Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania.
Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania.
复制标题
DOI：
10.3389/fped.2021.764163
复制
发表时间：
2021
影响因子：
2.6
通讯作者：
Kortz TB
中科院分区：
文献类型：
--
作者：
Smith AM;Sawe HR;Matthay MA;Murray BL;Reynolds T;Kortz TB
背景资料：全球超过40%的败血症发生在5岁以下的儿童中，使儿科败血症成为该年龄组的首要死亡原因。先前的研究表明，脓毒症儿童的结局可以通过最大限度地缩短症状发作和治疗之间的时间来改善。这在资源有限的环境中是一个挑战，因为获得最终护理的机会有限。研究方法：对2016年7月1日至2017年6月30日期间在Muhimbili国立医院（MNH）急诊科（艾德）就诊的1，803例疑似感染和≥2项临床全身炎症反应综合征标准的患者（28天-14岁）的数据进行了次要分析。本研究的目的是确定延迟就诊与死亡率之间的关系（从发热到就诊至艾德之间>48 h），以及社会经济地位（SES）与延迟就诊之间的关系。多变量逻辑回归模型测试了这两种关系。我们报告了未调整和调整的比值比和95%置信区间。结果：在研究期间，11.3%（n = 203）的儿童谁提出的MNH败血症死于医院。与存活者（n = 614/1，353，45%）相比，非存活者（n = 90/151，60%）中延迟就诊更常见（p ≤ 0.01）。与未延迟就诊的儿童相比，延迟就诊的儿童死亡率的调整优势比为1.85（95%CI：1.17-3.00）。结论：延迟就诊是该队列死亡率的独立危险因素，强调了及时就诊对儿科脓毒症患者的重要性。潜在的干预措施包括更有效的转诊网络和MNH紧急运输系统。在坦桑尼亚，额外的儿科重症监护诊所或医院可以降低儿科脓毒症死亡率，以及识别儿科脓毒症的家长教育计划。
Background: Over 40% of the global burden of sepsis occurs in children under 5 years of age, making pediatric sepsis the top cause of death for this age group. Prior studies have shown that outcomes in children with sepsis improve by minimizing the time between symptom onset and treatment. This is a challenge in resource-limited settings where access to definitive care is limited. Methods: A secondary analysis was performed on data from 1,803 patients (28 days−14 years old) who presented to the emergency department (ED) at Muhimbili National Hospital (MNH) from July 1, 2016 to June 30, 2017 with a suspected infection and ≥2 clinical systemic inflammatory response syndrome criteria. The objective of this study was to determine the relationship between delayed presentation to definitive care (>48 h between fever onset and presentation to the ED) and mortality, as well as the association between socioeconomic status (SES) and delayed presentation. Multivariable logistic regression models tested the two relationships of interest. We report both unadjusted and adjusted odds ratios and 95% confidence intervals. Results: During the study period, 11.3% (n = 203) of children who presented to MNH with sepsis died inhospital. Delayed presentation was more common in non-survivors (n = 90/151, 60%) compared to survivors (n = 614/1,353, 45%) (p ≤ 0.01). Children who had delayed presentation to definitive care, compared to those who did not, had an adjusted odds ratio for mortality of 1.85 (95% CI: 1.17–3.00). Conclusions: Delayed presentation was an independent risk factor for mortality in this cohort, emphasizing the importance of timely presentation to care for pediatric sepsis patients. Potential interventions include more efficient referral networks and emergency transportation systems to MNH. Additional clinics or hospitals with pediatric critical care may reduce pediatric sepsis mortality in Tanzania, as well as parental education programs for recognizing pediatric sepsis.
登录
查看更多内容
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：
168.9
作者：
Gakidou, Emmanuela;Cowling, Krycia;Murray, Christopher J. L.
通讯作者：
Murray, Christopher J. L.
影响因子：
2.6
作者：
Remtullah, Aleya Z.;Sirili, Nathanael;Sunguya, Bruno F.
通讯作者：
Sunguya, Bruno F.
影响因子：
4.1
作者：
Kissoon, Niranjan;Carcillo, Joseph A.;Latour, Jos
通讯作者：
Latour, Jos
影响因子：
6.4
作者：
Helbok, Raimund;Kendjo, Eric;Kremsner, Peter Gottfried
通讯作者：
Kremsner, Peter Gottfried