Abstract
.In low-resource settings, many children are severely ill at arrival to hospital. The risk factors for mortality among such ill children are not well-known. Understanding which of these patients are at the highest risk could assist in the allocation of limited resources to where they are most needed. A cohort study of severely ill children treated in the resuscitation room of the pediatric emergency department at Queen Elizabeth Central Hospital in Malawi was conducted over a 6-month period in 2017. Data on signs and symptoms, vital signs, blood glucose levels, and nutritional status were collected and linked with in-hospital mortality data. The factors associated with in-hospital mortality were analyzed using multivariable logistic regression. Data for 1,359 patients were analyzed and 118 (8.7%) patients died. The following factors were associated with mortality: presence of any severely deranged vital sign, unadjusted odds ratio (UOR) 2.6 (95% CI 1.7–4.0) and adjusted odds ratio (AOR) 3.2 (95% CI 2.0–5.0); severe dehydration, UOR 2.6 (1.4–5.1) and AOR 2.8 (1.3–6.0); hypoglycemia glycemia (< 5 mmol/L), UOR 3.6 (2.2–5.8) and AOR 2.7 (1.6–4.7); and severe acute malnutrition, UOR 5.8 (3.5–9.6) and AOR 5.7 (3.3–10.0). This study suggests that among severely sick children, increased attention should be given to those with hypo/low glycemia, deranged vital signs, malnutrition, and severe dehydration to avert mortality among these high-risk patients.
Highlights
In 2016, 5.6 million children younger than 5 years died worldwide.[1]
The WHO developed the Emergency Triage Assessment and Treatment (ETAT) guidelines in 2005, as a tool aiming to improve the care for acutely ill children in hospitals.[4]
The ETAT was introduced at Queen Elizabeth Central Hospital (QECH) in 2001,5 and severely ill children with a WHO emergency sign are identified at triage and referred into the resuscitation room for immediate treatment and stabilization before admission and continued management
Summary
In 2016, 5.6 million children younger than 5 years died worldwide.[1]. More than half of the deaths were due to conditions that could be prevented or treated with simple and affordable interventions.[2]. The WHO developed the Emergency Triage Assessment and Treatment (ETAT) guidelines in 2005, as a tool aiming to improve the care for acutely ill children in hospitals.[4] In these guidelines, children with emergency features are identified on arrival to the hospital for immediate stabilization and treatment. The introduction of ETAT and restructuring of the admission process reduced in-hospital mortality from 18% to 8% in a Malawian referral hospital.[5] Similar tools for identifying children at high risk of deterioration or mortality have been developed in other settings, such as the Pediatric Risk of Mortality[6] score, the Pediatric Index of Mortality (PIM),[7] and the Pediatric Early Warning Score (PEWS).[8]
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