Pediatric High Dependency Unit (HDU): Pattern of Admission, Length of Stay (LoS) and Outcome

Abstract

Patients admitted to the HDU usually need medical care more than the capacity of general pediatric ward and less than Pediatric Intensive Care Unit (PICU) and they are usually children with acute medical problems necessitate close observation, monitoring and management. Objectives: To determine the pattern of admissions, length of stay (LoS) and outcome of patients admitted to pediatric high dependency (PHDU) in Elobied Pediatrics Teaching Hospital. Methods: It is a retrospective cross-sectional hospital-based study where data including age, sex, origin, length of stay (LoS), diagnosis and outcome were retrieved from pediatric HDU and hospital records for a 2-year period. All cases were individually reviewed by two pediatricians to identify the cause of admission along with LoS and outcome. Results: During the study period; 519 children were admitted with age ranging from 1 day to 17 years with the median age of 7 months. Males were 295 (56.8%) and females were 224 (43.1%). It was found that most patient 323 (62.2%) were from rural area and 196 (37.7%) were from urban area. Pattern of admission was as follows: neonatal Sepsis 123 (23.7%), severe malaria 52 (10%), cardiovascular diseases 51 (9.8%) of which heart failure in 29 (5.5%) due to anemia or congenital heart disease, diabetic ketoacidosis (DKA) 49 (9.4%), respiratory diseases 49 (9.4%) of which pneumonia 33 (6.3%) meningoencephalitis 49 (9.4%), renal diseases 33 (6.3%), neurological diseases 18 (3.4%), gastrointestinal diseases 13 (2.5%), septic shock 11 (2.1%), surgical cases 18 (3.4%) of which intestinal obstruction was 9 (1.7%) and others 53 (10.2%). The length of stay (LoS) was ranging from 1 day to 40 days with the median of 4 days. Regarding the outcome; 192 (37%) were discharged from HDU in good condition, 215 (41.4%) died out of them; 121 (23.3% died within 48 hours after admission to hospital and 101(19.8%) died after 48 hours after admission), 81 (15.6%) referred to higher centres and 31 (6%) left against medical advice (LAMA). Conclusion: It was obvious that communicable and preventable diseases are the most prevalent causes for morbidity and mortality among children admitted to HDU with high mortality rate.