627 - Global PARITY: the Burden of Pediatric Acute Critical Illness in Resource-limited Settings

The prevalence of pediatric critical illness in resource-limited settings (RLS) is largely unknown as critically-ill children are frequently managed outside of formal pediatric intensive care units (PICUs). To address this knowledge gap, Global PARITY (Pediatric Acute cRitical Illness point prevalence sTudY), a prospective, observational, international point-prevalence study, measured the burden of acute pediatric critical illness in RLS.

Objective: To measure the prevalence of and hospital mortality associated with pediatric acute critical illness in RLS.

Design/Methods: Eligible hospitals self-identified as being resource-limited, defined as regularly experiencing limited availability of medications, equipment, supplies, or devices; lacking infrastructure; or having too few or under-trained personnel. Eligible subjects were children aged 29d-14yrs with acute illness or injury presenting to an emergency department or directly admitted to a hospital in aRLS. Enrollment occurred over five 24hr sampling periods from July 2021-Aug 2022. Subjects were followed for up to 30d for hospital outcomes. Primary outcome was prevalence of acute critical illness, defined as death within 48hrs, need for a higher level-of-care (e.g., transfer to PICU, high dependency unit, or other hospital), or intensive care-level intervention (e.g., vasoactives, mechanical ventilation).

Results: Forty-seven RLS hospitals in 20 countries participated in at least two data collection periods (Figure 1). A total of 7,489 children were enrolled; 45.1% (N=3381) were female, the median age was 3yrs (interquartile range 1.2-7), and 33.9% (N=2536) were admitted. A total of 1013 subjects met criteria for acute critical illness (13.8% prevalence), among whom 7.1% (N=72) died within 48hrs, 91.9% required higher level-of-care (N=931), and 18.2% (N=184) received intensive care-level interventions. Overall 30-day hospital mortality for the cohort was 3.4% (N=86).

Conclusion(s): Pediatric critical illness is common in RLS hospitals; more than one in 10 children in this study were critically ill. Additionally, hospital mortality was almost double (3.4%) that of US PICU mortality (1.8%). To address high child mortality in RLS, there is an urgent need to expand pediatric critical care resources and expertise; next steps include analysis of available resources to identify crucial gaps. Global PARITY is a necessary first step to determine research priorities to improve outcomes for critically ill children in RLS. It will provide important insight into future resource investment and allocation for equitable care of critically ill children worldwide.