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Chen J, Aluisio AR, Tang OY, Nwakibu UA, Hunold KM, Wangara AA, Kiruja J, Maingi A, Mutiso V, Thompson P, Wachira B, Dunlop SJ, Martin IBK, Myers JG. Diagnostic Accuracy of the World Health Organization Pediatric Emergency Triage, Assessment and Treatment Tool Plus Among Patients Seeking Care in Nairobi, Kenya: A Cross-sectional Study. Pediatr Emerg Care 2024; 40:515-520. [PMID: 38048556 DOI: 10.1097/pec.0000000000003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
INTRODUCTION The World Health Organization developed Emergency Triage Assessment and Treatment Plus (ETAT+) guidelines to facilitate pediatric care in resource-limited settings. ETAT+ triages patients as nonurgent, priority, or emergency cases, but there is limited research on the performance of ETAT+ regarding patient-oriented outcomes. This study assessed the diagnostic accuracy of ETAT+ in predicting the need for hospital admission in a pediatric emergency unit at Kenyatta National Hospital in Nairobi, Kenya. METHODS This was a secondary analysis of a cross-sectional study of pediatric emergency unit patients enrolled over a 4-week period using fixed random sampling. Diagnostic accuracy of ETAT+ was evaluated using receiver operating curves (ROCs) and respective 95% confidence intervals (CIs) with associated sensitivity and specificity (reference category: nonurgent). The ROC analysis was performed for the overall population and stratified by age group. RESULTS A total of 323 patients were studied. The most common reasons for presentation were upper respiratory tract disease (32.8%), gastrointestinal disease (15.5%), and lower respiratory tract disease (12.4%). Two hundred twelve participants were triaged as nonurgent (65.6%), 60 as priority (18.6%), and 51 as emergency (15.8%). In the overall study population, the area under the ROC curve was 0.97 (95% CI, 0.95-0.99). The ETAT+ sensitivity was 93.8% (95% CI, 87.0%-99.0%), and the specificity was 82.0% (95% CI, 77.0%-87.0%) for admission of priority group patients. The sensitivity and specificity for the emergency patients were 66.0% (95% CI, 55.0%-77.0%) and 98.0% (95% CI, 97.0%-100.0%), respectively. CONCLUSIONS ETAT+ demonstrated diagnostic accuracy for predicting patient need for hospital admission. This finding supports the utility of ETAT+ to inform emergency care practice. Further research on ETAT+ performance in larger populations and additional patient-oriented outcomes would enhance its generalizability and application in resource-limited settings.
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Affiliation(s)
- Josephine Chen
- From the Division of Biology and Medicine, Brown University
| | - Adam R Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Oliver Y Tang
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Uzoma A Nwakibu
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Jason Kiruja
- Accident and Emergency Department, Kenyatta National Hospital
| | - Alice Maingi
- Department of Emergency Medicine, Ohio State University, Columbus, OH
| | - Vincent Mutiso
- University of Nairobi School of Medicine, Nairobi, Kenya
| | - Peyton Thompson
- Division of Infectious Disease, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Ian B K Martin
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Justin G Myers
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Mancini V, Borellini M, Belardi P, Colucci MC, Kadinde EY, Mwibuka C, Maziku D, Parisi P, Di Napoli A. Factors associated with hospitalization in a pediatric population of rural Tanzania: findings from a retrospective cohort study. Ital J Pediatr 2024; 50:53. [PMID: 38500138 PMCID: PMC10949679 DOI: 10.1186/s13052-024-01622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/24/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Despite pediatric acute illnesses being leading causes of death and disability among children, acute and critical care services are not universally available in low-middle income countries, such as Tanzania, even if in this country significant progress has been made in child survival, over the last 20 years. In these countries, the hospital emergency departments may represent the only or the main point of access to health-care services. Thus, the hospitalization rates may reflect both the health system organization and the patients' health status. The purpose of the study is to describe the characteristics of clinical presentations to a pediatric Outpatient Department (OPD) in Tanzania and to identify the predictive factors for hospitalization. METHODS Retrospective cohort study based on 4,324 accesses in the OPD at Tosamaganga Voluntary Agency Hospital (Tanzania). Data were collected for all 2,810 children (aged 0-13) who accessed the OPD services, within the period 1 January - 30 September 2022. The association between the hospitalization (main outcome) and potential confounding covariates (demographic, socio-contextual and clinical factors) was evaluated using univariate and multivariate logistic regression models. RESULTS Five hundred three (11.6%) of OPD accesses were hospitalized and 17 (0.4%) died during hospitalization. A higher (p < 0.001) risk of hospitalization was observed for children without health insurance (OR = 3.26), coming from more distant districts (OR = 2.83), not visited by a pediatric trained staff (OR = 3.58), and who accessed for the following conditions: burn/wound (OR = 70.63), cardiovascular (OR = 27.36), constitutional/malnutrition (OR = 62.71), fever (OR = 9.79), gastrointestinal (OR = 8.01), respiratory (OR = 12.86), ingestion/inhalation (OR = 17.00), injury (OR = 6.84). CONCLUSIONS The higher risk of hospitalization for children without health insurance, and living far from the district capital underline the necessity to promote the implementation of primary care, particularly in small villages, and the establishment of an efficient emergency call and transport system. The observation of lower hospitalization risk for children attended by a pediatric trained staff confirm the necessity of preventing admissions for conditions that could be managed in other health settings, if timely evaluated.
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Affiliation(s)
- Vincenzo Mancini
- Chair of Pediatrics, NESMOS department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
- Doctors with Africa CUAMM, Iringa, Tanzania
| | | | | | - Maria Carolina Colucci
- Chair of Pediatrics, NESMOS department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | | | | | | | - Pasquale Parisi
- Chair of Pediatrics, NESMOS department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | - Anteo Di Napoli
- Epidemiolgy Unit, National Institute for Health Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy.
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Agbesanwa TA, Babatola AO, Fatunla OA, Ibrahim A, Aina FO, Ogundare EO, Adeniyi AT, Egbedi F, Olubamiwa T, Olanipekun B, Olatunya OS. Pattern of admissions and outcome in the children emergency department of a tertiary health institution in Southwestern Nigeria: A four-year review. Afr J Emerg Med 2023; 13:45-51. [PMID: 36864888 PMCID: PMC9970896 DOI: 10.1016/j.afjem.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Pediatrics and adolescents are susceptible to illnesses that often necessitate emergency attention. Morbidity and mortality from illnesses in these ages have attracted much interest globally, particularly in Africa. Knowledge of pattern and outcomes of admissions may guide policy and interventions especially in resource constrained settings. The study aimed to determine the pattern of admissions, outcomes and seasonal variations of conditions that presented at the children emergency of a tertiary health institution over a four-year period. Methods A retrospective descriptive study of children emergency admissions from January 2016 to December 2019. Information obtained included age, diagnosis, month and year of admission, and outcome. Descriptive statistics were used to describe the demographic characteristics and Chi-squared test to assess their associations with the diagnoses made. Results There were 3,223 admissions. There were more males (1866; 57.9%) and more toddlers (1181; 36.6%). The highest number of admissions were observed in the year 2018 (951; 29.6%) and during the wet season (1962; 60.9%). There was an overall mortality rate of 7%; complicated malaria, gastroenteritis and meningitis were the leading causes of death. Malaria (χ2 = 135.522, p value < 0.001), and gastroenteritis (χ2 = 130.883, p value < 0.001) were predominant among the toddlers while sepsis (χ2 = 71.530, p value < 0.001) and pneumonia (χ2 = 133.739, p value < 0.001) were more among the infants. Typhoid enteritis (χ2 = 26.629, p value < 0.001) and HIV (χ2 = 16.419, p value = 0.012) were commoner among the early adolescents. Conclusion The major causes of death in the study area are preventable with more of these amongst the children under the age of 5 years. There are seasonal and age-related patterns to admissions and the need for policy formulations and emergency preparations to be tailored towards these observed patterns through the year.
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Affiliation(s)
- Tosin Anthony Agbesanwa
- Department of Family Medicine, Ekiti State University/ Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Adefunke Olarinre Babatola
- Department of Paediatrics and Child Health, Ekiti State University/Ekiti State Universty Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria,Corresponding author.
| | - Odunayo Adebukola Fatunla
- Department of Paediatrics, Afe Babalola University/ Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Azeez Ibrahim
- Department of Family Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti, Nigeria
| | - Felix O Aina
- Department of Family Medicine, Ekiti State University/ Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Ezra Olatunde Ogundare
- Department of Paediatrics and Child Health, Ekiti State University/Ekiti State Universty Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Adewuyi Temidayo Adeniyi
- Department of Paediatrics and Child Health, Ekiti State University/Ekiti State Universty Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Funmilayo Egbedi
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Tinu Olubamiwa
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Bolanle Olanipekun
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
| | - Oladele Simeon Olatunya
- Department of Paediatrics and Child Health, Ekiti State University/Ekiti State Universty Teaching Hospital, Ado-Ekiti, Ekiti, Nigeria
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Eze JN, Edelu BO, Ndu IK, Oguonu T. Paediatric emergency medicine practice in Nigeria: a narrative review. BMC Emerg Med 2023; 23:31. [PMID: 36927266 PMCID: PMC10022062 DOI: 10.1186/s12873-023-00790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
The practice of paediatric emergency medicine in Nigeria is still evolving, and laden with enormous challenges which contribute to adverse outcomes of childhood illnesses in emergency settings. Deaths from childhood illnesses presenting as emergencies contribute to overall child mortality rates in Nigeria. This narrative review discusses existing structures, organization, and practice of paediatric emergency in Nigeria. It highlights some of the challenges and suggests ways of surmounting them in order to reduce deaths in the children emergency units in Nigerian hospitals. Important aspects of this review include current capacity and need for capacity development, equipment needs for emergency care, quality of service in the context of inadequate healthcare funding and the need for improvement.
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Affiliation(s)
- Joy N Eze
- Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, 400001, Nigeria.
- University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
| | - Benedict O Edelu
- Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, 400001, Nigeria
- University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ikenna K Ndu
- Department of Paediatrics, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
- Enugu State University of Science and Technology Teaching Hospital, Enugu, Nigeria
| | - Tagbo Oguonu
- University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Mengistu ST, Achila OO, Negash ST, Tesfaldet Y, Tewolde NY, Yohannes NA, Embaye PT, Yemane F, Abraha B, Hagos G, Tewolde Y. Portrait of the Emergency Department at Orotta National Referral and Teaching Hospital in Asmara, Eritrea: A Prospective Observational Study. OPEN ACCESS EMERGENCY MEDICINE 2022; 14:195-215. [PMID: 35509433 PMCID: PMC9059985 DOI: 10.2147/oaem.s352638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Provision of high-quality emergency care for acute, life-threatening illnesses can significantly reduce DALY and mortality in sub-Saharan Africa. Here, we present data on the profile of an Emergency Department (ED) in the largest referral hospital in Eritrea and potential gaps for intervention. Patients and Methods This was a prospective single-center observational study of 1093 patients who presented to the ED between September and October of 2020. Data were collected using a questionnaire from the patients’ interview, observation and medical record review. The data were summarized using descriptive statistics and where applicable logistic regressions were performed. Results The median age was 45.0 years among the patients. In terms of acuity, 741 (68.5%), 283 (26.2%), 48 (4.4%), 10 (0.9%) patients were triaged as green, yellow, red, and black, respectively. In addition, the number of self-referred patients was 857 (79.1%) and among all the visitors, 376 (34.9%) used Ambulance service. The median ± IQR for ED length of stay (LOS) was 2.7 (1.4–10.0) Hours. Further, 154 (14.4%) patients stayed in the ED for >24 hours. The hospitalization rate was 146 (14.7%). In the multivariate analysis, higher likelihood of prolonged ED LOS was observed in: medical department patients (aOR = 3.53, 95% CI = 2.03–6.14); patients referred from primary health-care centers (aOR = 2.63, 95% CI = 1.10–6.30) and hospital (aOR = 3.70, 95% CI = 2.15–6.37). Prolonged ED LOS was also associated with prior emergency visit (aOR = 1.96, 95% CI = 1.13–3.40); consultation (aOR = 12.27, 95% CI = 6.98–21.56); the need for inpatient admission (aOR = 2.34, 95% CI = 1.38–3.96); and the need for investigation and treatment (aOR = 2.03, 95% CI = 1.07–3.85). Conclusion Improvements regarding ED specialist personnel, inpatient ward capacity, availability of investigations throughout the day and night shifts, amendments in referral system, strengthening ED and critical care capacity in zonal referral hospitals, and access to quality care among the non-communicable disease patients may ameliorate most of the bottlenecks observed in this set-up.
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Affiliation(s)
| | - Oliver Okoth Achila
- Department of Clinical Laboratory Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | | | | | | | | | - Peniel Tsehaye Embaye
- Department of Clinical Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | | | - Beyene Abraha
- Department of Clinical Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Goitom Hagos
- Department of Internal medicine, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Yoseph Tewolde
- Department of Surgery, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
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Ismail H, Chowdhary H, Taira BR, Moiane S, Faruk L, Alface B, Mohole J, Gonçalves O, Hartford EA, Buck WC. Paediatric emergency care at an academic referral hospital in Mozambique. Afr J Emerg Med 2021; 11:410-415. [PMID: 34703732 PMCID: PMC8524113 DOI: 10.1016/j.afjem.2021.07.003] [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: 02/04/2021] [Revised: 05/30/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Improved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique. Methods This was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country. All children 0–14 years of age seen in the 12-month period from August 2018–July 2019 were included. Descriptive statistical analyses were performed. Results Data from 346 days and 64,966 patient encounters were analyzed. The large majority of patients (96.4%) presented directly to the PED without referral from a lower level facility. An average of 188 patients was seen per day, with significant seasonal variation peaking in March (292 patients/day). The most common diagnoses were upper respiratory infections (URI), gastroenteritis, asthma, and dermatologic problems. The highest acuity diagnoses were neurologic problems (59%), asthma (57%), and neonatal diagnoses (50%). Diagnoses with the largest proportion of admissions included neurologic problems, malaria, and neonatal diagnoses. Rapid malaria antigen tests were the most commonly ordered laboratory test across all diagnostic categories; full blood count (FBC) and chemistries were also commonly ordered. Urinalysis and HIV testing were rarely done in the PED. Conclusion This epidemiologic profile of illness seen in the HCM PED will allow for improved resource utilisation. We identified opportunities for evidence-based care algorithms for common diagnoses such as respiratory illness to improve patient care and flow. The PED may also be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis.
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