Risk factors predicting early in-hospital mortality among underfive children and need for decentralization of...

Area of Science:

• Pediatric Emergency Medicine
• Neonatal Care
• Public Health Systems

Background:

• Peripheral healthcare centers often lack specialized pediatric triage and emergency care.
• This deficiency results in the unnecessary referral of low- and medium-risk pediatric patients to tertiary care facilities.
• A critical need exists to identify factors contributing to early mortality in referred pediatric cases.

Purpose of the Study:

• To investigate the risk factors associated with mortality within 48 hours of admission in neonates and children under five years old.
• To analyze predictors of early in-hospital mortality in referred pediatric patients at a tertiary care hospital in India.

Main Methods:

• A prospective study involving 246 referred children (0-5 years) admitted to a pediatric emergency department.
• Patients were followed up to determine survival or death status at 48 hours post-admission.
• Logistic regression analysis was employed to identify independent predictors of early mortality.

Main Results:

• Overall mortality within 48 hours was 20%.
• Independent risk factors for early mortality included lack of pediatric intensive care (OR 4.07), lack of neonatal intensive care (OR 2.10), transport time >1 hour (OR 7.75), and very sick condition on arrival (OR 210.1).
• Factors like distance >20 km (OR 4.61) and unstable vital signs on arrival also predicted mortality.

Conclusions:

• Strengthening pediatric emergency services and implementing triage systems are crucial for reducing early mortality.
• Developing tele-pediatric intensive care units and improving interhospital communication for referral services are recommended.
• Regionalizing referral systems can optimize care for critically ill children and reduce preventable deaths.