Profile of hospitalizations in Pediatric Intensive Care Units of the Brazilian Unified Health System in the state of Pernambuco, Brazil

Mendonça, Juliana Guimarães de; Guimarães, Maria José Bezerra; Mendonça, Vilma Guimarães de; Portugal, José Luiz; Mendonça, Carolina Guimarães de

doi:10.1590/1413-81232018243.02152017

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FREE THEMES • Ciênc. saúde colet. 24 (3) • Mar 2019 • https://doi.org/10.1590/1413-81232018243.02152017 copy

Profile of hospitalizations in Pediatric Intensive Care Units of the Brazilian Unified Health System in the state of Pernambuco, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

In Brazil, the distribution of pediatric intensive care units (PICUs), causes of admission, costs incurred and how care is provided are still poorly understood. The objective was to describe the profile of hospitalizations in the PICUs of the Brazilian Unified Health System in the state of Pernambuco, in 2010. A cross-sectional study was performed, with 1,915 hospitalizations in the six PICUs, collected in the Hospital Information System. The variables were compared by age group. There was a predominance of male hospitalizations (58.1%), an age range of between one and four years old (32.5%), the use of philanthropic units (64.1%) and type III PICUs (59.2%) and admissions due to neoplasms (28.9%). The mean hospital stay was 14.4 days, and the mean cost was BRL 6,674.80. The mean distance between the municipality of residence and the PICU ranged from 8.7 to 486.5 km. There were 207 deaths (10.8/100 admissions), of which 30% were due to infectious and parasitic diseases. Differences were identified between the age groups (p < 0.05), except regarding gender. In conclusion, admissions to PICUs in Pernambuco show differences in geographical access and sociodemographic characteristics, admissions, and causes of hospitalization and death among age groups.

Pediatric intensive care units; Hospital information systems; Morbidity; Hospital costs; Access to health services

Variables	Age group

	< 1 year	1-4 years	5-9 years	≥ 10 years	Total
Hospitalizations
Nº (%)	496 (25.9)	622 (32.5)	411 (21.5)	386 (20.2)	1915 (100.0)
Average monthly (Nº)	41	52	34	32	160
Average stay (in days)	18.7	14.3	11.9	11.7	14.4
Average cost (in BRL)	8,361.50	7,089.23	5,563.79	5,022.60	6,674.80
Deaths
Nº (%)	83 (40.1)	53 (25.6)	29 (14.0)	42 (20.3)	207 (100.0)
Average monthly (Nº)	7	4	2	4	17
Lethality rate (%)*	16.7	8.5	7.1	10.9	10.8

Variables	<1 year		1-4 years		5-9 years		>10 years		p*	Total

	n	%	n	%	n	%	n	%		n	%

	(496)	(100.0)	(622)	(100.0)	(411)	(100.0)	(386)	(100.0)		(1915)	(100.0)
Sex
Male	290	58.5	365	58.7	237	57.7	221	57.3	0.967	1113	58.1
Female	206	41.5	257	41.3	174	42.3	165	42.7		802	41.9
Nature of the PICU
SUS's own network	257	51.8	203	32.6	99	24.1	128	33.2	<0.001	687	35.9
Philanthropic Network	239	48.2	419	67.4	312	75.9	258	66.8		1228	64.1
Type of PICU
PICU II	288	58.1	239	38.4	115	28.0	139	36.0	<0.001	781	40.8
PICU III	208	41.9	383	61.6	296	72.0	247	64.0		1134	59.2
Length of stay
<3 days	63	12.7	76	12.2	67	16.3	44	11.4	<0.001	250	13.1
4 - 7 days	89	17.9	168	27.0	114	27.7	107	27.7		478	25.0
8 - 14 days	133	26.8	195	31.4	125	30.4	133	34.5		586	30.6
15 - 21 days	82	16.5	61	9.8	45	10.9	58	15.0		246	12.8
22 - 28 days	35	7.1	37	5.9	15	3.6	22	5.7		109	5.7
29 days and more	94	19.0	85	13.7	45	10.9	22	5.7		246	12.8
Procedures performed †
Clinical @procedures	234	47.2	352	56.6	273	66.4	236	61.1	<0.001	1095	57.2
Surgical Procedures	262	52.8	270	43.4	135	32.8	142	36.8		809	42.2
Organ, tissue and cell transplants	-	-	-	-	3	0.7	8	2.1		11	0.6

Variables	< 1 year		1-4 years		5-9 years		≥ 10 years		p*	Total

	Nº	%	Nº	%	Nº	%	Nº	%		Nº	%
Main cause of hospitalization (Chapter ICD-10)
Neoplasms	37	7.5	201	32.3	173	42.1	142	36.8	< 0.001	553	28.9
Congenital malformations	118	23.8	127	20.4	60	14.6	59	15.3		364	19.0
Infectious and parasitic diseases	88	17.7	80	12.9	50	12.2	45	11.7		263	13.7
Diseases of the respiratory system	66	13.3	68	10.9	18	4.4	28	7.3		180	9.4
Diseases of the digestive system	74	14.9	26	4.2	8	1.9	10	2.6		118	6.2
Diseases of the nervous system	17	3.4	49	7.9	29	7.1	9	2.3		104	5.4
Diseases of @the circulatory system	18	3.6	15	2.4	17	4.1	15	3.9		65	3.4
Diseases of the genitourinary system	3	0.6	14	2.3	14	3.4	25	6.5		56	2.9
External causes	1	0.2	13	2.1	16	3.9	22	5.7		52	2.7
Other chapters †	74	14.9	29	4.7	26	6.3	31	8.0		160	8.4
Total	496	100.0	622	100.0	411	100.0	386	100.0		1915	100.0
Cause of death (Chapter ICD-10)
Infectious and parasitic diseases	22	26.5	15	28.3	10	34.5	15	35.7	< 0.001	62	30.0
Neoplasms	2	2.4	4	7.5	11	37.9	12	28.6		29	14.0
Congenital malformations	19	22.9	5	9.4	2	6.9	2	4.8		28	13.5
Diseases of the respiratory system	9	10.8	10	18.9	1	3.4	6	14.3		26	12.6
Other chapters ‡	31	37.3	19	35.8	5	17.2	7	16.7		62	30.0
Total	83	100.0	53	100.0	29	100.0	42	100.0		207	100.0

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

JG Mendonça participated in the design, data collection, analysis and interpretation of data and writing of the article. VG Mendonça participated in the design, interpretation of data and revision of the article. MJB Guimarães participated in the design, analysis and interpretation of the data and writing of the article. CG Mendonça participated in the data collection and revision of the article. JL Portugal participated in the analysis and interpretation of the data and revision of the article.