Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models

doi:10.1136/bmjopen-2015-009449

. 2015 Nov 25;5(11):e009449.

doi: 10.1136/bmjopen-2015-009449.

Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models

M O Wiens¹, E Kumbakumba², C P Larson³, J M Ansermino⁴, J Singer⁵, N Kissoon⁶, H Wong¹, A Ndamira², J Kabakyenga⁷, J Kiwanuka², G Zhou⁸

Affiliations

¹ School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
² Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
³ Center for International Child Health, BC Children's Hospital, Child and Family Research Institute, Vancouver, Canada.
⁴ Department of Pediatric Anesthesiology, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
⁵ School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada Canadian HIV Trials Network, St. Paul's Hospital and University of British Columbia, Vancouver, Canada.
⁶ Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
⁷ Maternal, Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.
⁸ Department of Statistics, University of British Columbia, Vancouver, Canada.

PMID: 26608641
PMCID: PMC4663423
DOI: 10.1136/bmjopen-2015-009449

Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models

M O Wiens et al. BMJ Open. 2015.

. 2015 Nov 25;5(11):e009449.

doi: 10.1136/bmjopen-2015-009449.

Authors

M O Wiens¹, E Kumbakumba², C P Larson³, J M Ansermino⁴, J Singer⁵, N Kissoon⁶, H Wong¹, A Ndamira², J Kabakyenga⁷, J Kiwanuka², G Zhou⁸

Affiliations

¹ School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
² Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
³ Center for International Child Health, BC Children's Hospital, Child and Family Research Institute, Vancouver, Canada.
⁴ Department of Pediatric Anesthesiology, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
⁵ School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada Canadian HIV Trials Network, St. Paul's Hospital and University of British Columbia, Vancouver, Canada.
⁶ Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
⁷ Maternal, Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.
⁸ Department of Statistics, University of British Columbia, Vancouver, Canada.

PMID: 26608641
PMCID: PMC4663423
DOI: 10.1136/bmjopen-2015-009449

Abstract

Objectives: To derive a model of paediatric postdischarge mortality following acute infectious illness.

Design: Prospective cohort study.

Setting: 2 hospitals in South-western Uganda.

Participants: 1307 children of 6 months to 5 years of age were admitted with a proven or suspected infection. 1242 children were discharged alive and followed up 6 months following discharge. The 6-month follow-up rate was 98.3%.

Interventions: None.

Primary and secondary outcome measures: The primary outcome was postdischarge mortality within 6 months following the initial hospital discharge.

Results: 64 children died during admission (5.0%) and 61 died within 6 months of discharge (4.9%). Of those who died following discharge, 31 (51%) occurred within the first 30 days. The final adjusted model for the prediction of postdischarge mortality included the variables mid-upper arm circumference (OR 0.95, 95% CI 0.94 to 0.97, per 1 mm increase), time since last hospitalisation (OR 0.76, 95% CI 0.61 to 0.93, for each increased period of no hospitalisation), oxygen saturation (OR 0.96, 95% CI 0.93 to 0·99, per 1% increase), abnormal Blantyre Coma Scale score (OR 2.39, 95% CI 1·18 to 4.83), and HIV-positive status (OR 2.98, 95% CI 1.36 to 6.53). This model produced a receiver operating characteristic curve with an area under the curve of 0.82. With sensitivity of 80%, our model had a specificity of 66%. Approximately 35% of children would be identified as high risk (11.1% mortality risk) and the remaining would be classified as low risk (1.4% mortality risk), in a similar cohort.

Conclusions: Mortality following discharge is a poorly recognised contributor to child mortality. Identification of at-risk children is critical in developing postdischarge interventions. A simple prediction tool that uses 5 easily collected variables can be used to identify children at high risk of death after discharge. Improved discharge planning and care could be provided for high-risk children.

Keywords: EPIDEMIOLOGY; PAEDIATRICS.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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Figures

**Figure 1**
Consort diagram of study flow.

**Figure 2**
Performance of the primary prediction model derived with data from admission (AUC, area under the curve; NPV, negative predictive value; PPV, positive predictive value; ROC, receiver operating characteristic; Sens, sensitivity; Spec, specificity).

See this image and copyright information in PMC

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References

1. Liu L, Oza S, Hogan D et al. . Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015;385: 430–40. 10.1016/S0140-6736(14)61698-6 - DOI - PubMed
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1. Wiens MO, Pawluk S, Kissoon N. Pediatric post-discharge mortality in resource poor countries: a systematic review. PLoS ONE 2013;8:e66698 10.1371/journal.pone.0066698 - DOI - PMC - PubMed
1. Karlen W, Dumont G, Petersen C et al. . Human-centered phone oximeter interface design for the operating room: Pulse Oximeter interfaced to a mobile device for anesthesia monitoring in the developing world. Proceedings of the International Conference on Health Informatics Rome, Italy: SciTePress, 2011:433–8.
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[1] Liu L, Oza S, Hogan D et al. . Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015;385: 430–40. 10.1016/S0140-6736(14)61698-6 - DOI - PubMed

[2] Liu L, Oza S, Hogan D et al. . Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015;385: 430–40. 10.1016/S0140-6736(14)61698-6 - DOI - PubMed

[3] Wang H, Liddell CA, Coates MM et al. . Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384:957–79. 10.1016/S0140-6736(14)60497-9 - DOI - PMC - PubMed

[4] Wang H, Liddell CA, Coates MM et al. . Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384:957–79. 10.1016/S0140-6736(14)60497-9 - DOI - PMC - PubMed

[5] Wiens MO, Pawluk S, Kissoon N. Pediatric post-discharge mortality in resource poor countries: a systematic review. PLoS ONE 2013;8:e66698 10.1371/journal.pone.0066698 - DOI - PMC - PubMed

[6] Wiens MO, Pawluk S, Kissoon N. Pediatric post-discharge mortality in resource poor countries: a systematic review. PLoS ONE 2013;8:e66698 10.1371/journal.pone.0066698 - DOI - PMC - PubMed

[7] Karlen W, Dumont G, Petersen C et al. . Human-centered phone oximeter interface design for the operating room: Pulse Oximeter interfaced to a mobile device for anesthesia monitoring in the developing world. Proceedings of the International Conference on Health Informatics Rome, Italy: SciTePress, 2011:433–8.

[8] Karlen W, Dumont G, Petersen C et al. . Human-centered phone oximeter interface design for the operating room: Pulse Oximeter interfaced to a mobile device for anesthesia monitoring in the developing world. Proceedings of the International Conference on Health Informatics Rome, Italy: SciTePress, 2011:433–8.

[9] The WHO Child Growth Standards [Internet]. 2006. (cited 1 Mar 2015). http://www.who.int/childgrowth/standards/en/

[10] The WHO Child Growth Standards [Internet]. 2006. (cited 1 Mar 2015). http://www.who.int/childgrowth/standards/en/

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Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models

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Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models

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