Uncounted Deaths: Estimating Postdischarge Pediatric Mortality.

Abstract

Madrid et al1 explored the “hidden” mortality in Sub-Saharan Africa: children who die after hospital discharge. Their study revealed a postdischarge mortality within the first 90 days after hospital discharge of 3.6%, which is consistent with the results of previous studies.2,3 One-half of the deaths occurred within 30 days of discharge, and >80% of the deaths occurred without families subsequently seeking medical attention in this semirural setting. The authors used demographic and clinical variables collected at the time of hospital admission to derive models that were predictive of postdischarge mortality. Several models were derived, including those without laboratory variables that would be scalable in resource-limited settings and models used to specifically target postdischarge mortality in infants <3 months of age, when postdischarge mortality is highest. The validation of these models in other resource-limited settings will be crucial. An optimal risk-stratification tool for postdischarge mortality would include variables that were already collected as part of routine care (or low-cost, readily available tests), have high interobserver reliability, and can be used across different pediatric age cohorts. The model would be used to identify children early enough … Address correspondence to Andrea T. Cruz, MD, MPH, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin St, Suite A2210, Houston, TX 77030. E-mail: acruz{at}bcm.edu