Abstract
AbstractPediatric patients are referred for multiple reasons, either for better therapeutic services or diagnostic purposes. The clinical condition of patients at the time of referral can significantly affect the outcome of such patients and there is not much data on this aspect. The overall objective of this study was to study the demographic and clinical profile, the causes for referral, and the outcome of pediatric patients being referred to a single tertiary care hospital. This was a prospective observational study done in the Department of Pediatrics of a single tertiary care hospital in North India over the course of 1 year. Patients referred from other health facilities in the age group 0 to 12 years who were admitted in the pediatric ward of the hospital were enrolled. The primary objective was to study the clinical profile and outcome (mortality) of these patients. The secondary objectives were to study the referral pattern of the referred patients, causes for referral, and the severity of illness at the time of admission as assessed by Irish Pediatric Early Warning Score (PEWS) and its correlation with the outcome. The outcomes were categorized as: discharge, death, left against medical advice, referred to other centers, others. Early warning scores are useful to measure the severity of disease and to follow patients' progress. The Irish PEWS score was used in this study to provide a rapid measure of the degree of sickness. Respiratory system disorders and neonatal illnesses were the most common illnesses observed. Most patients had low disease severity as per Irish PEWS score. The overall mortality rate among the referred patients was 19.25%. Patients with younger age, higher scores, neonatal illnesses, and neurological disorders had higher risk of mortality. Training of health personnel at primary and secondary levels in the commonly encountered illnesses will improve provision of care at the local level and decrease low risk referrals.
Highlights
Health systems and policies have a critical role in determining the manner in which health services are delivered, utilized, and affect health outcomes
This was a prospective observational study done in the Department of Pediatrics of a single tertiary care hospital in North India over the course of 1 year
In a study by Shahab et al[8] in a tertiary care center in Pakistan, 70% of patients were found to be less than 5 years of age, with infants contributing 37% and the male to female ratio was found to be 1.5:1
Summary
Health systems and policies have a critical role in determining the manner in which health services are delivered, utilized, and affect health outcomes. India has a mixed health care system, inclusive of public and private health care service providers.[1] The public health care system is organized into a three-tier system of primary, secondary, and tertiary levels of care.[2]. Patients are referred for multiple reasons, either for better therapeutic services or diagnostic purposes. The clinical condition of patients at the time of referral can significantly affect the outcome of such patients and there is not much data on this aspect.[3,11]. In a study conducted by Aggarwal et al in Delhi, it was found that most deaths in referred neonates occurred within 24 to 48 hours of admission.[3]
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