A pediatric death audit in a large referral hospital in Malawi.
A pediatric death audit in a large referral hospital in Malawi.
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DOI：
10.1186/s12887-018-1051-9
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发表时间：
2018-02-21
期刊：
影响因子：
2.4
通讯作者：
Eckerle M
中科院分区：
文献类型：
--
作者：
Fitzgerald E;Mlotha-Mitole R;Ciccone EJ;Tilly AE;Montijo JM;Lang HJ;Eckerle M
死亡审计已被用于描述在资源不足的情况下，记录保存往往是一个挑战的儿科死亡率。这些信息为质量改进举措奠定了基础。马拉维位于撒哈拉以南非洲，目前5岁以下儿童死亡率为64/1 000。卡穆祖中心医院位于首都利隆圭，是一家忙碌转诊医院，每月收治多达3000名儿童。2013年发表的一项研究报告称，死亡率高达9%。这是已知的第一次在这家医院进行的儿科死亡档案审计。使用标准化死亡审计表对13个月期间在Kamuzu中央医院发生的所有儿科死亡（不包括新生儿保育室的死亡）进行回顾性图表审查。完成了描述性分析，包括患者人口统计学、艾滋病毒和营养状况以及死亡原因。确定了可能导致死亡的可变因素，包括缺乏生命体征收集，记录不良，以及延迟采购或测试，研究和专家审查结果。共记录了743例儿科死亡，并审查了700例死亡患者的档案。按月计算的死亡率从最低的2.2%到最高的4.4%不等。44%的死亡发生在入院后的前24小时内，59%发生在前48小时内。最常见的死亡原因是疟疾、营养不良、艾滋病毒相关疾病和败血症。自上次公布死亡率数据以来，该儿科转诊中心的死亡率在6年内大幅下降，但仍然很高。确定继续发展的领域包括改进记录保存、改进患者评估和监测以及更及时和可靠地提供检测和治疗。这项研究表明，在低资源的环境中，可靠的记录保存往往是困难的，死亡审计是有用的工具，以描述病情最重的患者人群，并确定可能导致死亡率的因素，可能是服从质量改进干预措施。
Death audits have been used to describe pediatric mortality in under-resourced settings, where record keeping is often a challenge. This information provides the cornerstone for the foundation of quality improvement initiatives. Malawi, located in sub-Saharan Africa, currently has an Under-5 mortality rate of 64/1000. Kamuzu Central Hospital, in the capital city Lilongwe, is a busy government referral hospital, which admits up to 3000 children per month. A study published in 2013 reported mortality rates as high as 9%. This is the first known audit of pediatric death files conducted at this hospital. A retrospective chart review on all pediatric deaths that occurred at Kamuzu Central Hospital (excluding deaths in the neonatal nursery) during a 13-month period was done using a standardized death audit form. A descriptive analysis was completed, including patient demographics, HIV and nutritional status, and cause of death. Modifiable factors were identified that may have contributed to mortality, including a lack of vital sign collection, poor documentation, and delays in the procurement or results of tests, studies, and specialist review. Seven hundred forty three total pediatric deaths were recorded and 700 deceased patient files were reviewed. The mortality rate by month ranged from a low of 2.2% to a high of 4.4%. Forty-four percent of deaths occurred within the first 24 h of admission, and 59% occurred within the first 48 h. The most common causes of death were malaria, malnutrition, HIV-related illnesses, and sepsis. The mortality rate for this pediatric referral center has dramatically decreased in the 6 years since the last published mortality data, but remains high. Areas identified for continued development include improved record keeping, improved patient assessment and monitoring, and more timely and reliable provision of testing and treatment. This study demonstrates that in low-resource settings, where reliable record keeping is often difficult, death audits are useful tools to describe the sickest patient population and determine factors possibly contributing to mortality that may be amenable to quality improvement interventions.
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影响因子：
11.1
作者：
Obermeyer Z;Abujaber S;Makar M;Stoll S;Kayden SR;Wallis LA;Reynolds TA;Acute Care Development Consortium
通讯作者：
Acute Care Development Consortium
评估PFHRP2和基于PLDH的快速诊断测试，以诊断2名非洲儿童种群的严重疟疾诊断。
DOI：
10.1093/cid/cir143
发表时间：
2011-05
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Hendriksen IC;Mtove G;Pedro AJ;Gomes E;Silamut K;Lee SJ;Mwambuli A;Gesase S;Reyburn H;Day NP;White NJ;von Seidlein L;Dondorp AM
通讯作者：
Dondorp AM
影响因子：
158.5
作者：
Maitland, Kathryn;Kiguli, Sarah;Gibb, Diana M.
通讯作者：
Gibb, Diana M.
影响因子：
3.8
作者：
Krug, Angelika;Patrick, Mark;Stephen, Cindy
通讯作者：
Stephen, Cindy
影响因子：
3.7
作者：
Hodkinson, Peter;Argent, Andrew;Ward, Alison
通讯作者：
Ward, Alison