Clinico-Etiological Profile and Outcome of Shock in Children Admitted To A Tertiary Care Hospital

Abstract

Objective: To describe the clinical profile, etiology, and immediate outcome of shock in children admitted to the pediatric intensive care unit of a tertiary care hospital.

Methods: This hospital-based descriptive observational study was conducted over 18 months at Bharati Vidyapeeth Medical College and Hospital, Sangli, India. Ninety children aged 1 month to 18 years with shock were enrolled. Clinical features, type and etiology of shock, organ involvement, organ support, Pediatric Risk of Mortality III score, and immediate outcome were recorded.

Results: Of 90 children, 51.1% were girls and 44.4% were older than 60 months. Fever (94.4%), altered sensorium (83.3%), and breathlessness (82.2%) were the commonest symptoms; cold extremities (98.9%), hypotension (96.7%), and tachypnea (95.6%) were the commonest signs. Distributive shock was most frequent (60.0%), followed by hypovolemic (23.3%), cardiogenic (13.3%), and obstructive shock (3.3%). Septicemia was the leading etiology (64.4%); Klebsiella pneumoniae (11.1%) and Acinetobacter baumannii (10.0%) were the commonest isolates. Neurological involvement occurred in 84.4%, and 66.7% needed invasive mechanical ventilation. Overall, 53 children (58.9%) survived and 37 (41.1%) died. All deaths occurred in children with a Pediatric Risk of Mortality III score above 18 (mortality 59.7% in this group).

Conclusion: Septicemia was the leading cause of pediatric shock, and distributive shock was the commonest type. Most children needed advanced respiratory and hemodynamic support, and mortality remained high. A higher Pediatric Risk of Mortality III score identified children at greatest risk of death. Early recognition, etiology-directed treatment, timely intensive care, and risk stratification are essential to improve outcomes.