Pediatric Shock: The Magnitude, Its Determinants and Short-Term Outcome on Patients. A Cross-Sectional Hospital-Based Study

Figures & data

Table 1 Socio-Demographic Characteristics of Study Participants and Caregivers Among Pediatric Shock Patients

Variables	Category	Count(n)	Percentage (%)
Sex of the children	Male	75	56.8%
	Female	57	43.2%
Residence	Urban	73	55.3%
	Rural	59	44.7%
Age of participant	1 month-11 month	37	28%
	1–5 years	38	28.8%
	Above 5 years	57	43.2%
Mothers’ educational status	No formal education	30	22.7%
	Primary	52	39.3%
	Secondary	36	27.4%
	Tertiary	14	10.6%
Referred from other health facility	Yes	88	66.7%
	No	44	33.3%

Table 2 Physical Finding and Measurements of Pediatric Shock Patients

Variables	Category	Count (%)	Variables	Category	Count (%)
HR	Tachycardia	115 (87.1%)	W/L	Normal	28 (21.1)
	Normal	15 (11.4%)		−2 and −3 Z score	53 (40.2%)
	Bradycardia	2(1.5%)		<3 Z score	51 (41.7%)
RR	Normal	32 (24.2%)	Sign of dehydration	Yes	98 (74.2%)
	Tachypnea	94 (71.2%)		No	34 (25.8%)
	Bradypnea	6(4.5%)		Normal	5(3.8%)
SPO2	<90%	88 (66.7%)	Pulse volume	Feeble	111 (84.1%)
				Bounding	16 (12.1%)
	91% and above	44 (33.3%)	Capillary refill	<3 Second	15 (11.45%)
				3–5 Second	93 (70.5%)
				>5 Second	24 (18.2%)
BP	Not measured	75 (56.8%)	UOP	Normal	34 (25.8%)
	Unrecordable	20 (15.2%)		Oliguria	84 (63.6%)
	Hypotensive	33 (25%)		Polyuria	14 (10.6%)
	Normotensive	4(3%)	GCS	15	13 (9.8%)
TO	Hypothermic	50 (37.9%)		14–9	100 (75.8%)
	Febrile	49 (37.1%)		3–8	19 (14.4%)
	Normal	33 (25%)
MUAC	Normal	32 (24.2%)	RBS	Normal	77 (58.3%)
	−2 and −3Z score	45 (34.1%)		Hypoglycemia	40 (30.3%)
	<−3 Z score	55 (41.7%)		Hyperglycemia	15 (11.4%)

Abbreviations: HR, heart rate; RR, respiratory rate: SPO₂, saturation of peripheral oxygen; BP, blood pressure; T0, temperature; MUAC, mid upper arm circumference; W/L, weight for length; OUP, urine output; GCS, Glasgow Coma Scale; RBS, random blood sugar.

Table 3 Laboratory Parameters of Pediatric Shock Patients

Variables	(n)	Category	Count (N)	Percentage
CBC	87 (66%)
WBC		Leukocytosis	44	50.6%
		Normal	30	34.7%
		Leukopenia	13	14.9%
Hemoglobin		Normal	32	36.8%
		Anemia	55	63.2%
PLT		Thrombocytosis	19	21.8%
		Normal	33	37.9%
		Thrombocytopenia	35	40.2%
Cr	94 (71.2%)	Normal	40	42.6%
		Elevated	54	57.4%
LFT	42 (31.8%)	Normal	23	54.8%
		Elevated	19	45.2%
Na	85 (64.4%)	Hypernatremia	26	30.6%
		Normal	30	35.3%
		Hyponatremia	29	34.1%
Ka	85 (64.4%)	Hyperkalemia	23	27%
		Normal	28	33%
		Hypokalemia	34	40%
Ca	11 (8.3%)	Normal	2	18.2%
		Hypocalcemia	9	81.8%

Abbreviations: CBC, complete blood count; WBC, white blood cell; PLT, platelet; Cr, creatinine; LFT, liver function test; Na, sodium; Ka, potassium; Ca, calcium.

Table 4 Electrolyte Abnormality and Stage of Shock among Pediatric Patient

Variables	Compensated		Decompensated
	Count (n)	%	Count (n)	%
Hypernatremia	6	23.1	20	76.9
Hyponatremia	13	44.8	16	55.2
Hyperkalemia	8	34.8	15	65.2
Hypokalemia	13	38.2	21	61.8
Hypocalcemia	3	33.3	6	66.7

Table 5 Type, Stage and Management of Pediatric Shock Patients

Variables	Characteristics	Count(n)	Percentage
Type of shock	Hypovolemic	70	53%
	Septic	46	34.8%
	Mixed	9	6.8%
	Cardiogenic	3	2.3%
	Anaphylactic	3	2.3%
	Obstructive	1	0.8%
Stage of shock	Compensated	39	29.5%
	Decompensated	93	70.5%
Multi-organ dysfunction syndrome	Yes	44	33.3%
	No	88	66.7%
Fluids administration	Crystalloids only	76	57.6%
	Crystalloids and colloid	56	42.4%
Antibiotic administration	Started just on arrival	45	35.2%
	He/she was on antibiotic	83	64.8%
Inotropic administration	Yes	60	45.5%
	No	72	54.5%
Steroid administration	Yes	50	37.9%
	No	82	62.1%
Invasive ventilation provided	Yes	47	35.6%
	No	85	64.4%
Patient outcome	Improved	72	54.5%
	Dead	60	45.5%

Figure 1 Type and stage of shock in children.

Figure 2 Type versus outcome of pediatric shock patients.

Table 6 Assessing Predictors of Mortality Among Pediatric Shock Patient Using Binary Logistic Regression

Variables		Outcome of Shock		Odds Ratio
		Improved	Died	COR (95% CI)	P - value	AOR (95% CI)	P –value
Duration of illness	1–2 days	26 (76.5%)	8(23.5%)	1		1
	8 and above	27 (37.5%)	45 (62.5%)	5.4 (2.213.6)	<0.001	16.9 (2.3–123)	0.005
Duration of hospital stay	1–3 days	9(24.3%)	28 (75.7%)	5(2–13)	<0.001	9(1.7–48)	0.008
	Above 10 days	37 (62.7%)	22 (37.3%)	1		1
Underlying illness	Yes	18 (42.9%)	24 (57.1%)	2(0.9–4)	0.067	0.59 (0.15–2.4)	0.467
	No	54 (60%)	36 (40%)	1		1
Type of shock	Hypovolemic	55 (78.6%)	15 (21%)	1		1
	Others	17 (27.4%)	45 (72.6%)	9.7 (4.4–21.5)	<0.001	8.3 (1.4–48)	0.02
Stage of shock	Compensated	37 (94.9%)	2(5.1%)	1		1
	Decompensated	35 (37.6%)	58 (62.4%)	30.6 (6.9–135)	<0.001	27.8 (2.8–157)	0.003
MODS	Yes	9(20.5%)	35 (79.5%)	9.8 (4.2–23.3)	<0.001	3(0.77–12)	0.110
	No	63 (71.6%)	25 (28.4%)	1		1
Inotrope administration	Yes	17 (28.3%)	43 (71.1%)	8.2 (3.7–17.8)	<0.001	0.00 (00)	1
	No	55 (76.4%)	17 (23.6%)	1		1
Steroid	Yes	14 (28%)	36 (72%)	6.2 (2.8–13)	<0.001	1(0.11–8)	0.994
	No	58 (70.7%)	24 (29.3.0%)	1		1
Invasive ventilation provided	Yes	9(19.1%)	38 (80.9%)	12 (5–29)	<0.001	11 (2.6–53)	0.001
	No	63 (74.1%)	22 (25.9%)	1		1

Abbreviation: MODS, multi-organ dysfunction syndrome.

Data Sharing Statement

All data related to this study are contained in this paper.