title: Predictors of mortality in a paediatric intensive care unit in Kigali, Rwanda.
abstract: BACKGROUND
  The enormous burden of critical illness in resource-limited settings has led to a growing interest in paediatric critical care in these regions. However, published data on the practice of critical care and patient outcomes in these settings are scant.
  
  
  OBJECTIVE
  This study sought to identify risk factors associated with mortality in the newly established Paediatric Intensive Care Unit (PICU) at Kigali University Teaching Hospital (KUTH) in Rwanda and test the predictive ability of a newly devised mortality risk score, the modified PRISM (MP) score.
  
  
  METHODS
  All admissions to the PICU at KUTH from October 2012 to October 2014 were included. Demographic and physiological data on each patient were gathered and each was assigned a MP score. This prospective cross-sectional study examined the association between the characteristics and physiological status of these patients and mortality. Using logistic regression, factors associated with mortality in the PICU were analysed.
  
  
  RESULTS
  A total of 213 children were admitted to the PICU during the study period. Three patients were excluded because of missing data. Of this total, 59% were male, 25% were neonates and nearly 60% were moderately to severely malnourished. The overall mortality rate was 50%. On bivariate analysis, factors associated with increased mortality were male sex, use of vasoactive medications, a MP score ≥ 5, a discharge diagnosis of septic shock, and malnutrition on admission. On multivariate analysis, only the use of vasoactive drugs [odds ratio (OR) 12.24, 95% confidence interval (CI) 4.4-35.4, p < 0.001] and MP score ≥ 5 (OR 16.1, CI 6.3-40.8, p < 0.001) were associated with mortality.
  
  
  CONCLUSIONS
  The observed mortality rate was in the range reported in other resource-limited settings. The initial attempt to create and implement a risk of mortality tool for this setting determined a score that could identify those patients at higher risk of mortality. In PICUs in resource-limited settings, the gathering of data and use of severity of illness tools could improve care in a number of ways.
authors.affiliation: a Department of Pediatrics and Child Health , Ministry of Health, Rwamagana Provincial Hospital , Rwamagana , Rwanda.
authors.forename: Rosine
authors.initials: R
authors.lastname: Nyirasafari
authors.affiliation: b Division of Hospital Medicine , Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Corden
authors.affiliation: c Department of Paediatrics and Child Health , Kigali University Teaching Hospital , Kigali , Rwanda.
authors.forename: Angélique Charlie
authors.initials: AC
authors.lastname: Karambizi
authors.affiliation: d School of Medicine and Pharmacy, College of Medicine and Health Sciences , University of Rwanda , Butare , Rwanda.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Kabayiza
authors.affiliation: e STIs Care and Treatment Senior Office, HIV and STIs Division, Rwanda Biomedical Centre , Kigali , Rwanda.
authors.forename: Jean Damascene
authors.initials: JD
authors.lastname: Makuza
authors.affiliation: f Yale University Global Health Leadership Institute , New Haven , CT , USA.
authors.forename: Rex
authors.initials: R
authors.lastname: Wong
authors.affiliation: g Department of Pediatrics, Division of Critical Care , Yale University School of Medicine , New Haven , CT , USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Canarie
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality*; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology
keywords: Critical care; MP, modified PRISM; Mechanical ventilation; PCC, paediatric critical care; PICU, paediatric critical care unit; PRISM, paediatric risk of mortality; Resource-limited settings; SOI, severity of illness; Sepsis