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Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models.

AbstractOBJECTIVES:
To derive a model of paediatric postdischarge mortality following acute infectious illness.
DESIGN:
Prospective cohort study.
SETTING:
2 hospitals in South-western Uganda.
PARTICIPANTS:
1307 children of 6 months to 5 years of age were admitted with a proven or suspected infection. 1242 children were discharged alive and followed up 6 months following discharge. The 6-month follow-up rate was 98.3%.
INTERVENTIONS:
None.
PRIMARY AND SECONDARY OUTCOME MEASURES:
The primary outcome was postdischarge mortality within 6 months following the initial hospital discharge.
RESULTS:
64 children died during admission (5.0%) and 61 died within 6 months of discharge (4.9%). Of those who died following discharge, 31 (51%) occurred within the first 30 days. The final adjusted model for the prediction of postdischarge mortality included the variables mid-upper arm circumference (OR 0.95, 95% CI 0.94 to 0.97, per 1 mm increase), time since last hospitalisation (OR 0.76, 95% CI 0.61 to 0.93, for each increased period of no hospitalisation), oxygen saturation (OR 0.96, 95% CI 0.93 to 0·99, per 1% increase), abnormal Blantyre Coma Scale score (OR 2.39, 95% CI 1·18 to 4.83), and HIV-positive status (OR 2.98, 95% CI 1.36 to 6.53). This model produced a receiver operating characteristic curve with an area under the curve of 0.82. With sensitivity of 80%, our model had a specificity of 66%. Approximately 35% of children would be identified as high risk (11.1% mortality risk) and the remaining would be classified as low risk (1.4% mortality risk), in a similar cohort.
CONCLUSIONS:
Mortality following discharge is a poorly recognised contributor to child mortality. Identification of at-risk children is critical in developing postdischarge interventions. A simple prediction tool that uses 5 easily collected variables can be used to identify children at high risk of death after discharge. Improved discharge planning and care could be provided for high-risk children.
AuthorsM O Wiens, E Kumbakumba, C P Larson, J M Ansermino, J Singer, N Kissoon, H Wong, A Ndamira, J Kabakyenga, J Kiwanuka, G Zhou
JournalBMJ open (BMJ Open) Vol. 5 Issue 11 Pg. e009449 (Nov 25 2015) ISSN: 2044-6055 [Electronic] England
PMID26608641 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightPublished by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Topics
  • Acute Disease
  • Area Under Curve
  • Child Mortality
  • Child, Preschool
  • Female
  • Hospitalization
  • Humans
  • Infant
  • Infections (mortality)
  • Male
  • Models, Biological
  • Patient Discharge
  • Prospective Studies
  • ROC Curve
  • Risk Factors
  • Uganda (epidemiology)

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