Kumwenda Mercy, Assies Roxanne, Chathima Gloria, Khofi Harriet, van Woensel Job B M, Chimalizeni Yamikani, Langton Josephine, Calis Job C J
Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
Department of Paediatrics and Child Health, Kamuzu Central Hospital, Lilongwe, Malawi.
PLOS Glob Public Health. 2024 Jan 8;4(1):e0002282. doi: 10.1371/journal.pgph.0002282. eCollection 2024.
Shock is considered one of the most important mechanisms of critical illness in children. However, data on paediatric shock in sub-Saharan Africa is limited, which constrains development of effective treatment strategies. We aimed to describe the prevalence, mortality, and aetiology of paediatric shock in a tertiary hospital in Malawi. Children aged two months to 16 years presenting with shock (FEAST criteria; respiratory distress and/or impaired consciousness, and at least one sign of impaired circulation; capillary refill>3 seconds, cold extremities, weak pulse, or severe tachycardia) to the emergency department were included and followed-up prospectively using routinely collected data between February 2019 and January 2020. Prevalence, mortality and aetiology of shock were reported for both the FEAST criteria and World Health Organization (WHO) definition. The association between aetiology and mortality was assessed with univariable analysis. Of all screened admissions (N = 12,840), 679 (5.3%) children presented with shock using FEAST criteria and the mortality was 79/663 (11.9%). WHO-defined shock applied to 16/12,840 (0.1%) and the mortality was 9/15 (60.0%). Main diagnoses were viral/reactive airway diseases (40.4%), severe pneumonia (14.3%), gastroenteritis (11.3%) and presumed sepsis (5.7%). Children diagnosed with presumed sepsis and gastroenteritis had the highest odds of dying (OR 11.3; 95%-CI:4.9-25.8 and OR 4.4; 95%-CI:2.4-8.2). Considering the high mortality, prevalence of paediatric shock (FEAST and WHO definitions) in Malawi is high. Sepsis and gastroenteritis are diagnoses associated with poor outcome in these children. Consensus on a clinical meaningful definition for paediatric shock is essential to boost future studies.
休克被认为是儿童危重病最重要的机制之一。然而，撒哈拉以南非洲地区有关儿童休克的数据有限，这限制了有效治疗策略的制定。我们旨在描述马拉维一家三级医院中儿童休克的患病率、死亡率及病因。纳入2019年2月至2020年1月期间因休克（采用FEAST标准：呼吸窘迫和/或意识障碍，以及至少一项循环障碍体征；毛细血管再充盈时间>3秒、四肢冰冷、脉搏微弱或严重心动过速）到急诊科就诊的2个月至16岁儿童，并使用常规收集的数据进行前瞻性随访。报告了FEAST标准和世界卫生组织（WHO）定义下休克的患病率、死亡率及病因。采用单变量分析评估病因与死亡率之间的关联。在所有筛查的入院病例（N = 12840）中，679名（5.3%）儿童符合FEAST标准的休克表现，死亡率为79/663（11.9%）。WHO定义的休克适用于16/12840（0.1%），死亡率为9/15（60.0%）。主要诊断为病毒性/反应性气道疾病（40.4%）、重症肺炎（14.3%）、胃肠炎（11.3%）和疑似脓毒症（5.7%）。诊断为疑似脓毒症和胃肠炎的儿童死亡几率最高（比值比11.3；95%置信区间：4.9 - 25.8和比值比4.4；95%置信区间：2.4 - 8.2）。考虑到高死亡率，马拉维儿童休克（FEAST和WHO定义）的患病率较高。脓毒症和胃肠炎是这些儿童预后不良的相关诊断。就儿童休克具有临床意义的定义达成共识对于推动未来研究至关重要。
