Pediatric post-discharge mortality in resource poor countries: a systematic review.
Pediatric post-discharge mortality in resource poor countries: a systematic review.
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DOI：
10.1371/journal.pone.0066698
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Larson C
中科院分区：
文献类型：
--
作者：
Wiens MO;Pawluk S;Kissoon N;Kumbakumba E;Ansermino JM;Singer J;Ndamira A;Larson C
出院后死亡率是发展中国家儿童总体死亡率的一个重要但未被充分认识的因素。本系统评价的主要目的是确定所有报告儿童出院后死亡率的研究，估计死亡可能性，并确定最重要的死亡风险因素。从成立之日到 2012 年 10 月，使用 MeSH 术语和关键词对 MEDLINE 和 EMBASE 进行了系统搜索。还使用 Google Scholar™ 进行了关键词搜索，并对检索到的文章的参考文献进行了手动搜索。发展中国家报告儿科人群出院后死亡率的研究被考虑纳入。确定了十三项报告出院后死亡率的研究。研究根据设计、研究人群的基本特征和随访持续时间的不同而存在显着差异。不同研究之间出院后的死亡率差异显着（1%–18%）。据报道，出院后死亡率往往超过院内死亡率。与出院后死亡率相关的最重要的基线变量是年轻、营养不良、多次住院、艾滋病毒感染和肺炎。大多数出院后死亡发生在出院后早期。只有一项研究对因疟疾入院后出院的儿童进行疟疾预防进行了检查，结果显示对出院后死亡率没有显着改善。出院后的几个月存在着巨大的发病和死亡风险。虽然有几个特征与出院后死亡率密切相关，但没有经过验证的工具可以帮助卫生工作者或政策制定者系统识别出院后死亡高风险的儿童。未来的研究必须重点关注创建工具来帮助确定最有可能从出院后干预措施中受益的儿童群体，并正式评估此类干预措施在降低出院后头几个月发病率和死亡率方面的有效性。
Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for death. MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from the inception date to October, 2012. Key word searches using Google Scholar™ and hand searching of references of retrieved articles was also performed. Studies from developing countries reporting mortality following hospital discharge among a pediatric population were considered for inclusion. Thirteen studies that reported mortality rates following discharge were identified. Studies varied significantly according to design, underlying characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly between studies (1%–18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition, multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during the post-discharge period. Follow-up care was examined in only one study examining malaria prophylaxis in children discharged following an admission secondary to malaria, which showed no significant benefit on post-discharge mortality. The months following hospital discharge carry significant risk for morbidity and mortality. While several characteristics are strongly associated with post-discharge mortality, no validated tools are available to aid health workers or policy makers in the systematic identification of children at high risk of post-discharge mortality. Future research must focus on both the creation of tools to aid in defining groups of children most likely to benefit from post-discharge interventions, and formal assessment of the effectiveness of such interventions in reducing morbidity and mortality in the first few months following hospital discharge.
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