Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study.

Summary

In 7,538 children across 19 countries, 13.1% met criteria for paediatric acute critical illness, with the highest prevalence (28.0%) in low-SDI countries. Sepsis/septic shock accounted for 10.4% of P-ACI, and 59% of all deaths occurred within 48 hours, underscoring the need for basic critical care capacity.

Key Findings

• Overall P-ACI prevalence was 13.1% (985/7,538), highest in low-SDI countries at 28.0%.
• Sepsis/septic shock accounted for 10.4% of P-ACI; pneumonia was 15.4% and malaria 9.6%.
• Among P-ACI patients, mortality was 6.3%, and 59% of all deaths occurred within 48 hours of presentation.
• Country SDI category was not independently associated with P-ACI frequency after adjustment.

Clinical Implications

Health systems in low-resource settings should prioritize early triage and delivery of basic critical care (oxygen, fluids, antibiotics, organ support), with focus on the first 48 hours. Data inform resource allocation and capacity building targeting sepsis and pneumonia.

Limitations

• Point-prevalence design across four discrete days may not capture temporal variability
• In-hospital follow-up only; long-term outcomes not assessed

Future Directions

Implementation research to scale basic critical care in low-SDI settings, targeted interventions within the first 48 hours, and prospective evaluation of sepsis care bundles.