Characteristics and Outcomes of Patients Admitted to a Pediatric Intensive Care Unit in Southwest of Iran
-
Mohsen Alisamir
,
Mohammadreza Mirkarimi
,
Sadegh Mirzaee
,
Solmaz Heidari
,
Shahriar Barouti
,
Shooka Mohammadi
Abstract
Data on pediatric critical care in Iran are insufficient. This study was performed to determine the outcomes and characteristics of critically ill children admitted to a pediatric intensive care unit (PICU) in Ahvaz, Iran. A retrospective study was conducted among all patients in the PICU of Abuzar Hospital for one year. Their medical documents were reviewed. A total of 400 patients were identified. The average age of patients was 29.94±39.55 months, and 53.8% of them were males. Nearly half of the cases were under age one. The most prevalent causes of PICU admission were respiratory (36.5%), neurological (18.5%), and infection-related diseases (15%). Besides, 55.7% of patients (n=223) had no history of underlying health problems. Admissions were more frequent in winter (n=125; 31.3%) and spring (n=101; 25.3%). The mortality rate and the mean hospital length of stay (LOS) were 15.5% and 10.79±6.39 days, respectively. In addition, 231 patients had an abnormal respiratory rate and a quarter of them (n=97) required ventilation support. Moreover, 377 and 82 patients were malnourished and severely underweight, respectively. A significant association was found between the mortality of patients and malnutrition, as well as having consanguineous parents (P<0.001). The death rate was significantly higher in patients with infectious disease than non-infectious, as well as in long-stay PICU patients than in short-stay patients (P<0.05). Additional studies are required to find factors contributing to the disease burden among PICU patients in Iran to develop appropriate therapeutic strategies and improve the outcomes of pediatric patients.
1. Abhulimhen-Iyoha BI, Pooboni SK, Vuppali NK. Morbidity pattern and outcome of patients admitted into a pediatric intensive care unit in India. Indian J Clin Med 2014;5:IJCM-S13902.
2. Downes JJ. Development of paediatric critical care medicine how did we get here and why? In: Wheeler D, Wong H, Shanely T, eds. Paediatric Critical Care Medicine: Basic Science and Clinical Evidence. London: Springer Press; 2007:3-32.
3. Wieczorek B, Ascenzi J, Kim Y, Lenker H, Potter C, Shata NJ, et al. PICU Up!: Impact of a quality improvement intervention to promote early mobilization in critically ill children. Pediatr Crit Care Med 2016;17:e559-66.
4. Doorenbos A, Lindhorst T, Starks H, Aisenberg E, Curtis JR, Hays R. Palliative care in the pediatric ICU: challenges and opportunities for family-centered practice. J Soc Work End Life Palliat Care 2012;8:297-315.
5. Becerra MR, Tantaleán JA, Suárez VJ, Alvarado MC, Candela JL, Urcia FC. Epidemiologic surveillance of nosocomial infections in a Pediatric Intensive Care Unit of a developing country. BMC Pediatr 2010;10:66.
6. Riviello ED, Letchford S, Achieng L, Newton MW. Intensive care in poor-resource settings: Solutions are in the hands at home. Crit Care Med 2011;39:2385-6.
7. Yousef RA, El Gendy FM, Abd El Aziz AA. Prognostic scoring systems in pediatric ICUs: Pediatric Risk of Mortality III versus Pediatric Index of Mortality 2. Alexandria J Pediatr 2019;32:27-32.
8. Marcin JP, Song J, Leigh JP. The impact of pediatric intensive care unit volume on mortality: a hierarchical instrumental variable analysis Pediatr Crit Care Med 2005;6:136-41.
9. de Araujo Costa G, Delgado AF, Ferraro A, Okay TS. Application of the Pediatric Risk of Mortality Score (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit. Clinics (Sao Paulo) 2010;65:1087-92.
10. Qiu J, Lu X, Wang K, Zhu Y, Zuo C, Xiao Z. Comparison of the pediatric risk of mortality, pediatric index of mortality, and pediatric index of mortality 2 models in a pediatric intensive care unit in China: A validation study. Medicine (Baltimore) 2017;96:e6431.
11. Ghaffari J, Abbaskhanian A, Nazari Z. Mortality rate in pediatric intensive care unit (PICU): a local center experience. Int J Pediatr 2014;2:81-8.
12. Earan SK, Dhandapani L, Arunagirinathan A, Kantamneni S. Clinical Spectrum and Epidemiological Profile of Patients Admitted to Pediatric Intensive Care Unit at a Tertiary Care Centre in South India. Int J Sci. 2016;4:187-91.
13. Slusher T, Bjorklund A, Aanyu HT, Kiragu A, Christo P. The assessment, evaluation and management of the critically ill child in resource limited international settings. J Pediatr Intensive Care 2016;6:066-76.
14. Purcell LN, Prin M, Sincavage J, Kadyaudzu C, Phillips MR, Charles A. Outcomes Following Intensive Care Unit Admission in a Pediatric Cohort in Malawi. J Trop Pediatr 2020;66:621-9.
15. Weiss SL, Fitzgerald JC, Faustino EV, Festa MS, Fink EL, Jouvet P, et al. Understanding the global epidemiology of pediatric critical illness: the power, pitfalls, and practicalities of point prevalence studies. Pediatr Crit Care Med 2014;15:660-6.
16. Chang L, Horng CF, Huang YC, Hsieh YY. Prognostic accuracy of Acute Physiology and Chronic Health Evaluation II scores in critically ill cancer patients. Am J Crit Care 2006;15:47-53.
17. World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. World Health Organization; Geneva, 2006.
18. Valavi E, Aminzadeh M, Shirvani E, Jaafari L, Madhooshi S. The Main Causes of Mortality in Pediatric Intensive Care Unit in South West of Iran. Zahedan J Res Med Sci. 2018;20:e63006.
19. Shah GS, Shah BK, Thapa A, Shah L, Mishra OP. Admission patterns and outcome in a pediatric intensive care unit in Nepal. J Adv Med Med Res 2014;4:4939-45.
20. Wu Y. Risk factors for death in pediatric intensive care unit of a tertiary children's hospital in Guangzhou city. HKU Theses Online (HKUTO) [dissertation]. Pokfulam, Hong Kong: The University of Hong Kong.; 2014.
21. Mirkarimi M, Alisamir M, Saraf S, Heidari S, Barouti S, Mohammadi S. Clinical and Epidemiological Determinants of Lower Respiratory Tract Infections in Hospitalized Pediatric Patients. Int J Pediatr 2020;2020:8844420.
22. Mirkarimi M, Alisamir M, Nasiri P, Barouti S, Mohammadi S. Determinants of Complicated Pneumonia in Hospitalized Pediatric Patients. Acta Med Iran 2021;59:155-60.
23. Lanetzki CS, Oliveira CA, Bass LM, Abramovici S, Troster EJ. The epidemiological profile of pediatric intensive care center at hospital israelita albert einstein. Einstein (São Paulo) 2012;10:16-21.
24. Haque A, Siddiqui NR, Jafri SK, Hoda M, Bano S, Mian A. Clinical profiles and outcomes of children admitted to the pediatric intensive care unit from the emergency department. J Coll Physicians Surg Pak 2015;25:301-3.
25. Sawe HR, Mfinanga JA, Lidenge SJ, Mpondo BC, Msangi S, Lugazia E, et al. Disease patterns and clinical outcomes of patients admitted in intensive care units of tertiary referral hospitals of Tanzania. BMC Int Health Hum Rights 2014;14:26.
26. Zhang S, Sammon PM, King I, Andrade AL, Toscano CM, Araujo SN, et al. Cost of management of severe pneumonia in young children: systematic analysis. J Glob Health 2016;6:010408.
27. Cappell J, Kernie SG. Advances in Pediatric Neurocritical Care. Pediatr Clin North Am 2013;60:709-24.
28. Murphy S. Pediatric neurocritical care. Neurotherapeutics 2012;9:3-16.
29. Alamarat Z, Hasbun R. Management of Acute Bacterial Meningitis in Children. Infect Drug Resist 2020;13:4077-89.
30. Burns JP, Sellers DE, Meyer EC, Lewis-Newby M, Truog RD. Epidemiology of death in the pediatric intensive care unit at five US teaching hospitals. Crit Care Med 2014;42:2101-8.
31. Susianawati V, Suryantoro P, Naning R. Prognostic predictor at pediatrics intensive care unit (PICU) with Pediatric Risk of Mortality III (PRISM III) scores. J Med Sci 2014;46:71-7.
32. Schlapbach LJ, Straney L, Alexander J, MacLaren G, Festa M, Schibler A, et al. ANZICS Paediatric Study Group. Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002–13: a multicentre retrospective cohort study. Lancet Infect Dis 2015;15:46-54.
33. Okechukwu AA, Nwalozie C. Morbidity and mortality pattern of admissions into the Emergency Paediatric Unit of University of Abuja Teaching Hospital, Gwagwalada. Niger J Med 2011;20:109-13.
34. Embu HY, Yiltok SJ, Isamade ES, Nuhu SI, Oyeniran OO, Uba FA. Paediatric admissions and outcome in a general intensive care unit. Afr J Paediatr Surg 2011;8:57-61.
35. Tripathi S, Meixsell LJ, Astle M, Kim M, Kapileshwar Y, Hassan N. A Longer Route to the PICU Can Lead to a Longer Stay in the PICU: A Single-Center Retrospective Cohort Study. J Intensive Care Med 2020;37:60-7.
36. Joosten KF, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr 2008;20:590-6.
37. Ventura JC, Hauschild DB, Barbosa E, Bresolin NL, Kawai K, Mehta NM, et al. Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children. J Acad Nutr Diet 2020;120:219-29.
38. Bechard LJ, Duggan C, Touger-Decker R, Parrott JS, Rothpletz-Puglia P, Byham-Gray L, et al. Nutritional status based on body mass index is associated with morbidity and mortality in mechanically ventilated critically ill children in the PICU. Crit Care Med 2016;44:1530-7.
39. Prince NJ, Brown KL, Mebrahtu TF, Parslow RC, Peters MJ. Weight-for-age distribution and case-mix adjusted
outcomes of 14,307 paediatric intensive care admission. Intensive Care Med 2014;40:1132-9.
40. Compher C, Mehta NM. Diagnosing malnutrition: Where are we and where do we need to go? J Acad Nutr Diet 2016;116:779-84.
41. de Neef M, Geukers VG, Dral A, Lindeboom R, Sauerwein HP, Bos AP. Nutritional goals, prescription and delivery in a pediatric intensive care unit. Clin Nutr 2008;27:65-71.
42. Delgado AF, Okay TS, Leone C, Nichols B, Del Negro GM, Vaz FA. Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit. Clinics (Sao Paulo) 2008;63:357-62.
43. Khademi G, Imani B, Mehdizadeh A. Assessment, Intervention, and Monitoring: Stepwise Nutritional Management in Pediatric Intensive Care Units: A Short Review. J Compr Pediatr 2019;10:e66474.
44. Skillman HE, Zebuhr CA. Physical Therapy and Rehabilitation in Pediatric Critical Care: Optimal Nutrition for Acute Rehabilitation in the PICU. J Pediatr Intensive Care 2015;4:194-203.
45. Fivez T, Kerklaan D, Mesotten D, Verbruggen S, Joosten K, Van den Berghe G. Evidence for the use of parenteral nutrition in the pediatric intensive care unit. Clin Nutr 2017;36:218-23.
46. Joffe A, Anton N, Lequier L, Vandermeer B, Tjosvold L, Larsen B, et al. Nutritional support for critically ill children. Cochrane Database Syst Rev 2016;2016:CD005144.
47. Tume LN, Valla FV, Joosten K, Chaparro CJ, Latten L, Marino LV, et al. Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Med 2020;46:411-25.
48. Sotoudeh M, Khalili M, Azizian M, Imani B. Prevalence of malnutrition based on underweight inpatients in pediatric intensive care unit. Int J Pharm Technol 2016;8:12333-40.
49. Siddiqui S. Mortality profile across our intensive care units: a 5-year database report from a Singapore restructured hospital. Indian J Crit Care Med 2015;19:726-7.
50. Bhadoria P, Bhagwat AG. Severity scoring systems in paediatric intensive care units. Indian J Anaesth 2008;52:663-75.
51. Kourtis SA, Burns JP. Quality improvement in pediatric intensive care: A systematic review of the literature. Pediatr Investig 2019;3:110-6.
52. Frankel LR, Hsu BS, Yeh TS, Simone S, Agus MS, Arca MJ, et al. Criteria for critical care infants and children: PICU admission, discharge, and triage practice statement and levels of care guidance. Pediatr Crit Care Med 2019;20:847-87.
53. Rosenberg DI, Moss MM. Guidelines and levels of care for pediatric intensive care units. Pediatrics 2004;114:1114-25.
54. Jaimovich DG. Admission and discharge guidelines for the pediatric patient requiring intermediate care. Pediatrics 2004;113:1430-3.
55. Heidari S, Mohammadi S, Fathi M, Cigary S, Alisamir M, Mirkarimi M, et al. Association of vitamin D status with COVID‐19 disease severity in pediatric patients: A retrospective observational study. Health Sci Rep 2022;5:e569.
56. Heidari S, Torabizadeh M, Shokouhifar S, Mirkarimi M, Alisamir M, Mohammadi S. Association of Asthma with COVID-19 Disease Severity in Pediatric Patients. Curr Respir Med Rev 2022;18.
2. Downes JJ. Development of paediatric critical care medicine how did we get here and why? In: Wheeler D, Wong H, Shanely T, eds. Paediatric Critical Care Medicine: Basic Science and Clinical Evidence. London: Springer Press; 2007:3-32.
3. Wieczorek B, Ascenzi J, Kim Y, Lenker H, Potter C, Shata NJ, et al. PICU Up!: Impact of a quality improvement intervention to promote early mobilization in critically ill children. Pediatr Crit Care Med 2016;17:e559-66.
4. Doorenbos A, Lindhorst T, Starks H, Aisenberg E, Curtis JR, Hays R. Palliative care in the pediatric ICU: challenges and opportunities for family-centered practice. J Soc Work End Life Palliat Care 2012;8:297-315.
5. Becerra MR, Tantaleán JA, Suárez VJ, Alvarado MC, Candela JL, Urcia FC. Epidemiologic surveillance of nosocomial infections in a Pediatric Intensive Care Unit of a developing country. BMC Pediatr 2010;10:66.
6. Riviello ED, Letchford S, Achieng L, Newton MW. Intensive care in poor-resource settings: Solutions are in the hands at home. Crit Care Med 2011;39:2385-6.
7. Yousef RA, El Gendy FM, Abd El Aziz AA. Prognostic scoring systems in pediatric ICUs: Pediatric Risk of Mortality III versus Pediatric Index of Mortality 2. Alexandria J Pediatr 2019;32:27-32.
8. Marcin JP, Song J, Leigh JP. The impact of pediatric intensive care unit volume on mortality: a hierarchical instrumental variable analysis Pediatr Crit Care Med 2005;6:136-41.
9. de Araujo Costa G, Delgado AF, Ferraro A, Okay TS. Application of the Pediatric Risk of Mortality Score (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit. Clinics (Sao Paulo) 2010;65:1087-92.
10. Qiu J, Lu X, Wang K, Zhu Y, Zuo C, Xiao Z. Comparison of the pediatric risk of mortality, pediatric index of mortality, and pediatric index of mortality 2 models in a pediatric intensive care unit in China: A validation study. Medicine (Baltimore) 2017;96:e6431.
11. Ghaffari J, Abbaskhanian A, Nazari Z. Mortality rate in pediatric intensive care unit (PICU): a local center experience. Int J Pediatr 2014;2:81-8.
12. Earan SK, Dhandapani L, Arunagirinathan A, Kantamneni S. Clinical Spectrum and Epidemiological Profile of Patients Admitted to Pediatric Intensive Care Unit at a Tertiary Care Centre in South India. Int J Sci. 2016;4:187-91.
13. Slusher T, Bjorklund A, Aanyu HT, Kiragu A, Christo P. The assessment, evaluation and management of the critically ill child in resource limited international settings. J Pediatr Intensive Care 2016;6:066-76.
14. Purcell LN, Prin M, Sincavage J, Kadyaudzu C, Phillips MR, Charles A. Outcomes Following Intensive Care Unit Admission in a Pediatric Cohort in Malawi. J Trop Pediatr 2020;66:621-9.
15. Weiss SL, Fitzgerald JC, Faustino EV, Festa MS, Fink EL, Jouvet P, et al. Understanding the global epidemiology of pediatric critical illness: the power, pitfalls, and practicalities of point prevalence studies. Pediatr Crit Care Med 2014;15:660-6.
16. Chang L, Horng CF, Huang YC, Hsieh YY. Prognostic accuracy of Acute Physiology and Chronic Health Evaluation II scores in critically ill cancer patients. Am J Crit Care 2006;15:47-53.
17. World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. World Health Organization; Geneva, 2006.
18. Valavi E, Aminzadeh M, Shirvani E, Jaafari L, Madhooshi S. The Main Causes of Mortality in Pediatric Intensive Care Unit in South West of Iran. Zahedan J Res Med Sci. 2018;20:e63006.
19. Shah GS, Shah BK, Thapa A, Shah L, Mishra OP. Admission patterns and outcome in a pediatric intensive care unit in Nepal. J Adv Med Med Res 2014;4:4939-45.
20. Wu Y. Risk factors for death in pediatric intensive care unit of a tertiary children's hospital in Guangzhou city. HKU Theses Online (HKUTO) [dissertation]. Pokfulam, Hong Kong: The University of Hong Kong.; 2014.
21. Mirkarimi M, Alisamir M, Saraf S, Heidari S, Barouti S, Mohammadi S. Clinical and Epidemiological Determinants of Lower Respiratory Tract Infections in Hospitalized Pediatric Patients. Int J Pediatr 2020;2020:8844420.
22. Mirkarimi M, Alisamir M, Nasiri P, Barouti S, Mohammadi S. Determinants of Complicated Pneumonia in Hospitalized Pediatric Patients. Acta Med Iran 2021;59:155-60.
23. Lanetzki CS, Oliveira CA, Bass LM, Abramovici S, Troster EJ. The epidemiological profile of pediatric intensive care center at hospital israelita albert einstein. Einstein (São Paulo) 2012;10:16-21.
24. Haque A, Siddiqui NR, Jafri SK, Hoda M, Bano S, Mian A. Clinical profiles and outcomes of children admitted to the pediatric intensive care unit from the emergency department. J Coll Physicians Surg Pak 2015;25:301-3.
25. Sawe HR, Mfinanga JA, Lidenge SJ, Mpondo BC, Msangi S, Lugazia E, et al. Disease patterns and clinical outcomes of patients admitted in intensive care units of tertiary referral hospitals of Tanzania. BMC Int Health Hum Rights 2014;14:26.
26. Zhang S, Sammon PM, King I, Andrade AL, Toscano CM, Araujo SN, et al. Cost of management of severe pneumonia in young children: systematic analysis. J Glob Health 2016;6:010408.
27. Cappell J, Kernie SG. Advances in Pediatric Neurocritical Care. Pediatr Clin North Am 2013;60:709-24.
28. Murphy S. Pediatric neurocritical care. Neurotherapeutics 2012;9:3-16.
29. Alamarat Z, Hasbun R. Management of Acute Bacterial Meningitis in Children. Infect Drug Resist 2020;13:4077-89.
30. Burns JP, Sellers DE, Meyer EC, Lewis-Newby M, Truog RD. Epidemiology of death in the pediatric intensive care unit at five US teaching hospitals. Crit Care Med 2014;42:2101-8.
31. Susianawati V, Suryantoro P, Naning R. Prognostic predictor at pediatrics intensive care unit (PICU) with Pediatric Risk of Mortality III (PRISM III) scores. J Med Sci 2014;46:71-7.
32. Schlapbach LJ, Straney L, Alexander J, MacLaren G, Festa M, Schibler A, et al. ANZICS Paediatric Study Group. Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002–13: a multicentre retrospective cohort study. Lancet Infect Dis 2015;15:46-54.
33. Okechukwu AA, Nwalozie C. Morbidity and mortality pattern of admissions into the Emergency Paediatric Unit of University of Abuja Teaching Hospital, Gwagwalada. Niger J Med 2011;20:109-13.
34. Embu HY, Yiltok SJ, Isamade ES, Nuhu SI, Oyeniran OO, Uba FA. Paediatric admissions and outcome in a general intensive care unit. Afr J Paediatr Surg 2011;8:57-61.
35. Tripathi S, Meixsell LJ, Astle M, Kim M, Kapileshwar Y, Hassan N. A Longer Route to the PICU Can Lead to a Longer Stay in the PICU: A Single-Center Retrospective Cohort Study. J Intensive Care Med 2020;37:60-7.
36. Joosten KF, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr 2008;20:590-6.
37. Ventura JC, Hauschild DB, Barbosa E, Bresolin NL, Kawai K, Mehta NM, et al. Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children. J Acad Nutr Diet 2020;120:219-29.
38. Bechard LJ, Duggan C, Touger-Decker R, Parrott JS, Rothpletz-Puglia P, Byham-Gray L, et al. Nutritional status based on body mass index is associated with morbidity and mortality in mechanically ventilated critically ill children in the PICU. Crit Care Med 2016;44:1530-7.
39. Prince NJ, Brown KL, Mebrahtu TF, Parslow RC, Peters MJ. Weight-for-age distribution and case-mix adjusted
outcomes of 14,307 paediatric intensive care admission. Intensive Care Med 2014;40:1132-9.
40. Compher C, Mehta NM. Diagnosing malnutrition: Where are we and where do we need to go? J Acad Nutr Diet 2016;116:779-84.
41. de Neef M, Geukers VG, Dral A, Lindeboom R, Sauerwein HP, Bos AP. Nutritional goals, prescription and delivery in a pediatric intensive care unit. Clin Nutr 2008;27:65-71.
42. Delgado AF, Okay TS, Leone C, Nichols B, Del Negro GM, Vaz FA. Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit. Clinics (Sao Paulo) 2008;63:357-62.
43. Khademi G, Imani B, Mehdizadeh A. Assessment, Intervention, and Monitoring: Stepwise Nutritional Management in Pediatric Intensive Care Units: A Short Review. J Compr Pediatr 2019;10:e66474.
44. Skillman HE, Zebuhr CA. Physical Therapy and Rehabilitation in Pediatric Critical Care: Optimal Nutrition for Acute Rehabilitation in the PICU. J Pediatr Intensive Care 2015;4:194-203.
45. Fivez T, Kerklaan D, Mesotten D, Verbruggen S, Joosten K, Van den Berghe G. Evidence for the use of parenteral nutrition in the pediatric intensive care unit. Clin Nutr 2017;36:218-23.
46. Joffe A, Anton N, Lequier L, Vandermeer B, Tjosvold L, Larsen B, et al. Nutritional support for critically ill children. Cochrane Database Syst Rev 2016;2016:CD005144.
47. Tume LN, Valla FV, Joosten K, Chaparro CJ, Latten L, Marino LV, et al. Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Med 2020;46:411-25.
48. Sotoudeh M, Khalili M, Azizian M, Imani B. Prevalence of malnutrition based on underweight inpatients in pediatric intensive care unit. Int J Pharm Technol 2016;8:12333-40.
49. Siddiqui S. Mortality profile across our intensive care units: a 5-year database report from a Singapore restructured hospital. Indian J Crit Care Med 2015;19:726-7.
50. Bhadoria P, Bhagwat AG. Severity scoring systems in paediatric intensive care units. Indian J Anaesth 2008;52:663-75.
51. Kourtis SA, Burns JP. Quality improvement in pediatric intensive care: A systematic review of the literature. Pediatr Investig 2019;3:110-6.
52. Frankel LR, Hsu BS, Yeh TS, Simone S, Agus MS, Arca MJ, et al. Criteria for critical care infants and children: PICU admission, discharge, and triage practice statement and levels of care guidance. Pediatr Crit Care Med 2019;20:847-87.
53. Rosenberg DI, Moss MM. Guidelines and levels of care for pediatric intensive care units. Pediatrics 2004;114:1114-25.
54. Jaimovich DG. Admission and discharge guidelines for the pediatric patient requiring intermediate care. Pediatrics 2004;113:1430-3.
55. Heidari S, Mohammadi S, Fathi M, Cigary S, Alisamir M, Mirkarimi M, et al. Association of vitamin D status with COVID‐19 disease severity in pediatric patients: A retrospective observational study. Health Sci Rep 2022;5:e569.
56. Heidari S, Torabizadeh M, Shokouhifar S, Mirkarimi M, Alisamir M, Mohammadi S. Association of Asthma with COVID-19 Disease Severity in Pediatric Patients. Curr Respir Med Rev 2022;18.
| Files | ||
| Issue | Vol 60 No 10 (2022) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v60i10.11558 | |
| Keywords | ||
| Pediatric intensive care unit (PICU) Epidemiological profile Children Infants Ahvaz Iran | ||
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How to Cite
1.
Alisamir M, Mirkarimi M, Mirzaee S, Heidari S, Barouti S, Mohammadi S. Characteristics and Outcomes of Patients Admitted to a Pediatric Intensive Care Unit in Southwest of Iran. Acta Med Iran. 2022;60(10):646-654.
