Dataset Information

Pertussis requiring intensive care.

ABSTRACT:

Objectives

To describe children with pertussis who require intensive care.

Design, setting and patients

An audit in Auckland, New Zealand, of pertussis admissions to the national paediatric intensive care unit (PICU) from 1991 to 2003.

Results

72 children, 97% of whom were <12 months old. The annual number of cases increased with time (p = 0.04). Forty patients (56%) were coughing for less than 8 days before admission. Apnoea or paroxysmal cough was present in 33 (83%) of these children. Thirty five (49%) received assisted ventilation. Four died. 19% were readmitted to PICU. Those readmitted presented with more atypical disease and had a shorter first admission but longer total PICU admission (9 vs 5 days, p = 0.009). Of the 58 children from Auckland, nine either died (three) or had subsequent respiratory or neurodevelopmental problems (six). There was an increased risk (relative risk, 95% CI) of death or disability associated with having a co-morbidity (RR = 5.56, 1.50 to 8.15), an elevated lymphocyte count (RR = 5.75, 1.54 to 13.65), presenting with seizures/encephalopathy (4.87, 1.18 to 8.34) or shock (6.50, 1.89 to 8.94), having a PIM score of 1% or more (RR = 6.20, 1.22 to 21.72), any abnormal neurological signs (RR = 9.65, 3.32 to 15.23) or being readmitted to PICU (RR = 4.63, 1.44 to 8.82).

Conclusions

Apnoea and paroxysmal cough are key symptoms of pertussis in those with shorter cough duration. Death or disability are frequent. Clinical factors define children at increased risk of these poor outcomes. Early discharge from PICU is associated with an increased risk of readmission and poor outcome.

SUBMITTER: Surridge J

PROVIDER: S-EPMC2083622 | biostudies-literature | 2007 Nov

REPOSITORIES: biostudies-literature

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Publications

Pertussis requiring intensive care.

Surridge Julia J Segedin Elizabeth R ER Grant Cameron C CC

Archives of disease in childhood 20070704 11

<h4>Objectives</h4>To describe children with pertussis who require intensive care.<h4>Design, setting and patients</h4>An audit in Auckland, New Zealand, of pertussis admissions to the national paediatric intensive care unit (PICU) from 1991 to 2003.<h4>Results</h4>72 children, 97% of whom were <12 months old. The annual number of cases increased with time (p = 0.04). Forty patients (56%) were coughing for less than 8 days before admission. Apnoea or paroxysmal cough was present in 33 (83%) of t ...[more]

PMID: 17611239

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Project description:Importance:Cellulitis is a commonly occurring skin and soft tissue infection and one of the most frequently seen dermatological diseases in the intensive care unit (ICU). However, clinical characteristics of patients with cellulitis requiring intensive care treatment are poorly defined. Necrotizing fasciitis is often confused for cellulitis at initial presentation and is considered to be more severe and thus has previously been described in more detail. Objective:To describe the clinical presentation and outcomes of patients with ICU-necessitating cellulitis and to compare them with patients with necrotizing fasciitis. Design, Setting, and Participants:This prospective cohort study includes all ICU admissions from 2 tertiary hospitals in the Netherlands. Of 2562 sepsis admissions, 101 had possible, probable, or definite cellulitis or soft tissue infections. Retrospective review identified severe cellulitis was the reason for ICU admission in 23 patients, necrotizing fasciitis in 31 patients, and other diagnoses in 47 patients. Main Outcomes and Measures:Patient and disease characteristics, cultured pathogens, lengths of stay, and short-term and long-term mortality. Results:Overall, 54 patients with cellulitis (n?=?23; mean [SD] age, 57.2 [17.7] years) or necrotizing fasciitis (n?=?31; mean [SD] age, 54.3 [13.5]) were included in this study. Patients with cellulitis were found to be less severely ill than patients with necrotizing fasciitis. This is reflected in rates of shock (7 [30.4%] vs 19 [61.3%]; P?=?.03), need for mechanical ventilation (12 [52.2%] vs 19 [93.5%]; P?=?.003) and slightly lower mean Sequential Organ Failure Assessment scores (8 vs 10; P?=?.046). Median (interquartile range [IQR]) Acute Physiology and Chronic Health Evaluation IV scores did not differ significantly (82 [75-98] vs 76 [70-96]; P?=?.16). Patients with cellulitis had more chronic comorbidities than patients with necrotizing fasciitis (20 [87.0%] vs 17 [54.8%]; P?=?.02), especially cardiovascular insufficiencies (10 [43.5%] vs 4 [12.9%]; P?=?.02) and immunodeficiencies (9 [39.1%] vs 3 [9.7%]; P?=?.02). Among patients with cellulitis and patients with patients with necrotizing fasciitis, Staphylococcus aureus (10 [43.5%] vs 4 [12.9%]; P?=?.02), Streptococcus pyogenes (2 [8.7%] vs 19 [61.3%]; P?<?.001) and Escherichia coli (4 [17.4%] vs 5 [16.2%]; P?=?.90) were the most frequently observed pathogens. Median (IQR) length of ICU stay was shorter for patients with cellulitis vs patients with necrotizing fasciitis (3 [2-5] vs 5 [3-11]; P?=?.01), while median (IQR) hospital length of stay did not differ significantly (22 [10.25-32] vs 36 [14.25-40]; P?=?.16); and the in-hospital mortality rate (26.1% vs 22.6%, P?>?.99) and 90-day mortality rate (30.4% vs 22.6%; P?=?.54) were similar. Conclusions and Relevance:Patients with cellulitis patients are seldom admitted to the ICU. However, while these patients are less critically ill on admission than patients with necrotizing fasciitis, they have more chronic comorbidities and most notably similar short-term and long-term mortality. Trial Registration:clinicaltrials.gov Identifier: NCT01905033.

Dataset Information

Pertussis requiring intensive care.

Objectives

Design, setting and patients

Results

Conclusions

Publications

Pertussis requiring intensive care.

Similar Datasets

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