PIM 3 predicted mortality compared to the observed mortality rate for patients in the PICU in Universitas Academic Hospital, segregated into four physico-chemical aspects for acid-base disturbances
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Date
2020-07
Authors
Robbetze, John Werner
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Publisher
University of the Free State
Abstract
Background: The PIM 3 score is widely used in PICU’s, to monitor the quality of care of patients. The reason for this study is to compare the mortality rate for the PICU at Universitas Academic Hospital with the PIM 3 predicted mortality rate and like previous studies to see if there is any association between mortality and the magnitude or nature of the metabolic acidosis. Objective: The primary objective is to determine the SMR for the PICU at Universitas Academic Hospital for the period 1 January 2016 to 31 December 2018 and the secondary objective, to determine the association between mortality and the different variable for D.A. Story’s four equations for the base excess (BESID, BELact, BEAlb and BEOI). Method: It was a retrospective cross-sectional chart review of all patients, between 0 and 156 months of age, admitted from 1 January 2016 to 31 December 2018. The data used was obtained from the statistics kept in the PICU, patient’s files and NHLS Trackcare system. The data was analysed by the Department of Biostatistics at the University of the Free State and Fisher’s Exact Test was applied to the data to determine if there is any statistical significance. Results: 711 patients were admitted. 12 were excluded due to their ages being more than 156 months. 251 patient files had complete bloodgas information. There were 74 deaths (10.9%) in the PICU during this period. The SMR was calculated as 1.5. Among patients with complete data, an association was noted between mortality and increasing PIM 3 risk score (p-value of 0.0001). Hyperlactataemia (>2 mmol/L) and hyperchloraemia (above 120 mmol/L), had a strong association with mortality with p-values of 0.0041 and 0.013 respectively. Conclusion: The observed mortality rate was higher than the predicted mortality rate according to the PIM 3 score. The study also concluded that mortality is not associated with the magnitude of the metabolic acidosis, but rather the nature (Hyperlactataemnia and hyperchloraemia) of the acidosis.
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Dissertation (M.Med. (Paediatrics and Child Health))--University of the Free State, 2020, Quality care of patients, Infants -- Mortality, Paediatric Intensive Care Unit (PICU) -- Universitas Hospital