title: Outcome of pediatric intensive care at six centers in Mexico and Ecuador.
abstract: OBJECTIVE
  To improve understanding of the causes of morbidity and mortality among critically ill children in the countries studied.
  
  
  METHODS
  Survey of hospital records between 1992 and 1994.
  
  
  METHODS
  Six pediatric intensive care units (ICUs) (four ICUs in Mexico City and two ICUs in Ecuador).
  
  
  METHODS
  Consecutive patients (n = 1,061) admitted to the units studied.
  
  
  METHODS
  None.
  
  
  RESULTS
  The mortality rate for low-risk patients (pediatric Risk of Mortality [PRISM] score of < or = 10, n = 701) was more than four times the rate predicted by the PRISM score (8.1% vs. 1.8%, p < .001), with an additional 11.3% of this group incurring major morbidity. The mortality rate for moderate-risk patients (PRISM scores of 11 to 20, n = 232) was more than twice predicted (28% vs. 12%, p < .001). For low-risk patients, death was significantly associated with tracheal intubation, central venous cannulation, pneumonia, age of < 2 months, use of more than two antibiotics, and nonsurgical diagnosis (after controlling for PRISM score). Central venous cannulation and tracheal intubation in the lower-risk groups were performed more commonly in units in Mexico than in one comparison unit in the United States (p < .001).
  
  
  CONCLUSIONS
  For six pediatric ICUs in Mexico and Ecuador, mortality was significantly higher than predicted among lower-risk patients. Tracheal intubation, central catheters, pneumonia, sepsis, and nonsurgical status were associated with poor outcome for low-risk groups. We speculate that reducing the use of invasive central catheters and endotracheal intubation for lower-risk patients, coupled with improved infection control, could lower mortality rates in the population studied.
authors.affiliation: Division of Pediatric Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: M
authors.initials: M
authors.lastname: Earle
authors.forename: O
authors.initials: O
authors.lastname: Martinez Natera
authors.forename: A
authors.initials: A
authors.lastname: Zaslavsky
authors.forename: E
authors.initials: E
authors.lastname: Quinones
authors.forename: H
authors.initials: H
authors.lastname: Carrillo
authors.forename: E
authors.initials: E
authors.lastname: Garcia Gonzalez
authors.forename: A
authors.initials: A
authors.lastname: Torres
authors.forename: M P
authors.initials: MP
authors.lastname: Marquez
authors.forename: J
authors.initials: J
authors.lastname: Garcia-Montes
authors.forename: I
authors.initials: I
authors.lastname: Zavala
authors.forename: R
authors.initials: R
authors.lastname: Garcia-Davila
authors.forename: I D
authors.initials: ID
authors.lastname: Todres
mesh_terms: D002675:Child, Preschool; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004484:Ecuador; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D008800:Mexico; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index