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Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction
M O Wiens1, E Kumbakumba2, C P Larson3
1School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Postdischarge mortality in children after infectious illness is significant. A simple model using five variables can identify high-risk children for targeted interventions.
Area of Science:
- Global child health
- Pediatric infectious diseases
- Epidemiology
Background:
- Postdischarge mortality is a critical yet underrecognized aspect of child mortality.
- Acute infectious illnesses contribute significantly to pediatric hospitalizations and subsequent mortality.
Purpose of the Study:
- To develop and validate a predictive model for identifying children at high risk of mortality following hospital discharge after acute infectious illness.
- To inform targeted interventions and improve discharge planning for vulnerable pediatric populations.
Main Methods:
- A prospective cohort study was conducted in two hospitals in South-western Uganda.
- 1307 children aged 6 months to 5 years admitted with infection were followed for 6 months post-discharge.
- A multivariable logistic regression model was used to identify predictors of postdischarge mortality.
Main Results:
- The postdischarge mortality rate was 4.9%, with over half of deaths occurring within 30 days.
- Key predictors identified included low mid-upper arm circumference, recent hospitalization, low oxygen saturation, abnormal Blantyre Coma Scale score, and HIV-positive status.
- The final model demonstrated good predictive accuracy (Area Under Curve = 0.82), identifying 35% of children as high risk with an 11.1% mortality risk.
Conclusions:
- A simple, validated tool using readily available clinical variables can effectively identify children at high risk of death after hospital discharge.
- Targeted interventions and enhanced discharge planning for high-risk children are crucial for reducing postdischarge mortality.
- This model can guide resource allocation and clinical decision-making in low-resource settings.
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.
