Pattern of neurological dysfunctions in pediatric intensive care unit

Abstract

The aim of this retrospective study is to evaluate the burden, characterize the demographics and visualize the final outcome of the critical neurological cases admitted to a tertiary pediatric intensive care unit in Cairo University Children Hospital. Data of 139 pediatric critical care patients admitted with neurological dysfunction were reviewed, retrospectively. Patients with critical neurological illness represented 30% of the total admissions (n = 139). Coma patients (n = 115, 83%) were divided into structural/intrinsic coma (n = 54, 47%) and metabolic/toxic (n = 61, 53%). Patients with neuromuscular disorders comprised 17% (24/139) of the cohort. Patients with toxic/metabolic coma had higher Pediatric Risk of Mortality scores, higher inotrope scores, more organ system failures, a higher percentage of pre admission cardiac arrests and higher frequency of septic shock diagnosis. Predictors of death in the whole group included (a) Number of organ failure: patients with three or more organ systems failure were 3.1 times more liable to die (b) Glasgow Coma Scale (GCS): cases with GCS score less than eight were 4.2 times more prone to die, (c) Those who developed acute lung injury in less than 14 days of mechanical ventilation were 10.7 times more prone to die than those who had not. Patients with toxic/metabolic coma required more intensive support giving into consideration that advanced sepsis and presence of a family member with drug addiction played a big role as an underlying cause. National programs for implementation of sepsis goal directed therapy and health awareness about the hazards of accidental drug intake are of supreme importance. Predictive factors for death in coma patients on admission were low GCS score, presence of multiple organ system failure and acute lung injury.

Keywords

Neurological dysfunction - PICU - critical pediatric patients - mortality