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Kortz TB, Mediratta RP, Smith AM, Nielsen KR, Agulnik A, Gordon Rivera S, Reeves H, O’Brien NF, Lee JH, Abbas Q, Attebery JE, Bacha T, Bhutta EG, Biewen CJ, Camacho-Cruz J, Coronado Muñoz A, deAlmeida ML, Domeryo Owusu L, Fonseca Y, Hooli S, Wynkoop H, Leimanis-Laurens M, Nicholaus Mally D, McCarthy AM, Mutekanga A, Pineda C, Remy KE, Sanders SC, Tabor E, Teixeira Rodrigues A, Yuee Wang JQ, Kissoon N, Takwoingi Y, Wiens MO, Bhutta A. Etiology of hospital mortality in children living in low- and middle-income countries: a systematic review and meta-analysis. Front Pediatr 2024; 12:1397232. [PMID: 38910960 PMCID: PMC11190367 DOI: 10.3389/fped.2024.1397232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%-4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9-14)]; respiratory [9 (95% CI 5-13)]; and gastrointestinal [9 (95% CI 6-11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231-280)]; infectious [214 (95% CI 193-234)]; and gastrointestinal [166 (95% CI 143-190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation.
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Affiliation(s)
- Teresa B. Kortz
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Rishi P. Mediratta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Audrey M. Smith
- Department of Medicine, Miller School of Medicine, Miami, FL, United States
| | - Katie R. Nielsen
- Department of Pediatrics and Department of Global Health, University of Washington, Seattle, WA, United States
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Stephanie Gordon Rivera
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Hailey Reeves
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nicole F. O’Brien
- Department of Pediatrics, Ohio State University/Nationwide Children’s Hospital, Columbus, OH, United States
| | - Jan Hau Lee
- Children's Intensive Care Unit, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Qalab Abbas
- Department of Pediatrics and Child Health, Section of Pediatric Critical Care Medicine, Aga Khan University, Karachi, Pakistan
| | - Jonah E. Attebery
- Department of Pediatrics, University of Colorado, Aurora, CO, United States
- Barrow Global Health, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Tigist Bacha
- Department of Pediatric and Child Health, Saint Paul Hospital Medical College, Addis Ababa, Ethiopia
| | - Emaan G. Bhutta
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Carter J. Biewen
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Jhon Camacho-Cruz
- Department of Pediatrics, Universidad Nacional de Colombia, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de Cirugía de Bogota-Hospital San José, Fundación Universitaria Sanitas, Clínica Reina Sofia Pediátrica y Mujer Colsanitas, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Bogotá D.C.,Colombia
| | - Alvaro Coronado Muñoz
- Pediatric Critical Care Division, Department of Pediatrics, Children’s Hospital at Montefiore, New York, NY, United States
| | - Mary L. deAlmeida
- Department of Pediatrics, Emory University, Atlanta, GA, United States
| | - Larko Domeryo Owusu
- Pediatric Emergency Unit, Child Health Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Yudy Fonseca
- Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, United States
| | - Shubhada Hooli
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Hunter Wynkoop
- Department of Pediatrics, Ohio State University/Nationwide Children’s Hospital, Columbus, OH, United States
| | - Mara Leimanis-Laurens
- Department of Pediatrics and Human Development, Michigan State University, East Lansing and Helen DeVos Children’s Hospital, Grand Rapids, MI, United States
| | - Deogratius Nicholaus Mally
- Pediatric Intensive Care Unit, Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Amanda M. McCarthy
- Department of Pediatrics, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Andrew Mutekanga
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Carol Pineda
- Department of Pediatrics, Baystate Medical Center, University of Massachusetts Chan Medical School, Springfield, MA, United States
| | - Kenneth E. Remy
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, and Department of Internal Medicine, University Hospitals of Cleveland, Cleveland, OH, United States
| | - Sara C. Sanders
- Department of Pediatrics, Connecticut Children’s and University of Connecticut, Hartford, CT, United States
| | - Erica Tabor
- Department of Biology, Pennsylvania State University, University Park, PA, United States
| | | | - Justin Qi Yuee Wang
- Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
| | - Niranjan Kissoon
- Department of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Edgbaston and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Matthew O. Wiens
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
- Walimu, Kampala, Uganda
| | - Adnan Bhutta
- Department of Pediatrics, Indiana University School of Medicine and Riley Children’s Health, Indianapolis, IN, United States
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Dick S, MacRae C, McFaul C, Rasul U, Wilson P, Turner SW. Interventions to reduce acute paediatric hospital admissions: a systematic review. Arch Dis Child 2022; 107:234-243. [PMID: 34340984 DOI: 10.1136/archdischild-2021-321884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Admission rates are rising despite no change to burden of illness, and interventions to reduce unscheduled admission to hospital safely may be justified. OBJECTIVE To systematically examine admission prevention strategies and report long-term follow-up of admission prevention initiatives. DATA SOURCES MEDLINE, Embase, OVID SP, PsychINFO, Science Citation Index Expanded/ISI Web of Science, The Cochrane Library from inception to time of writing. Reference lists were hand searched. STUDY ELIGIBILITY CRITERIA Randomised controlled trials and before-and-after studies. PARTICIPANTS Individuals aged <18 years. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were independently screened by two reviewers with final screening by a third. Data extraction and the Critical Appraisals Skills Programme checklist completion (for risk of bias assessment) were performed by one reviewer and checked by a second. RESULTS Twenty-eight studies were included of whom 24 were before-and-after studies and 4 were studies comparing outcomes between non-randomised groups. Interventions included referral pathways, staff reconfiguration, new healthcare facilities and telemedicine. The strongest evidence for admission prevention was seen in asthma-specific referral pathways (n=6) showing 34% (95% CI 28 to 39) reduction, but with evidence of publication bias. Other pathways showed inconsistent results or were insufficient for wider interpretation. Staffing reconfiguration showed reduced admissions in two studies, and shorter length of stay in one. Short stay admission units reduced admissions in three studies. CONCLUSIONS AND IMPLICATIONS There is little robust evidence to support interventions aimed at preventing paediatric admissions and further research is needed.
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Affiliation(s)
- Smita Dick
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Clare MacRae
- Usher institute, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Claire McFaul
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Usman Rasul
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Philip Wilson
- Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
| | - Stephen W Turner
- Department of Child Health, University of Aberdeen, Aberdeen, UK
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Turner S, Raja EA. The association between opening a short stay paediatric assessment unit and trends in short stay hospital admissions. BMC Health Serv Res 2021; 21:523. [PMID: 34049553 PMCID: PMC8164232 DOI: 10.1186/s12913-021-06541-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Many inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most short stay (also called zero day) admissions are accommodated. Here we describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions. Methods Details of all emergency medical paediatric admissions to Scottish hospitals between 2000 and 2013 were obtained, including the number of zero day admissions per month and health board (i.e. geographic region). The month and year that an SSPAU opened in each health board was provided by local clinicians. Results SSPAUs opened in 7 health boards, between 2004 and 2012. Health boards with an SSPAU had a slower rise in zero day admissions compared to those without SSPAU (0.6% per month [95% CI 0.04, 0.09]. Across all 7 health boards, opening an SSPAU was associated with a 13% [95% CI 10, 15] increase in the proportion of zero day admissions. When considered individually, zero day admissions rose in four health boards after their SSPAU opened, were unchanged in one and fell in two health boards. Independent of SSPAUs opening, there was an increase in the proportion of all admissions which were zero day admissions (0.1% per month), and this accelerated after SSPAUs opened. Conclusion Opening an SSPAU has heterogeneous outcomes on the proportion of zero day admissions in different settings. Zero day admissions could be reduced in some health boards by understanding differences in clinical referral pathways between health boards with contrasting trends in zero day admissions after their SSPAU opens. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06541-x.
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Affiliation(s)
- Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK. .,Women and Children Division, NHS Grampian, Aberdeen, AB25 2ZG, UK.
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