Browsing by Author "Shrestha, Pun Narayan"
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Publication Application of Pediatric Risk of Mortality (PRISM) III Score in Predicting Mortality Outcomes(Nepal Health Research Council, 2023) Joshi, Prakash; Agrawal, Sumit; Ghimire, Jagat Jeevan; Shrestha, Pun Narayan; Najala Khatun,; Banjara, Megha RajAbstract Background: Children admitted in a pediatric intensive care unit have a high risk of mortality. Pediatric risk of mortality III score in first 24 hours of admission has increasingly been used to predict mortality. The objective of this study was to evaluate the validity of Pediatric risk of mortality score in prediction of mortality among the patient admitted in pediatric intensive care unit. Methods: This prospective observational study was conducted at pediatric intensive care unit of a government pediatric hospital from January to June 2021. Patients between 1 month to 14 years of age and meeting the inclusion criteria were enrolled. Pediatric risk of mortality III score was calculated within 24 hours of admission. Patients were followed up for outcome measure as survivors and non survivors. Chi square test and logistic regression analysis were used to find the association of predictors and the score. Results: The mean Pediatric risk of mortality III score was lower in survivors than in non-survivors (4.67 ± 3.8 versus 14.10 ± 6.07; p<0.001). Those requiring inotropic and ventilator support have significantly higher mortality [49.4 versus 0.6 (p<0.001) and 81.8 versus 1.5 (p<0.001) respectively]. Minimum systolic blood pressure, abnormal pupillary reflex, increased blood urea nitrogen and decreased platelet were the significant (p<0.001) risk factors. The area under the Receiver Operating Characteristic curve was 0.916±0.024 (p<0.001) and goodness-of-fit test showed no significant difference between observed and expected mortalities (p=0.186). Conclusions: The Pediatric risk of mortality score constitutes a useful prognostic tool in predicting the mortality. Key words: Mortality; pediatrics; pediatric intensive care unit; risk score,Publication Clinical Profile, Immediate Outcome and Predictors of Poor Outcome of Children in Pediatric Intensive Care Unit with Sepsis(Institute of Medicine, Tribhuvan University, 2024) Poudel, Bulu Wagley; Shrestha, Pun Narayan; Shrestha, Sanjeet Kumar; Malla, Sadikshya Shah; Rayamajhi, AjitAbstract: Introduction Sepsis remains a major cause of death in children with death rate ranging from 5% in developed countries to 35% in developing countries. However, data on the predictive factors for poor outcome particularly in developing countries, remain limited. So this study aims to evaluate the clinical profile, immediate outcome and factors associated with poor outcome of the children with sepsis. Methods This retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at Kanti Children Hospital, Kathmandu. Medical records of patients aged 30 days to 14 years, diagnosed with sepsis based on clinical and laboratory parameters and admitted to the PICU between April 2024 to September 2024 were analyzed. The clinical features, outcome in the form of discharge or death during the hospital stay and factors effecting the poor outcome were tabulated and the data analysis was done by SPSS version 21. Results The total number of patient enrolled in the study were 53. The mean age of the patient was (3.49±0.183) yrs. Among them 31/53(58 %) were male and 22/53(42%) were female. Among them 42/53(79.25%) were Hindus 5/53(9.43%) were Muslims 4/53(7.54%) Buddhist and 2/53 (3.77%) Christian. The most common presenting symptom was fever observed in 50/53(94.4%) of cases. The mortality rate for sepsis was (14/53)26.41% which is statistically significant. Predictors of poor outcome included were the need for dialysis (p=0.016), the presence of Central Nervous System disease (p=0.001), the use of mechanical ventilation (p=0.00), the use of ionotropic support (p=0.010) and elevated D-dimer levels (p=0.036). Conclusion Fever was the most common symptom of sepsis with a mortality rate of 26.41%. Key predictors of poor outcome included the need of dialysis, presence of CNS disease, mechanical ventilation, the use of ionotropic support and elevated D-dimer level.