Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
BMJ Paediatr Open. 2022 Jan;6(1). doi: 10.1136/bmjpo-2021-001379.
Over half of the 5 million annual deaths among children aged 0-59 months occur in sub-Saharan Africa. The period immediately after hospitalisation is a vulnerable time in the life of a child in sub-Saharan Africa as postdischarge mortality rates are as high as 1%-18%. Identification of neonates and children who are at highest risk for postdischarge mortality may allow for the direction of interventions to target patients at highest risk.
The Predicting Post-Discharge Mortality study is a prospective, observational study being conducted at Muhimbili National Hospital (Dar es Salaam, Tanzania) and John F. Kennedy Medical Center (Monrovia, Liberia). The aim is to derive and validate two, age population specific, clinical prediction rules for the identification of neonates (n=2000) and children aged 1-59 months (n=2000) at risk for all-cause mortality within 60 days of discharge from the neonatal intensive care unit or paediatric ward. Caregivers of participants will receive phone calls 7, 14, 30, 45 and 60 days after discharge to assess vital status. Candidate predictor variables will include demographic, anthropometric and clinical factors. Elastic net regression will be used to derive the clinical prediction rules. Bootstrapped selection with repetitions will be used for internal validation. Planned secondary analyses include the external validation of existing clinical prediction models, determination of clinicians' ability to identify neonates and children at risk of postdischarge mortality at discharge, analysis of factors associated with hospital readmission and unplanned clinic visits and description of health-seeking behaviours in the postdischarge period.
This study received ethical clearance from the Tanzania National Institute of Medical Research, Muhimbili University of Health and Allied Sciences, the John F. Kennedy Medical Center Institutional Review Board, and the Boston Children's Hospital Institutional Review Board. Findings will be disseminated at scientific conferences and as peer-reviewed publications.
0-59 月龄儿童每年有超过 500 万例死亡，其中半数以上发生在撒哈拉以南非洲。在撒哈拉以南非洲，儿童在医院出院后的时期是生命中一个脆弱的时期，出院后死亡率高达 1%-18%。识别新生儿和儿童中最有可能发生出院后死亡的高危人群，可能有助于针对高危患者实施干预措施。
预测出院后死亡率研究是一项在达累斯萨拉姆穆希比利国家医院（坦桑尼亚）和蒙罗维亚约翰·肯尼迪医疗中心（利比里亚）进行的前瞻性观察性研究。该研究旨在得出并验证两个针对新生儿（n=2000）和 1-59 月龄儿童（n=2000）的年龄特定的临床预测规则，以识别新生儿重症监护病房或儿科病房出院后 60 天内全因死亡的高危人群。参与者的照顾者将在出院后第 7、14、30、45 和 60 天接受电话随访以评估生命状态。候选预测变量将包括人口统计学、人体测量学和临床因素。弹性网络回归将用于得出临床预测规则。重复进行引导选择用于内部验证。计划的次要分析包括对现有临床预测模型的外部验证、确定医生在出院时识别新生儿和儿童出院后死亡风险的能力、分析与医院再入院和非计划门诊就诊相关的因素以及描述出院后期间的寻医行为。
这项研究得到了坦桑尼亚国家医学研究研究所、穆希比利健康与联合科学大学、约翰·肯尼迪医疗中心伦理审查委员会和波士顿儿童医院伦理审查委员会的伦理批准。研究结果将在科学会议上和同行评议的出版物中公布。
