Clinical Profile and Outcomes of Shock in Children Aged 5-15 Years at a Tertiary Care Hospital.

BACKGROUND

Pediatric shock in school-aged children and adolescents presents distinct clinical challenges compared to younger age groups, with different etiological patterns and compensatory mechanisms. Understanding age-specific characteristics is crucial for optimizing management strategies and improving outcomes.

OBJECTIVES

To evaluate the clinico-etiological profile, laboratory correlations, and clinical outcomes of shock in children aged 5-15 years admitted to a tertiary care hospital.

METHODOLOGY: A prospective observational study was conducted over 24 months (March 2023-February 2025) involving 49 children aged 5-15 years presenting with shock. Shock was identified by the presence of tachycardia and/or hypotension with signs of systemic hypoperfusion. Comprehensive clinical assessment, laboratory investigations including inflammatory markers and sequential organ failure assessment (SOFA) scoring, and outcome monitoring were performed. Shock was classified using standardized operational definitions: Septic shock (distributive shock with confirmed or suspected infection), cardiogenic shock (primary cardiac dysfunction), and distributive shock (non-infectious causes, including anaphylaxis).

RESULTS

The cohort comprised 49 children with a mean age of 9.2 ± 2.8 years and a slight male predominance (51%). Septic shock predominated (63.3%), followed by cardiogenic (20.4%) and distributive shock (16.3%). Fever was the most common presentation (40.8%), followed by seizures (10.2%). Preexisting medical conditions were present in 44.9% of cases, with neurological disorders being the most common (12.2%). All patients demonstrated tachycardia and delayed capillary refill, while hypotension was present in 28.6%. Laboratory evaluation revealed elevated inflammatory markers (mean C-reactive protein 91.8 mg/L, procalcitonin 16.2 ng/mL, lactate 2.2 mmol/L). Respiratory infections remained the leading cause of septic shock (29%), followed by central nervous system infections (19.4%). Dengue virus was isolated in 16.3% of all cases. Mechanical ventilation was required in 48% of patients, with 59.2% requiring multiple inotropes. The overall mortality rate was 18.4%, significantly associated with multiple inotrope use (P < 0.001) and altered sensorium on admission (P = 0.001). Mean pediatric intensive care unit and hospital stays were 8.2 ± 7.1 and 14.7 ± 9.8 days, respectively. Higher SOFA scores correlated with prolonged intensive care stays (P = 0.002).

CONCLUSION

School-aged children and adolescents with shock demonstrate a high prevalence of septic shock with substantial mortality. Neurological involvement and requirement for multiple inotropes predict poor outcomes. Early recognition, appropriate antimicrobial therapy, and judicious hemodynamic support remain crucial for improving survival in this age group.