title: Burden of neurological illnesses in a pediatric intensive care unit of developing country.
abstract: OBJECTIVE
  To assess the burden and spectrum of neurological illness in a pediatric intensive care unit and review the associated mortality.
  
  
  METHODS
  Retrospective review of medical records of children (1 mo-16 years) with acute neurological diagnosis admitted in PICU in Aga Khan University hospital from January 2008 to December 2011 was done. Basic demographic, diagnosis, neuro diagnostic procedures performed, therapies and outcomes were done on a structured datasheet.
  
  
  RESULTS
  During study period, 231 (19.3%) patients were admitted with acute neurological illnesses in PICU. The mean age was 67 ±50 months, 54% (n=125) was under-five and 138 (59.7%) were males. Out of total, 144 (62.3%) had neurological illness and 87 (37.7%) had neurosurgical diagnosis. In acute neurological illness, 51.5% (n=119) had non-traumatic-coma (NTC) and 10.8% (n=25) had neuromuscular illness. CNS infection (26%, n=60) in structural cause and status epilepticus (10%, n=23) were the most common cause of structural and metabolic type of NTC respectively. Severe traumatic brain injury (21.2%, n=49) and postoperative neurosurgical illness (16.5%, n=38) were common neurosurgical cases in our cohort. The intensive care resources were utilized as mechanical ventilation in 78% (n=180), inotropic support in 29.4% (n=67) and therapeutic hypothermia in 33% (n=76). Fifty children (21.6%) required PICU care for observation only. More than 500 neurodiagnostic tests/procedures were performed in this cohort of children with acute neurological disorders in PICU. The mortality rate in neurological cases was 18% (42/231) as compared to the overall mortality rate was 12% in PICU.
  
  
  CONCLUSIONS
  Acute neurological disorders were common in PICU, and were associated with higher mortality. CNS infections, status epilepticus and severe traumatic brain injuries were the most common acute neurological illnesses in our cohort.
authors: Qalab Abbas, MBBS, Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
authors: Qalab
authors: Q
authors: Abbas
authors: Amber Shabbir, MBBS, Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
authors: Amber
authors: A
authors: Shabbir
authors: Naveedur Rehman Siddiqui, FCPS, Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
authors: Naveedur Rehman
authors: NR
authors: Siddiqui
authors: Raman Kumar, MBBS, Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
authors: Raman
authors: R
authors: Kumar
authors: Anwarul Haque, MBBS, Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
authors: Anwarul
authors: A
authors: Haque
keywords: Acute Neurological illnesses; Burden; Mortality; PICU