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Mortality-associated factors in the pediatric intensive care setting: a retrospective review of 519 patients in Çanakkale, Türkiye

Year 2025, Volume: 10 Issue: 2, 60 - 67, 27.06.2025

Fatih Battal , Tayyar Ayberk Borak

https://doi.org/10.22391/fppc.1666803

Abstract

Introduction: The Pediatric Intensive Care Unit plays a vital role in the management and continuous monitoring of life-threatening conditions affecting multiple organ systems. In recent years, the demand for pediatric intensive care services in our country has increased significantly. However, patient survival is influenced not only by bed availability but also by the quality of care provided. Therefore, identifying and analyzing mortality predictors is of critical importance for improving the quality of care in Pediatric Intensive Care Units (PICUs). This study aims to evaluate the clinical characteristics of patients admitted to the Pediatric Intensive Care Unit of Çanakkale Onsekiz Mart University Hospital and to identify the variables associated with survival outcomes.
Methods: In this retrospective cross-sectional study, the medical records of 519 patients admitted to the PICU of Çanakkale Onsekiz Mart University Hospital between May 1, 2019, and December 31, 2022, were reviewed. Collected data included demographic characteristics, admission diagnoses, length of stay in the ICU, need for invasive procedures, complications developed during hospitalization, and clinical scoring systems such as the Glasgow Coma Scale (GCS), Pediatric Risk of Mortality III (PRISM III), Pediatric Index of Mortality 2 (PIM2), and Pediatric Logistic Organ Dysfunction-2 (PELOD-2). Statistical analyses were conducted using appropriate tests, and factors associated with mortality were evaluated through logistic regression analysis.
Results: Among the 519 patients included in the study, 55.3% were male, and the median age was 55 months. The most frequent reasons for hospitalization were infectious diseases (31.2%), neurological disorders (15.1%), and intoxications (10.6%). Additionally, 27.0% of the patients had at least one chronic condition. Notably, the rate of intoxication was particularly high in the 97–216-month age group (69.4%). There was a statistically significant association between mortality and all the evaluated scoring systems, namely PRISM III, PIM2, PELOD-2, and the GCS (p = 0.001). Logistic regression analysis identified previous intensive care unit admission [OR: 4.697–6.898], the need for mechanical ventilation [OR: 0.151–0.094], and the development of nosocomial infection [OR: 2.474] as independent predictors of mortality (p = 0.021).
Conclusion: Survival outcomes in pediatric intensive care are influenced not only by diagnostic and therapeutic interventions but also by factors such as hospital-acquired infections, the need for mechanical ventilation, and prior intensive care unit admissions. Clinical scoring systems such as PRISM III, PIM2, and PELOD-2 offer valuable prognostic insight and contribute to clinical decision-making. The findings of this study provide important data for the assessment and enhancement of current pediatric intensive care practices. Therefore, the regular analysis of factors influencing mortality represents a critical step toward improving the quality of care delivered in PICUs.

Keywords

prognosis child glasgow coma scale pediatric intensive care units clinical decision making

References

  • 1. Downes JJ the historical evolution current status and prospective development of pediatric critical care. CritCareClin. 1992;8(1):1–22. https://doi.org/10.1016/S0749-0704(18)30264-1
  • 2. Koroglu TF Bayrakci B Dursun O Kendirli T Yildizdas D Karabocuoglu M [guideline for pediatric intensive care units: recommendations by the Turkish Society of Pediatric Emergency and Intensive Care] (in Turkish). Turk Pediatri Ars. 2006;41(3):139-45. https://doi.org/10.4274/tpa.45.82
  • 3. Ay B Tutanc M Yel S Kaplan M Bosnak M Ayintap E [antithrombin III level and prognostic value in patients admitted to intensive care] (in Turkish). Med J Mustafa Kemal Univ. 2010;1(1):1-5.
  • 4. Tutanc M Basarslan F Karcioglu M Yel S Kaplan M Arica M et al. [evaluation of patients admitted to the pediatric intensive care unit] (in Turkish). Duzce Med J. 2011;13(3):18-22.
  • 5. Orhan MF [evaluation of 938 patients admitted to the pediatric intensive care unit over 2 years] (in Turkish). Turk J Pediatr Dis. 2012;6(4):228-31.
  • 6. Poyrazoglu H Dursun I Gunes T Akcakus M Konuskan B Canpolat M et al. [evaluation and outcomes of patients admitted to the pediatric intensive care unit] (in Turkish). Erciyes Med J. 2008;30(4):232-37.
  • 7. UlgenTekerek N Akyildiz BN [evaluation of prognosis in pediatric intensive care patients in a tertiary center] (in Turkish). J Pediatr Dis. 2017;11(4):221-25.
  • 8. Konca C Tekin M Karakoc F Turgut M [evaluation of 770 patients admitted to the pediatric intensive care unit: a single center experience] (in Turkish). J Pediatr Dis. 2015;9(2):90-95.
  • 9. Oz O Bayraktar S Elevli M Duru HNS Civilibal M Sahin K [evaluation of patients admitted to the pediatric intensive care unit of a training and research hospital] (in Turkish). Cayd. 2015;2:65-70. https://doi.org/10.5505/cayb.2015.35220
  • 10. Zinter MS DuBois SG Spicer A Matthay K Sapru A pediatric cancer type predicts infection rate need for critical care intervention and mortality in the pediatric intensive care unit. Intensive Care Med. 2014;40:1536-44. https://doi.org/10.1007/s00134-014-3389-2

Pediatrik yoğun bakım ortamında mortalite ile ilişkili faktörler: Çanakkale, Türkiye'de 519 hastanın retrospektif incelemesi

Year 2025, Volume: 10 Issue: 2, 60 - 67, 27.06.2025

Fatih Battal , Tayyar Ayberk Borak

https://doi.org/10.22391/fppc.1666803

Abstract

Giriş: Çocuk Yoğun Bakım Ünitesi (ÇYBÜ), çoklu organ sistemlerini etkileyen yaşamı tehdit eden durumların yönetimi ve sürekli takibinde hayati bir rol oynamaktadır. Son yıllarda ülkemizde pediatrik yoğun bakım hizmetlerine olan ihtiyaç belirgin şekilde artış göstermektedir. Ancak hasta sağkalımı, yalnızca yoğun bakım yatak kapasitesine değil, aynı zamanda sunulan sağlık hizmetinin kalitesine de bağlıdır. Bu nedenle, Çocuk Yoğun Bakım Üniteleri'nde (ÇYBÜ) bakım kalitesinin iyileştirilmesi açısından mortalite belirleyicilerinin tanımlanması ve analiz edilmesi büyük önem taşımaktadır. Bu çalışmanın amacı, Çanakkale Onsekiz Mart Üniversitesi Hastanesi ÇYBÜ’ne yatırılan hastaların klinik özelliklerini değerlendirmek ve sağkalım sonuçlarıyla ilişkili değişkenleri belirlemektir.
Yöntem: Bu retrospektif kesitsel çalışmada, 1 Mayıs 2019 ile 31 Aralık 2022 tarihleri arasında Çanakkale Onsekiz Mart Üniversitesi Hastanesi ÇYBÜ’ne yatırılan 519 hastanın tıbbi kayıtları incelendi. Toplanan veriler demografik özellikler, yatış tanıları, yoğun bakım ünitesinde kalış süresi, invaziv prosedürlere duyulan ihtiyaç, hastanede yatış sırasında gelişen komplikasyonlar ve Glasgow Koma Skalası (GKS), Pediatrik Mortalite Riski III (PRISM III), Pediatrik Mortalite İndeksi 2 (PIM2) ve Pediatrik Lojistik Organ Disfonksiyonu-2 (PELOD-2) gibi klinik puanlama sistemlerini içeriyordu. Uygun testler kullanılarak istatistiksel analizler yapıldı ve mortalite ile ilişkili faktörler lojistik regresyon analizi ile değerlendirildi.
Bulgular: Çalışmaya dahil edilen 519 hastanın %55,3'ü erkekti ve ortanca yaş 55 aydı. Hastaneye yatışın en sık görülen nedenleri bulaşıcı hastalıklar (%31,2), nörolojik bozukluklar (%15,1) ve zehirlenmelerdi (%10,6). Ek olarak, hastaların %27,0'ında en az bir kronik rahatsızlık vardı. Özellikle, zehirlenme oranı 97-216 aylık yaş grubunda (%69,4) özellikle yüksekti. Mortalite ile değerlendirilen tüm puanlama sistemleri, yani PRISM III, PIM2, PELOD-2 ve Glasgow Koma Ölçeği (GKS) arasında istatistiksel olarak anlamlı bir ilişki vardı (p = 0,001). Lojistik regresyon analizi, daha önce yoğun bakım ünitesine yatış [OR: 4,697–6,898], mekanik ventilasyon ihtiyacı [OR: 0,151–0,094] ve hastane enfeksiyonu gelişimini [OR: 2,474] mortalitenin bağımsız öngörücüleri olarak tanımladı (p = 0,021).
Sonuç: Pediatrik yoğun bakımda sağkalım sonuçları yalnızca tanı ve tedavi müdahalelerinden değil, aynı zamanda hastane kaynaklı enfeksiyonlar, mekanik ventilasyon ihtiyacı ve daha önce yoğun bakım ünitesine yatış gibi faktörlerden de etkilenir. PRISM III, PIM2 ve PELOD-2 gibi klinik puanlama sistemleri değerli prognostik öngörüler sunar ve klinik karar almaya katkıda bulunur. Bu çalışmanın bulguları, mevcut pediatrik yoğun bakım uygulamalarının değerlendirilmesi ve iyileştirilmesi için önemli veriler sağlar. Bu nedenle, mortaliteyi etkileyen faktörlerin düzenli analizi, ÇYBÜ’lerde sunulan bakım kalitesini iyileştirmeye yönelik kritik bir adımdır.

Keywords

çocuk prognoz glasgow koma skoru pediatrik yoğun bakım üniteleri klinik karar verme süreci

Thanks

The authors would like to express their sincere gratitude to the nurses and auxiliary healthcare personnel of the PICU at Çanakkale Onsekiz Mart University Hospital for their dedicated service and valuable contributions to patient care during the study period.

References

  • 1. Downes JJ the historical evolution current status and prospective development of pediatric critical care. CritCareClin. 1992;8(1):1–22. https://doi.org/10.1016/S0749-0704(18)30264-1
  • 2. Koroglu TF Bayrakci B Dursun O Kendirli T Yildizdas D Karabocuoglu M [guideline for pediatric intensive care units: recommendations by the Turkish Society of Pediatric Emergency and Intensive Care] (in Turkish). Turk Pediatri Ars. 2006;41(3):139-45. https://doi.org/10.4274/tpa.45.82
  • 3. Ay B Tutanc M Yel S Kaplan M Bosnak M Ayintap E [antithrombin III level and prognostic value in patients admitted to intensive care] (in Turkish). Med J Mustafa Kemal Univ. 2010;1(1):1-5.
  • 4. Tutanc M Basarslan F Karcioglu M Yel S Kaplan M Arica M et al. [evaluation of patients admitted to the pediatric intensive care unit] (in Turkish). Duzce Med J. 2011;13(3):18-22.
  • 5. Orhan MF [evaluation of 938 patients admitted to the pediatric intensive care unit over 2 years] (in Turkish). Turk J Pediatr Dis. 2012;6(4):228-31.
  • 6. Poyrazoglu H Dursun I Gunes T Akcakus M Konuskan B Canpolat M et al. [evaluation and outcomes of patients admitted to the pediatric intensive care unit] (in Turkish). Erciyes Med J. 2008;30(4):232-37.
  • 7. UlgenTekerek N Akyildiz BN [evaluation of prognosis in pediatric intensive care patients in a tertiary center] (in Turkish). J Pediatr Dis. 2017;11(4):221-25.
  • 8. Konca C Tekin M Karakoc F Turgut M [evaluation of 770 patients admitted to the pediatric intensive care unit: a single center experience] (in Turkish). J Pediatr Dis. 2015;9(2):90-95.
  • 9. Oz O Bayraktar S Elevli M Duru HNS Civilibal M Sahin K [evaluation of patients admitted to the pediatric intensive care unit of a training and research hospital] (in Turkish). Cayd. 2015;2:65-70. https://doi.org/10.5505/cayb.2015.35220
  • 10. Zinter MS DuBois SG Spicer A Matthay K Sapru A pediatric cancer type predicts infection rate need for critical care intervention and mortality in the pediatric intensive care unit. Intensive Care Med. 2014;40:1536-44. https://doi.org/10.1007/s00134-014-3389-2
There are 10 citations in total.

Details

Primary Language English
Subjects Pediatric Intensive Care
Journal Section Original Research
Authors

Fatih Battal 0000-0001-9040-7880

Tayyar Ayberk Borak 0000-0001-6451-6565

Publication Date June 27, 2025
Submission Date March 27, 2025
Acceptance Date May 20, 2025
Published in Issue Year 2025Volume: 10 Issue: 2

Cite

APA Battal, F., & Borak, T. A. (2025). Mortality-associated factors in the pediatric intensive care setting: a retrospective review of 519 patients in Çanakkale, Türkiye. Family Practice and Palliative Care, 10(2), 60-67. https://doi.org/10.22391/fppc.1666803
AMA Battal F, Borak TA. Mortality-associated factors in the pediatric intensive care setting: a retrospective review of 519 patients in Çanakkale, Türkiye. Fam Pract Palliat Care. June 2025;10(2):60-67. doi:10.22391/fppc.1666803
Chicago Battal, Fatih, and Tayyar Ayberk Borak. “Mortality-Associated Factors in the Pediatric Intensive Care Setting: A Retrospective Review of 519 Patients in Çanakkale, Türkiye”. Family Practice and Palliative Care 10, no. 2 (June 2025): 60-67. https://doi.org/10.22391/fppc.1666803.
EndNote Battal F, Borak TA (June 1, 2025) Mortality-associated factors in the pediatric intensive care setting: a retrospective review of 519 patients in Çanakkale, Türkiye. Family Practice and Palliative Care 10 2 60–67.
IEEE F. Battal and T. A. Borak, “Mortality-associated factors in the pediatric intensive care setting: a retrospective review of 519 patients in Çanakkale, Türkiye”, Fam Pract Palliat Care, vol. 10, no. 2, pp. 60–67, 2025, doi: 10.22391/fppc.1666803.
ISNAD Battal, Fatih - Borak, Tayyar Ayberk. “Mortality-Associated Factors in the Pediatric Intensive Care Setting: A Retrospective Review of 519 Patients in Çanakkale, Türkiye”. Family Practice and Palliative Care 10/2 (June 2025), 60-67. https://doi.org/10.22391/fppc.1666803.
JAMA Battal F, Borak TA. Mortality-associated factors in the pediatric intensive care setting: a retrospective review of 519 patients in Çanakkale, Türkiye. Fam Pract Palliat Care. 2025;10:60–67.
MLA Battal, Fatih and Tayyar Ayberk Borak. “Mortality-Associated Factors in the Pediatric Intensive Care Setting: A Retrospective Review of 519 Patients in Çanakkale, Türkiye”. Family Practice and Palliative Care, vol. 10, no. 2, 2025, pp. 60-67, doi:10.22391/fppc.1666803.
Vancouver Battal F, Borak TA. Mortality-associated factors in the pediatric intensive care setting: a retrospective review of 519 patients in Çanakkale, Türkiye. Fam Pract Palliat Care. 2025;10(2):60-7.
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Family Practice and Palliative Care       ISSN 2458-8865       E-ISSN 2459-1505