Prioritizing Pediatric Emergency Transfers: Identifying Clinical and Resource-Based Indicators for PICU Admission in a Tertiary Care Hospital in Karachi, Pakistan.

Background: Pediatric critical care remains a major challenge in low- and middle-income countries (LMICs) because of the limited PICU capacity. This often forces critically ill children to be managed in emergency departments (EDs) for long periods, exhausting the already scarce resources. This delays care and contributes to poor outcomes. The purpose of this study was to describe the characteristics, triage levels, and outcomes of children admitted from the ED to the PICU at a tertiary hospital in Pakistan. Methods We reviewed charts of all children between 1 month and 18 years who were admitted from the ED to the PICU during 2021. Information on age, sex, presenting symptoms, diagnosis, triage level, ED resource use, length of stay, and outcomes was collected. Results: Among 418 patients, most were under 5 years of age (66.9%) and male (58.6%). The majority (83%) arrived in the ED as P1 (critical) triage. Respiratory diseases were the leading cause of PICU transfer (30.6%), followed by infectious illnesses (21.2%) and central nervous system disorders (15.7%). Pneumonia (18.5%), septic shock (13.2%), and meningoencephalitis (9.4%) were frequent diagnoses. These groups also consumed the greatest share of ED resources. By contrast, trauma, gastrointestinal, and endocrine/metabolic disorders required fewer transfers and shorter stays. Conclusion: In this LMIC setting, most children transferred from ED to PICU were very young and critically ill with respiratory, infectious, or CNS diseases. Earlier transfer and expansion of intermediate-level PICUs may help reduce ED strain and improve outcomes. Clearer admission and transfer guidelines are also needed to avoid unnecessary PICU use and preserve limited resources.