Skip to content
DraconiticResearch
Search Sources API
181,713 studies31 sourcesUpdated 48 min ago
Peer-reviewedCC BY 4.0PLOS One

Factors associated with mortality among critically ill pediatric patients referred to a tertiary hospital in Indonesia

  • Desy Rusmawatiningtyas1
  • Indah Kartika Murni1
  • Dwi Astuti Dharma Putri1
  • Antonius H. Pudjiadi2
  • Hennie Knoester3
  • Job B.M. van Woensel3
  1. 1Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/DR Sardjito General Hospital, Yogyakarta, Indonesia
  2. 2Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  3. 3Department of Pediatric Intensive Care, Emma Children’s Hospital/Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
Read full textPDFDOICite

Abstract

Background: An efficient referral system is an important but often under-recognized determinant of survival in critically ill children. Previous studies have reported high mortality rates among pediatric patients transferred to tertiary care facilities. This study aimed to identify factors associated with Pediatric Intensive Care Unit (PICU) mortality among critically ill children transferred and admitted to a tertiary-level referral hospital in Yogyakarta, Indonesia. Material and methods: This prospective cohort study was conducted over a 12-month period (July 1, 2023, to June 30, 2024) and included all critically ill children admitted to the PICU following interhospital referral. Demographic, clinical, referral, and transport data were prospectively collected. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with PICU mortality. Results: A total of 334 children were included, with a median age of 6 years. PICU mortality was 25.4%. The most common referral indication based on the Pediatric Assessment Triangle (PAT) was central nervous system dysfunction. Pre-referral management most commonly included oxygen therapy, antibiotic administration, and fluid resuscitation. Compared with survivors, non-survivors had higher PELOD-2 scores and were more likely to require intubation, mechanical ventilation, and vasoactive support before referral. In the multivariable analysis, pre-referral vasoactive support (adjusted OR 2.23, 95% CI 1.20–4.15; P = 0.011) and higher PELOD-2 scores within the first 24 hours after PICU admission (adjusted OR 1.32 per 1-point increase, 95% CI 1.20–1.45; P < 0.001) were independently associated with PICU mortality. Referral distance, decision time, and transfer time were not independently associated with mortality. Conclusion: PICU mortality among critically ill children transferred and admitted to a tertiary-care hospital in Indonesia remains high. Pre-referral vasoactive support and higher PELOD-2 scores at PICU admission were independently associated with PICU mortality. These findings generate the hypothesis that improvements in early stabilization and communication may improve outcomes, warranting prospective evaluation.

Related

  1. CSF pharmacokinetics-pharmacodynamics of linezolid in critically brain injured patients, with or without central nervous system healthcare-associated infection. The PK-Pop-LCR Study: A Multicentre Pharmacokinetics and Pharmacodynamics Population Study
    Claire Dahyot-Fizelier, Alexia Chauzy, Kévin Chalard +17
    International Journal of Antimicrobial AgentsPeer-reviewedLicence not stated1 citedGeneral biologyInfectious diseaseHAL
  2. Nutritional status, clinical burden, and healthcare utilization among pediatric outpatients with congenital heart disease: A retrospective cross-sectional study from Indonesia
    Putri Amelia, Lourents Christian Dika Sahertian, Rizky Adriansyah +1
    PLOS OnePeer-reviewedCC BY 4.0Full textDevelopmental biologyCardiovascular medicinePLOS
  3. Factors Associated With In-Hospital Mortality and Length of Stay Among Hospitalised Patients Receiving Carbapenem Therapy: A Retrospective Cohort Study.
    Abdullah Faiz Zaihan, Dhivyaa K Ganesan, Chia Siang Kow
    Interdisciplinary perspectives on infectious diseasesPeer-reviewedCC BYFull textMicrobiologyEurope PMC
  4. Evaluation of Model-Informed Precision Dosing of Cefepime in Critically Ill Patients: A French Before–After Study
    Giuseppe Balice, Soizic Percevault, Sabine Cohen +4
    Therapeutic Drug MonitoringPeer-reviewedLicence not statedFull textGeneral biologyEpidemiology & public healthHAL
  5. Machine learning for predicting mortality in patients with sepsis and its associated complications: A systematic review and meta-analysis
    Hanxi Lv, Yan Gao, Aiping Yu
    PLOS OnePeer-reviewedCC BYFull textNeurosciencePLOSEurope PMC

Cite

BibTeXRIS
BibTeX
@article{rusmawatiningtyas2026factors,
  title = {{Factors associated with mortality among critically ill pediatric patients referred to a tertiary hospital in Indonesia}},
  author = {Desy Rusmawatiningtyas and Indah Kartika Murni and Dwi Astuti Dharma Putri and Antonius H. Pudjiadi and Hennie Knoester and Job B.M. van Woensel},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0361504},
  url = {https://doi.org/10.1371/journal.pone.0361504},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Factors associated with mortality among critically ill pediatric patients referred to a tertiary hospital in Indonesia
AU  - Desy Rusmawatiningtyas
AU  - Indah Kartika Murni
AU  - Dwi Astuti Dharma Putri
AU  - Antonius H. Pudjiadi
AU  - Hennie Knoester
AU  - Job B.M. van Woensel
PY  - 2026
DA  - 2026/10/27
JO  - PLOS One
DO  - 10.1371/journal.pone.0361504
UR  - https://doi.org/10.1371/journal.pone.0361504
AB  - Background: An efficient referral system is an important but often under-recognized determinant of survival in critically ill children. Previous studies have reported high mortality rates among pediatric patients transferred to tertiary care facilities. This study aimed to identify factors associated with Pediatric Intensive Care Unit (PICU) mortality among critically ill children transferred and admitted to a tertiary-level referral hospital in Yogyakarta, Indonesia. Material and methods: This prospective cohort study was conducted over a 12-month period (July 1, 2023, to June 30, 2024) and included all critically ill children admitted to the PICU following interhospital referral. Demographic, clinical, referral, and transport data were prospectively collected. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with PICU mortality. Results: A total of 334 children were included, with a median age of 6 years. PICU mortality was 25.4%. The most common referral indication based on the Pediatric Assessment Triangle (PAT) was central nervous system dysfunction. Pre-referral management most commonly included oxygen therapy, antibiotic administration, and fluid resuscitation. Compared with survivors, non-survivors had higher PELOD-2 scores and were more likely to require intubation, mechanical ventilation, and vasoactive support before referral. In the multivariable analysis, pre-referral vasoactive support (adjusted OR 2.23, 95% CI 1.20–4.15; P = 0.011) and higher PELOD-2 scores within the first 24 hours after PICU admission (adjusted OR 1.32 per 1-point increase, 95% CI 1.20–1.45; P < 0.001) were independently associated with PICU mortality. Referral distance, decision time, and transfer time were not independently associated with mortality. Conclusion: PICU mortality among critically ill children transferred and admitted to a tertiary-care hospital in Indonesia remains high. Pre-referral vasoactive support and higher PELOD-2 scores at PICU admission were independently associated with PICU mortality. These findings generate the hypothesis that improvements in early stabilization and communication may improve outcomes, warranting prospective evaluation.
SN  - 1932-6203
ER  -