title: Paediatric intensive care in Kuala Lumpur, Malaysia: a developing subspecialty.
abstract: Paediatric intensive care in Malaysia is a developing subspecialty with an increasing number of specialists with a paediatric background being involved in the care of critically ill children. A part prospective and part retrospective review of 118 consecutive non-neonatal ventilated patients in University Hospital, Kuala Lumpur was carried out from 1 June 1995 to 31 December 1996 to study the clinical epidemiology and outcome in our paediatric intensive case unit (PICU). The mean age of the patients was 33.9 +/- 6.0 months (median 16 months). The main mode of admission was emergency (96.6 per cent) with an overall mortality rate of 42 per cent (50/118). The mean paediatric risk of mortality (PRISM) score was 20 +/- 0.98 SEM, with 53 per cent of patients having a score of over 30 per cent. Multiorgan dysfunction (MODS) was identified in 71 per cent of patients. Admission efficiency (mortality risk > 1 per cent) was 97 per cent. Standardized mortality rate using PRISM was an acceptable 1.06. The main diagnostic categories were respiratory (32 per cent), neurology (22 per cent), haematology-oncology (18 per cent); the aetiology of dysfunction was mainly infective. Non-survivors were older (29.5 vs. 13.8 months, p < 0.0001), had more severe illness (mean PRISM score 30 vs. 14, p < 0.0001), were more likely to develop MODS (96 vs. 53 per cent, p < 0.0001) and required more intervention and monitoring. Paediatric intensive care in Malaysia differs widely from that in developed countries in patient characteristics, severity of illness, and care modalities provided.
authors.affiliation: Paediatric Intensive Care Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: A Y
authors.initials: AY
authors.lastname: Goh
authors.forename: L C
authors.initials: LC
authors.lastname: Lum
authors.forename: P W
authors.initials: PW
authors.lastname: Chan
mesh_terms: D002675:Child, Preschool; D003695:Delivery of Health Care; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008296:Malaysia; D008297:Male; D009026:Mortality / Q000639:trends*; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D012121:Respiration, Artificial; D018570:Risk Assessment; D012720:Severity of Illness Index