PATTERNS OF REFERRAL TO PICU OF TERTIARY CARE HOSPITAL

Background: Pediatric Intensive Care Units (PICUs) play a critical role in managing children with life-threatening illnesses, and timely referral is essential for optimizing outcomes. Variations in referral practices may influence disease severity at admission, resource utilization, and mortality. Understanding local referral patterns is therefore important to identify gaps in care and improve pediatric critical care delivery. This study evaluated referral patterns to the PICU of a tertiary care hospital, focusing on demographic characteristics, referral sources, clinical indications, illness severity, and short-term outcomes. Objective: To analyze referral patterns to the PICU and identify key clinical and demographic factors associated with PICU admission and outcomes. Methods: A prospective observational study was conducted over six months at the PICU of CMH Kharian. A total of 256 pediatric patients aged 30 days to 12 years who were referred to the PICU were included. Data on age, sex, referral source, primary diagnosis, Pediatric Risk of Mortality (PRISM) score, and clinical outcomes were extracted from medical records. Descriptive statistics were used to summarize variables, while chi-square tests and logistic regression analyses were applied to identify predictors of PICU admission and severity. Statistical significance was set at p < 0.05. Results: The mean age of patients was 4.5 ± 3.1 years, with males comprising 58% of admissions. The emergency department accounted for 70% of referrals, followed by inter-hospital transfers (20%) and outpatient clinics (10%). Respiratory failure was the leading indication for admission (40%), followed by sepsis (25%) and neurological conditions (15%). The mean PRISM score was 12.4 ± 5.8, and 15% of patients had scores above 20, indicating high mortality risk. Overall outcomes showed that 80% of patients were discharged, 10% were transferred to other units, and 10% died. Respiratory failure, sepsis, severe neurological conditions, and higher PRISM scores were significant predictors of PICU admission severity. Conclusion: PICU referrals were predominantly driven by acute respiratory, septic, and neurological illnesses, with emergency departments serving as the main referral source. The findings emphasize the importance of early recognition of critical illness, standardized referral practices, and severity-based triage to improve pediatric critical care outcomes.