Clinical predictors of circulatory failure and coexisting morbidities in children seen in an emergency room in Southern Nigeria.

Abstract

Circulatory failure (shock) is a life-threatening emergency referring to a state of poor tissue perfusion and resultant anaerobic respiration at a cellular level. It is a common pathway for several severe pediatric morbidities. We evaluated the clinical predictors of shock and coexisting morbidities in acutely-ill children. This was a descriptive, cross-sectional study. Data were collected using a researcher-administered questionnaire eliciting demography, clinical features, diagnoses/differentials, and comorbidities. After binary analysis, multiple logistic regression identified variables that independently predict circulatory failure in the participants, using odds ratio (OR) and 95% confidence intervals (CI). Five hundred and fifty-four children took part in the study. Their median age was 60 (IQR: 24-132) months, mean weight 16.3 ± 13.6 kg and mean height was 90.8 ± 33.2 cm; 53.7% of them were males while 46.3% were females. The incidence of shock was 14.3% among the participants on arrival at the emergency room. Febrile seizure (14.9%), dehydration (4.7%), pallor (3.1%), and coma (1.8%) were the clinical findings significantly associated with shock (P < 0.05). Leading underlying diagnoses and comorbidities associated with shock were severe malaria (85.4%) and severe sepsis (25.0%) (P ≤ 0.01). Also, seizure (OR = 0.07, 95% CI: 0.04-0.13; P ≤ 0.001) and severe sepsis (OR = 0.31, 95% CI: 0.15-0.65; P = 0.002) were independent predictors of circulatory failure. The presence of acute neurologic morbidities and severe infection predicts circulatory failure in the pediatric emergency setting. Early detection and prompt treatment will forestall shock-related complications in affected children.