICU stay (in days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (65.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (23.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94 (59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e159 (52.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (76.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (18.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u0026ndash;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (5.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cb\u003eReason for admission and the type of treatment given during the ICU stay.\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eSevere pneumonia with impending respiratory failure was the most common reason for ICU admission, accounting for 90 cases (29.5%), followed by septic shock (40 cases, 13.1%) and complicated meningitis (29 cases, 9.5%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Nearly all patients, 301(98.7%), were treated with antibiotics, and most, 289(94.8%), required respiratory support, such as oxygen therapy. Other frequently administered treatments included fluid resuscitation 148 (48.5%), Steroids 135 (44.3%), and nutritional treatments 132(43.3%). Inotropic support was provided to nearly one-third of the patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Mechanical ventilation was needed for most patients 266 (87.2%), with 255 (95.9%) undergoing intubation. However, 11 patients (4.1%) could not be intubated due to the unavailability of mechanical ventilators. The duration of ventilator support ranged from 1 to 22 days, with an average of 7.34 days. The ICU length of stay ranged from 4 hours to 28 days, with an average stay of 6 days.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReason for Admission to the ICU Among Pediatric Patients in ARTH, Southeast Ethiopia, 2024 (n\u0026thinsp;=\u0026thinsp;305).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEvent (n\u0026thinsp;=\u0026thinsp;129)\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCensored (n\u0026thinsp;=\u0026thinsp;176)\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere Pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (55.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeptic Shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (72.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (27.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplicated meningitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (58.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epost-operative patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePARDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchiolitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGullian-Barre syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic Brain Injury (TBI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (58.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatus epilepticus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisseminated tuberculosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere Asthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (85.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongestive heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper airway obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere DKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiogenic shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiscellaneous conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSurvival status and incidence of In-ICU mortality among Pediatric Patients\u003c/h2\u003e \u003cp\u003eDuring the study period, 129 pediatric patients (42.3%) died in the ICU, while 176 patients (57.7%) were censored. Among the censored patients, 131 (43%) were discharged alive, 38 (12.5%) were left against medical advice, and seven (2.3%) were referred to other facilities (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn this study, patients were monitored for a period ranging from 4 hours to 28 days, with a median ICU stay of 5 days (IQR: 2\u0026ndash;7 days). Over the study period, there were 1,821 person-day observations, equivalent to 60.8 person-months. Among the 305 participants, 129 (42.3%) died during the follow-up period, resulting in an incidence rate of ICU mortality of \u003cb\u003e7.1 deaths\u003c/b\u003e per 100 person-days (95% CI: 5.86\u0026ndash;8.32 deaths per 100 person-days).\u003c/p\u003e \u003cp\u003eThe median survival time for all patients was 10 days. Of the patients who died, the majority 112 (86.8%) died within the first 7 days, 13 patients (10.1%) died between 7 and 14 days, and the remaining deaths occurred after 2 weeks of ICU admission. The primary causes of death were multiorgan failure (40.3%), respiratory failure (33.3%), cardiopulmonary failure (10.1%), brain herniation (9.3%), and cardiac arrest (7%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe comparison of survival functions among different mortality predictors in pediatric ICU patients was evaluated. Patients with organ dysfunction had a median survival of 6.0 days (95% CI: 5.34\u0026ndash;6.66), compared to 19.0 days (95% CI: 7.54\u0026ndash;30.46) for those without organ dysfunction (log-rank P\u0026thinsp;\u0026lt;\u0026thinsp;.001). Patients with elevated creatinine levels had a median survival of 19.0 days (95% CI: 11.56\u0026ndash;26.85), while those with normal creatinine levels had a median survival of 4.0 days (95% CI: 3.48\u0026ndash;5.31) (log-rank P\u0026thinsp;\u0026lt;\u0026thinsp;.001). Additionally, patients diagnosed with anemia had a median survival of 6.0 days (95% CI: 5.33\u0026ndash;6.67), whereas those without anemia had a median survival of 19.0 days (95% CI: 11.45\u0026ndash;26.55) (log-rank P\u0026thinsp;=\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Baseline differences between the patient strata were analyzed using the log-rank (χ\u0026sup2;) test, and the equality of hazards was assessed for the explanatory variables. Kaplan-Meier survival curves were plotted for organ dysfunction (P\u0026thinsp;=\u0026thinsp;.019), and Hemoglobin level (P\u0026thinsp;=\u0026thinsp;.008), all of which showed significant differences (Figs.\u0026nbsp;5\u0026ndash;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe mean and median survival times, along with the corresponding 95% CI, among various predictors of mortality in pediatric patients admitted to the ICU at ARTH, 2024 (N\u0026thinsp;=\u0026thinsp;305).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean survival time (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian survival time (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHealth insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.70(17.93,23.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.0(19.32,25.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.52(7.12,9.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.0(6.23,7.77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOrgan dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.74(7.15,10.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0(5.34,6.66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.22(14.51,21.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.0(7.54,30.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCreatinine (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.46(15.19,19.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.0(11.56, 26.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElevated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.06(3.90,6.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0(3.48,5.31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHemoglobin (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.23 (6.65,9.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0 (5.33,6.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.58 (14.02, 19.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.0 (11.45, 26.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePIM2 score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.52 (7.12, 9.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.00 (5.25, 6.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.76 (14.94, 20.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.00 (12.19, 25.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePredictors of mortality among pediatric patients admitted to ICU\u003c/h2\u003e \u003cp\u003eThe Cox proportional hazards model was used to identify factors associated with mortality within the ICU. In the univariate analysis, variables with a p-value less than 0.25 were identified as potential predictors for inclusion in the multivariable analysis. In a multivariate Cox proportional hazards regression model, health insurance status, multi-organ dysfunction, creatinine levels, hemoglobin levels, and PIM-2 scores were identified as predictors of mortality.\u003c/p\u003e \u003cp\u003e The mortality hazard \u003cb\u003ewas twofold higher\u003c/b\u003e for patients without health insurance coverage during their ICU stay (AHR: 2.03; 95% CI: 1.22, 3.39; P\u0026thinsp;=\u0026thinsp;.007) compared to those with health insurance. Additionally, the risk of mortality was 1.7 times higher in patients with organ dysfunction (AHR: 1.73; 95% CI: 1.09\u0026ndash;2.73; P\u0026thinsp;=\u0026thinsp;.019) and 1.8 times higher in patients with elevated creatinine levels (AHR: 1.82; 95% CI: 1.13\u0026ndash;2.93; P\u0026thinsp;=\u0026thinsp;.013) compared to their counterparts. Anemia was associated with a 1.7-fold increased risk of mortality (AHR: 1.73; 95% CI: 1.15\u0026ndash;2.60; P\u0026thinsp;=\u0026thinsp;.008), while patients with a PIM2 score above five had a 1.6 times higher mortality risk (AHR: 1.58; 95% CI: 1.03\u0026ndash;2.43; P\u0026thinsp;=\u0026thinsp;.038) than those with a score below five \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate and multivariable Cox proportional hazard regression analysis for mortality predictors among pediatric patients admitted to the ICU at ARTH, southeast Ethiopia, 2024(N\u0026thinsp;=\u0026thinsp;305).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSurvival status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCHR (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAHR (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eEvent\u003c/b\u003e n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCensored\u003c/b\u003e n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge in months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83(54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69(45.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73(70.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.49(0.33, 0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.67 (0.42, 1.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61\u0026ndash;120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(82.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.27(0.11, 0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.75 (0.27, 2.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121\u0026ndash;168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.93(0.48, 1.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.87 (0.81,4.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(64.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97(45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118(54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.32(0.89, 1.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.42 (0.92, 2.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCo-morbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27(41.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.66 (1.14, 2.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.39 (0.89, 2.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149(62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHealth insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87(78.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105(54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89(45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.41 (2.16, 5.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2.03\u003c/b\u003e (1.22, 3.39) \u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNutritional status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136(73.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(46.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.74 (0.97, 3.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.42 (0.76, 2.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSAM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(73.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.16 (2.18, 4.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.53 (0.97, 2.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134 (63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.76(0.53, 1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81 (0.55, 1.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNeed mechanical ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124 (46.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 (53.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.89 (1.18, 7.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.05 (0.77, 5.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (87.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOrgan dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.14(2.14, 4.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.73\u003c/b\u003e (1.09, 2.73) \u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121 (77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCreatinine (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170 (71.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElevated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.37(3.08, 6.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.82\u003c/b\u003e (1.13, 2.93) \u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHemoglobin (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.39(1.67, 3.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.73\u003c/b\u003e (1.15, 2.60) \u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118 (69.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePIM2 score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.86(1.95, 4.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.58\u003c/b\u003e (1.03, 2.43) \u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVaccination status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFully vaccinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107(71.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartially vaccinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61(51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57(48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.12(1.43, 3.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.12 (0.66, 1.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot vaccinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.89(1.77, 4.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.76 (0.39, 1.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGCS at admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131 (60.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.11 (0.77, 1.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.67 (0.43, 1.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eKeys: AHR\u003c/b\u003e, adjusted hazard ratio; \u003cb\u003eCHR\u003c/b\u003e, crude hazard ratio; \u003cb\u003eCI\u003c/b\u003e, confidence interval; \u003cb\u003eGCS\u003c/b\u003e, Glasgow coma scale; \u003cb\u003eICU\u003c/b\u003e, intensive care unit; \u003cb\u003eMV\u003c/b\u003e, mechanical ventilation; \u003cb\u003ePIM2\u003c/b\u003e, pediatric index of mortality 2; \u003cb\u003e1\u003c/b\u003e, reference group; *Shows statistical significance at a \u003cem\u003ep-\u003c/em\u003evalue\u0026thinsp;\u0026lt;\u0026thinsp;0.05. \u003cb\u003eBold variables\u003c/b\u003e with significant association.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis prospective cohort study aimed to assess the survival status and identify mortality predictors among pediatric patients admitted to the intensive care units at ARTH. Notably, it represents the first reported prospective cohort analysis of pediatric ICU admissions in Southeast Ethiopia. The study highlights a high mortality rate and identifies several key predictors of mortality, including lack of health insurance coverage, presence of organ dysfunction, elevated creatinine levels, hemoglobin levels below 10 g/dL, and a modified PIM2 score greater than five. These findings provide valuable insights for clinicians and healthcare planners, enabling evidence-based medical practice in resource-limited settings and facilitating prognosis-tailored care and efficient resource allocation.\u003c/p\u003e\n\u003cp\u003eAccording to this study, the overall in-ICU mortality among pediatric patients was 42.3%, with an incidence of 7.1 deaths per 100 person-day observations. This finding is consistent with mortality rates from studies conducted in Ethiopia: Addis Ababa at 43.8%(11), Wolayita at 41.7%(24), and Jimma at 40%(28). \u0026nbsp;Additionally, a study from Tanzania reported a mortality rate of 41.1%(29). However, these rates are lower than those found in other studies from low-income countries, such as a cohort study in Tanzania that reported a mortality rate of (49.8%) (12), and studies from Malawi (54.3%)(25), Rwanda (50%)(10), and Egypt (50.49%)(30). The differences in mortality rates among pediatric patients can be attributed to variations in study locations and settings, a scarcity of trained staff, and a lack of available resources(19).\u003c/p\u003e\n\u003cp\u003eThe in-ICU pediatric mortality rate in this study was higher than in recent Ethiopian studies, such as Ayder Referral Hospital (8.5%)(8), Gondar (32%)(17), Northwest Ethiopia (23.6%)(31), tertiary care hospitals in Ethiopia (28.6%)(18), and a systematic review that reported (28.5%)(32). This variation may arise from differences in sample sizes, study designs, resource limitations, the absence of a dedicated pediatric intensive care unit (ICU), which leads to pediatric and adult patients being managed together in a general ICU, and the lack of trained pediatric intensivists in the current study's setting. Additionally, inadequate transportation for critically ill children often leads to delayed arrivals and poor outcomes. The shortage of trained pediatric intensivists may also contribute to the high mortality rates in the pediatric ICU in our setting, which aligns with previous findings that indicate higher ICU mortality rates in locations without intensivist support(33). Furthermore, When we compare the proportion of mortality in PICUs in the present study with other lower-income countries, the mortality rate in our PICU is higher than the mortality rates in studies done in India (10.58%)(34), Nepal 12.6%(35), Pakistan 12.9%(36), rural North India 13.40%(37), South Africa (15.6%)(38), Iran16.5%(39), and Mozambique (25%)(40). The observed disparity could potentially be attributed to variations in economic status between the two study areas, which influence the availability and utilization of medical technology and consequently impact patient outcomes, and the hospital's role as a tertiary center receiving delayed referrals from distant locations, which may result in delayed admission and poor clinical outcomes(41). Many families, living in rural areas with limited infrastructure, often seek traditional healers before accessing medical care, leading to advanced stages of illness upon arrival. Additional contributing factors include a weak referral system, a shortage of skilled medical professionals, and inadequate PICU infection prevention and control practices. Furthermore, the lack of a high-dependency unit in the study area could be one of the factors contributing to the higher rate of ICU mortality.\u003c/p\u003e\n\u003cp\u003eIn our study, we found that organ dysfunction was an independent predictor of ICU mortality among pediatric patients. Our rate of MODS was 48.5%, which is significantly higher than the rates reported in studies from Ethiopia (30.7%) (17), India(7.6%) (42) and Egypt(41.3%) (43).\u0026nbsp;This discrepancy may be attributed to delayed admission to the PICU and limited early resuscitation practices in our setting, both of which are crucial for preventing organ failure.\u0026nbsp;This study revealed that Children admitted with organ dysfunction had a mortality risk of 1.7 times higher than those without organ dysfunction (P = .019).\u0026nbsp;Similar findings have been reported in previous studies, including data from a U.S. database on children admitted to various PICUs (44), a cohort study conducted in Tanzania (12) and a cross-sectional study at a tertiary hospital in Ethiopia(45).\u0026nbsp;This can be explained by the idea that organ dysfunction indicates the severity and advanced stage of an illness, resulting in either immediate mortality or the presence of sequelae that increase the long-term risk of mortality.\u003c/p\u003e\n\u003cp\u003eAmong the various tools for assessing disease severity at baseline, the PIM 2 score does not require extensive laboratory investigations and is unaffected by subsequent interventions. Since it is scored within one hour of admission, it enables early identification of illness severity, facilitating timely stratification of children for necessary interventions and providing essential information for counseling caregivers (46,47). In this study, we used a modified version of the PIM 2 score due to the unavailability of an arterial blood gas analyzer in our ICU during the study period. This scoring system has been validated and widely used in PICUs worldwide (48,49). \u0026nbsp;Patients with a modified PIM 2 score greater than five had a 1.6 times higher mortality risk than those with a low score, demonstrating its sensitivity in predicting outcomes. This finding aligns with earlier studies(17,37,50). However, the higher mortality rate observed in our study compared to predictions by the modified PIM 2 score highlights the poor quality of intensive care in our setting. Focusing care on patients with high modified PIM 2 scores, using the tool to predict outcomes, and directing resources to those most in need could improve critical care outcomes in low-income settings.\u003c/p\u003e\n\u003cp\u003eIn our study, \u003cstrong\u003e66 patients (21.6%)\u003c/strong\u003e had elevated creatinine levels at admission, this finding was comparable with the study done in Egypt which reports 23.7%, However, our AKI incidence was much lower than the 56% reported in an Egyptian study, which included only 60 patients(51). Differences in disease severity, coexisting conditions, and study populations may explain this discrepancy. This study found that elevated creatinine levels were an independent risk factor for mortality. These findings align with a major international study on AKI in children and young adults in ICUs, which identified severe AKI as an independent risk factor for death by day 28 after adjusting for covariates(52). \u0026nbsp;Additionally, Our result is consistent with the recent prospective study done in Egypt children with acute kidney injury were 11.6 times at increased risk of mortality(53), and in another multi-center cohort study done in Canada AKI was associated with increased mortality (adjusted odds ratio (OR) 3.7 (54). Our result is consistent with a study done by Samuels et al. (55). The reason could be an increased creatinine level indicates a kidney injury resulting in a loss of function in which metabolism is greatly affected, which leads to electrolyte imbalance and metabolic acidosis that greatly impacts mortality(56). In addition, patients with compromised kidney function noted increased creatinine levels might have associated comorbid conditions and sepsis, which could reduce the likelihood of survival(54,57).\u003c/p\u003e\n\u003cp\u003eAnemia was common in this study cohort at ICU admission of \u003cstrong\u003e135 patients (44.3%)\u003c/strong\u003e and was also associated with a significantly increased relative risk of death. This finding was in line with a Pediatric Cohort study done in Malawi which showed hemoglobin \u0026lt; 10 g/dl was associated with increased ICU mortality(25). Anemia is a known driver of ICU morbidity and mortality worldwide. Children in sub-Saharan Africa are at increased risk for anemia independent of their critical illness, secondary to overlapping tropical infectious diseases, poverty, and malnutrition(58–60). In sub-Saharan Africa, 12–29% of hospitalized children are severely anemic, with an in-hospital case fatality rate of between 8% and 17%(61). \u0026nbsp;In our cohort, the etiology of anemia at ICU admission is unknown. Recurrent laboratory assessments are not common in this low-resource hospital setting. Given the relatively low prevalence of HIV (4.0%) and malaria (29.4%), these conditions did not likely contribute meaningfully to mortality. With the large proportion of post-surgical ICU admissions (39%), acute traumatic and surgical losses likely contributed to some proportion of the observed anemia. This suggests anemia may be a modifiable risk factor for ICU mortality in this cohort. Future research must focus on elucidating the etiology of this condition to determine the best treatment and prevention course.\u003c/p\u003e\n\u003cp\u003eIn our study, only 36.4% of the children had mothers with health insurance, significantly lower than the 97.7% reported in a study from Nigeria (62). This discrepancy highlights the low health insurance coverage in the study area. Children with health insurance were found to be twice as likely to survive compared to those without, a finding consistent with a cohort study conducted in Tanzania (63). This suggests that inadequate healthcare access, likely due to mothers lacking health insurance, contributes to higher child mortality rates. Children with health insurance benefit from improved healthcare access. Moreover, the country's efforts to adopt universal health coverage through relevant legislation are expected to enhance access to care and reduce mortality rates (62). The higher mortality rates in the Intensive Care Unit require immediate attention. Research indicates that well-equipped PICUs with trained intensivists and professionals improve outcomes. Therefore, we recommend that planners and hospital administrators address staffing and equipment shortages in the ICU of Asella Referral and Teaching Hospital.\u003c/p\u003e\n\u003ch1\u003eStrengths and limitations of the study\u003c/h1\u003e\n\u003cp\u003eThis prospective cohort study employed survival analysis, a robust statistical method, to identify predictors of mortality. However, the calculation of the PIM 2 score was based on only nine out of the eleven parameters, as an arterial blood gas analyzer was unavailable in the ICU during the study period. The study also did not comprehensively assess the availability of medical equipment or the quality of ICU care, nor did it explore how these factors might influence patient survival using standard parameters. Furthermore, the study excluded patients who died within the first two hours of admission, which could have led to an underestimation of the overall mortality rate. Accurately determining the primary cause of death in children with multiple diagnoses also presented challenges.\u003c/p\u003e"},{"header":"Conclusion and Recommendation","content":"\u003cp\u003eThe study revealed a higher incidence of in-ICU mortality among pediatric patients compared to the previous studies. Significant predictors of ICU mortality included elevated creatinine levels, higher PIM 2 scores, hemoglobin levels below 10 g/dL, lack of health insurance, and the presence of multi-organ dysfunction.\u003c/p\u003e\n\u003cp\u003eEarly recognition, resuscitation, and timely transfer of critically ill patients are essential for preventing and improving outcomes in cases of multi-organ dysfunction syndrome (MODS). Close monitoring and meticulous care are particularly important for patients with higher Pediatric Index of Mortality 2 (PIM 2) scores. The modified PIM 2 score can be a valuable tool for prioritizing care for high-risk patients, ensuring resources are allocated to those most in need, and providing appropriate guidance to their caregivers. To address the impact of low health insurance coverage on child mortality, targeted initiatives should focus on increasing enrollment among caregivers. This can include implementing community-based health insurance programs, offering subsidies for low-income families, and conducting awareness campaigns to highlight the benefits of health insurance. Additionally, policies and programs should be developed to ensure equitable access to health insurance, reducing financial barriers to critical healthcare services for children.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAGN:\u003c/strong\u003e Acute Glomerulonephritis;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAHR:\u003c/strong\u003e Adjusted Hazard Ratio,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAKI:\u003c/strong\u003e Acute Kidney Injury,\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eARDS:\u003c/strong\u003e Acute Respiratory Distress Syndrome;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eARTH;\u003c/strong\u003e Asella Referral and Teaching Hospital\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCHR:\u003c/strong\u003e Crude Hazard Ratio,\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eCI:\u003c/strong\u003e Confidence Intervals,\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGCS:\u003c/strong\u003e Glasgow Coma Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;HAP:\u003c/strong\u003e Hospital Acquired Pneumonia,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCD:\u003c/strong\u003e International Classifications of Disease,\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eICU:\u003c/strong\u003e Intensive Care Unit,\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eIQR:\u003c/strong\u003e Interquartile Range,\u003cbr\u003e\u003cstrong\u003eIR:\u003c/strong\u003e Incidence Rate,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLAMA:\u003c/strong\u003e Left Against Medical Advice,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLOS:\u003c/strong\u003e Length of Hospital stay,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMAM:\u003c/strong\u003e Moderate Acute Malnutrition,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMODS:\u003c/strong\u003e Multiple Organ Dysfunction Syndrome,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMV:\u003c/strong\u003e Mechanical Ventilation,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePICU:\u003c/strong\u003e Pediatric Intensive Care Unit,\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;PIM2:\u003c/strong\u003e Pediatrics Index of Mortality 2,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSAM:\u003c/strong\u003e Severe acute Malnutrition,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSSA:\u003c/strong\u003e Sub-Saharan Africa\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTBI:\u003c/strong\u003e Traumatic Brain Injury;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUSA\u003c/strong\u003e: United States of America,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO:\u003c/strong\u003e World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their sincere gratitude to the data collectors and hospital staff for their invaluable support and assistance during the data collection process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMW;\u0026nbsp;\u003c/strong\u003econtributed to the conception and design of the study, proposal development, data collection, analysis, review, and preparation of the manuscript. \u003cstrong\u003eSG, TA,\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;BS;\u003c/strong\u003e contributed to conception and design; contributed to acquisition, analysis, and interpretation; drafted manuscript; critically revised manuscript. All authors read and approved the final version of the manuscript for publication, and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethical Review Committee (ERC) of Arsi University College of Health Science under [Protocol No. \u003cstrong\u003eA/CHS/RC/120/2290/15]\u003c/strong\u003e. Informed, written, and signed consent was obtained from hospital administrators before the data collection. Anonymity was maintained by using identification numbers instead of patient names. Additionally, all extracted data were kept confidential and not used for any other purpose than the stated objective, and all methods were carried out per ethical guidelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest concerning the research authorship, and/or publication of this article. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) received no financial support for the research authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and Sharing Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eORCID iDs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMesfin Wubishet; https://orcid.org/0009-0004-8758-9424\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMarshall JC, Bosco L, Adhikari NK, Connolly B, Diaz J V., Dorman T, et al. 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Available from: https://pubmed.ncbi.nlm.nih.gov/27959707/\u003c/li\u003e\n\u003cli\u003eMahmoud RA, Abdelatif RG, Bakheet MAM, Mohamed MM. Predictors of Outcome in an Egyptian Pediatric Intensive Care Unit. Egypt J Hosp Med. 2023;90(1):1558\u0026ndash;69. \u003c/li\u003e\n\u003cli\u003eAlkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: A two-center retrospective cohort study. Crit Care. 2011 Jun 10;15(3). \u003c/li\u003e\n\u003cli\u003eSamuels J, Ng CS, Nates J, Price K, Finkel K, Salahudeen A, et al. Small increases in serum creatinine are associated with prolonged ICU stay and increased hospital mortality in critically ill patients with cancer. Support Care Cancer [Internet]. 2011 Oct 15 [cited 2024 Dec 29];19(10):1527\u0026ndash;32. Available from: https://link.springer.com/article/10.1007/s00520-010-0978-7\u003c/li\u003e\n\u003cli\u003eHonore PM, Jacobs R, Joannes-Boyau O, De Regt J, Boer W, De Waele E, et al. Septic AKI in ICU patients. diagnosis, pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and future developments. Ann Intensive Care. 2011;1(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eHarrois A, Libert N, Duranteau J. Acute kidney injury in trauma patients. Curr Opin Crit Care [Internet]. 2017 Dec 1 [cited 2024 Dec 29];23(6):447\u0026ndash;56. Available from: https://journals.lww.com/co-criticalcare/fulltext/2017/12000/acute_kidney_injury_in_trauma_patients.2.aspx\u003c/li\u003e\n\u003cli\u003eEnglish M, Ahmed M, Ngando C, Berkley J, Ross A. Blood transfusion for severe anaemia in children in a Kenyan hospital. Lancet (London, England) [Internet]. 2002 Feb 9 [cited 2024 Dec 28];359(9305):494\u0026ndash;5. Available from: https://pubmed.ncbi.nlm.nih.gov/11853798/\u003c/li\u003e\n\u003cli\u003eKoram KA, Owusu-Agyei S, Utz G, Binka FN, Baird JK, Hoffman SL, et al. Severe anemia in young children after high and low malaria transmission seasons in the Kassena-Nankana district of northern Ghana. Am J Trop Med Hyg [Internet]. 2000 [cited 2024 Dec 28];62(6):670\u0026ndash;4. Available from: https://pubmed.ncbi.nlm.nih.gov/11304052/\u003c/li\u003e\n\u003cli\u003eCalis JCJ, Phiri KS, Faragher EB, Brabin BJ, Bates I, Cuevas LE, et al. Severe anemia in Malawian children. Malawi Med J [Internet]. 2016 Feb 28 [cited 2024 Dec 28];28(3):99\u0026ndash;107. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa072727\u003c/li\u003e\n\u003cli\u003eLackritz EM, Campbell CC, Ruebush TK, Hightower AW, Wakube W, Were JBO. Effect of blood transfusion on survival among children in a Kenyan hospital. Lancet (London, England) [Internet]. 1992 Aug 29 [cited 2024 Dec 28];340(8818):524\u0026ndash;8. Available from: https://pubmed.ncbi.nlm.nih.gov/1354285/\u003c/li\u003e\n\u003cli\u003eImo CK, De Wet-Billings N, Isiugo-Abanihe UC. The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study. Arch Public Heal [Internet]. 2022;80(1):1\u0026ndash;12. Available from: https://doi.org/10.1186/s13690-022-00968-2\u003c/li\u003e\n\u003cli\u003eDamian DK, Furia FF, Leyna G. Predictors of mortality among children at a tertiary hospital in Tanzania: a cohort study. Egypt Pediatr Assoc Gaz [Internet]. 2024;72(1). Available from: https://doi.org/10.1186/s43054-024-00271-5\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Survival status, Predictors, Mortality, PICU, Southeast Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-5868295/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5868295/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Pediatric mortality rates in intensive care units (ICUs) are much higher in developing countries compared to high-income nations. Although advancements in pediatric intensive care have improved outcomes worldwide, resource-limited settings still face significant challenges. The high burden of disease and mortality from preventable illnesses further complicate patient outcomes in these under-resourced ICUs. In Ethiopia, there is limited published data on pediatric ICU outcomes and their influencing factors. This study aimed to assess survival status and identify predictors of mortality among pediatric patients admitted to the ICU at Asella Referral and Teaching Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e An Institutional-based prospective cohort study was conducted in the ICU, involving 305 pediatric patients admitted between September 2023 and November 2024. We consecutively recruited eligible patients and followed them until they were either censored or died. Kaplan Meier was used to compare patient survival experiences and Cox regression analyses were used to identify independent predictors of ICU mortality. The strength of associations was measured using hazard ratios, and statistical significance was determined at a P-value of \u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn this cohort, A total of 129/305 patients died during the follow-up time, yielding an overall mortality of 42.3%. The mortality incidence was 7.1 deaths per 100 person-days of observation (95% CI: 5.86–8.32 deaths per 100 person-days), with a median survival time of 10 days. The independent predictors of ICU mortality include: Lack of health insurance (AHR: 2.03; 95% CI: 1.22–3.39; P = .007), Presence of multi-organ dysfunction (AHR: 1.73; 95% CI: 1.09–2.73; P = .019), Elevated creatinine levels (AHR: 1.82; 95% CI: 1.13–2.93; P = .013), Hemoglobin levels below 10 g/dL (AHR: 1.73; 95% CI: 1.15–2.60; P = .008), and Higher PIM 2 scores (AHR: 1.58; 95% CI: 1.03–2.43; P = .038).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe study found a concerningly high mortality rate among pediatric patients in the ICU. Key predictors of ICU mortality included elevated creatinine levels, higher PIM 2 scores, hemoglobin levels below 10 g/dL, lack of health insurance, and the presence of multi-organ dysfunction. These findings underscore the urgent need for early intervention strategies targeting these risk factors, particularly in high-risk patients, to enhance outcomes in pediatric critical care and significantly reduce ICU mortality rates.\u003c/p\u003e","manuscriptTitle":"Survival Status and Predictors of Mortality Among Pediatric Patients Admitted to Intensive Care Unit at a University Teaching Hospital in Southeastern Ethiopia: Insights from a Prospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-28 18:52:04","doi":"10.21203/rs.3.rs-5868295/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-12T07:06:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-18T12:05:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"193658696061135778366620448964571458233","date":"2025-04-08T12:38:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179581152415590813220871123903610516662","date":"2025-04-08T11:23:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T07:47:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73625327059472441651875770996050075568","date":"2025-04-03T13:33:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"99109335733689565790578057733302418711","date":"2025-03-31T12:03:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"186844978224754505160763583384508076289","date":"2025-03-27T04:16:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209695358298744429877404462762127742277","date":"2025-03-24T17:46:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-21T17:03:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249593838003610206774354953015414306596","date":"2025-03-20T08:04:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-20T06:30:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-01-28T16:58:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-25T03:07:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-25T03:07:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-01-20T19:04:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"342754b6-daa2-4fa3-a9c7-9e0f88038bdc","owner":[],"postedDate":"January 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-19T22:53:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-28 18:52:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5868295","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5868295","identity":"rs-5868295","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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