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Unplanned discharges and their impact on postdischarge mortality in Ugandan children: a multisite cohort study
Delnaz Dadkhah Tirani1, Cherri Zhang2, Rishika Bose1
1The University of British Columbia - Vancouver Campus, Vancouver, British Columbia, Canada.
Insights
Unplanned childhood discharges significantly increase mortality and readmission risks. Identifying and addressing clinical, socioeconomic, and structural factors is crucial for improving child health outcomes.
Area of Science:
- Pediatric critical care
- Global child health outcomes
- Health services research
Background:
- Unplanned discharges pose a significant risk to pediatric patient outcomes.
- Understanding factors contributing to unplanned discharges is essential for improving care.
- Previous research highlights the adverse effects of unplanned discharges on children.
Purpose of the Study:
- To evaluate the impact of unplanned discharge on postdischarge outcomes in children.
- To identify key clinical and socioeconomic risk factors associated with unplanned discharge.
- To inform interventions aimed at reducing unplanned discharges and improving child survival.
Main Methods:
- Secondary analysis of a multisite observational study in six Ugandan hospitals.
- Enrollment of children aged 0-60 months admitted with suspected sepsis.
- Utilized multivariable logistic regression and Cox proportional hazards regression to identify risk factors and assess impact on readmission and mortality.
Main Results:
- Unplanned discharge occurred in 12.8% of children, significantly increasing mortality (HR=2.6) and readmission (HR=2.4) risks.
- Identified risk factors for unplanned discharge include malnutrition, HIV, anemia, lower maternal education, and greater distance from the hospital.
- Children with unplanned discharge had a 13.4% mortality rate within 6 months, compared to 5.1% for planned discharges.
Conclusions:
- Unplanned discharges are prevalent and strongly linked to increased postdischarge mortality and readmission in children.
- Urgent interventions are needed to address clinical, socioeconomic, and structural barriers contributing to unplanned discharges.
- Targeting high-risk children can mitigate adverse outcomes and improve overall child health.
Objective:
Unplanned discharges are an important risk factor for adverse outcomes in children. We aimed to assess the impact of unplanned discharge on postdischarge outcomes and to identify key clinical and socioeconomic risk factors.
Methods:
We conducted a secondary analysis of a multisite observational study in six Ugandan hospitals. Children aged 0-60 months admitted with suspected sepsis were enrolled (July 2017-April 2020) and followed for 6 months after discharge. Multivariable logistic regression adjusted for demographic, clinical and socioeconomic factors (including age, sex and site) identified risk factors for unplanned discharge and Cox proportional hazards regression similarly adjusted for demographic, clinical and socioeconomic factors assessed its impact on readmission and mortality.
Results:
Of 6189 children who survived to discharge, 5403 (87.2%) had a planned discharge and 786 (12.8%) had an unplanned discharge with no unascertained cases. Among children with planned discharge, 271 (5.1%) of 5312 died within 6 months of discharge, compared with 105 (13.4%) of 760 among children with unplanned discharge. Unplanned discharge was associated with higher mortality (HR=2.6, 95% CI 1.9 to 3.5) and readmission (HR=2.4, 95% CI 1.4 to 4.2). In analyses identifying factors associated with unplanned discharge, risk factors included malnutrition, HIV and anaemia, as well as lower maternal education, greater distance from hospital and father-led presentation.
Conclusions:
Unplanned discharges are common and strongly associated with postdischarge mortality and readmission. Interventions targeting children at high risk of unplanned discharge, including those facing clinical, socioeconomic and structural barriers to care, are urgently needed to improve outcomes.
