Knappett Martina, Nguyen Vuong, Chaudhry Maryum, Trawin Jessica, Kabakyenga Jerome, Kumbakumba Elias, Jacob Shevin T, Ansermino J Mark, Kissoon Niranjan, Mugisha Nathan Kenya, Wiens Matthew O
Institute for Global Health, BC Children's Hospital and BC Women's Hospital + Health Centre, 305-4088 Cambie Street, Vancouver, BC V5Z 2X8, Canada.
Maternal Newborn & Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.
EClinicalMedicine. 2023 Dec 21;67:102380. doi: 10.1016/j.eclinm.2023.102380. eCollection 2024 Jan.
Under-five mortality remains concentrated in resource-poor countries. Post-discharge mortality is becoming increasingly recognized as a significant contributor to overall child mortality. With a substantial recent expansion of research and novel data synthesis methods, this study aims to update the current evidence base by providing a more nuanced understanding of the burden and associated risk factors of pediatric post-discharge mortality after acute illness.
Eligible studies published between January 1, 2017 and January 31, 2023, were retrieved using MEDLINE, Embase, and CINAHL databases. Studies published before 2017 were identified in a previous review and added to the total pool of studies. Only studies from countries with low or low-middle Socio-Demographic Index with a post-discharge observation period greater than seven days were included. Risk of bias was assessed using a modified version of the Joanna Briggs Institute critical appraisal tool for prevalence studies. Studies were grouped by patient population, and 6-month post-discharge mortality rates were quantified by random-effects meta-analysis. Secondary outcomes included post-discharge mortality relative to in-hospital mortality, pooled risk factor estimates, and pooled post-discharge Kaplan-Meier survival curves. PROSPERO study registration: #CRD42022350975.
Of 1963 articles screened, 42 eligible articles were identified and combined with 22 articles identified in the previous review, resulting in 64 total articles. These articles represented 46 unique patient cohorts and included a total of 105,560 children. For children admitted with a general acute illness, the pooled risk of mortality six months post-discharge was 4.4% (95% CI: 3.5%-5.4%, I = 94.2%, n = 11 studies, 34,457 children), and the pooled in-hospital mortality rate was 5.9% (95% CI: 4.2%-7.7%, I = 98.7%, n = 12 studies, 63,307 children). Among disease subgroups, severe malnutrition (12.2%, 95% CI: 6.2%-19.7%, I = 98.2%, n = 10 studies, 7760 children) and severe anemia (6.4%, 95% CI: 4.2%-9.1%, I = 93.3%, n = 9 studies, 7806 children) demonstrated the highest 6-month post-discharge mortality estimates. Diarrhea demonstrated the shortest median time to death (3.3 weeks) and anemia the longest (8.9 weeks). Most significant risk factors for post-discharge mortality included unplanned discharges, severe malnutrition, and HIV seropositivity.
Pediatric post-discharge mortality rates remain high in resource-poor settings, especially among children admitted with malnutrition or anemia. Global health strategies must prioritize this health issue by dedicating resources to research and policy innovation.
No specific funding was received.
五岁以下儿童死亡率仍然集中在资源匮乏的国家。出院后死亡率日益被认为是儿童总体死亡率的一个重要因素。随着近期研究和新型数据综合方法的大量扩展，本研究旨在通过更细致地了解急性疾病后儿科出院后死亡率的负担及相关风险因素，来更新当前的证据基础。
使用MEDLINE、Embase和CINAHL数据库检索2017年1月1日至2023年1月31日期间发表的符合条件的研究。2017年之前发表的研究在之前的综述中已被识别，并被纳入研究总数。仅纳入社会人口统计学指数低或中低的国家、出院后观察期超过七天的研究。使用乔安娜·布里格斯研究所患病率研究关键评估工具的修改版评估偏倚风险。研究按患者群体分组，通过随机效应荟萃分析对出院后6个月的死亡率进行量化。次要结局包括出院后死亡率与住院死亡率的比较、汇总风险因素估计值以及汇总的出院后Kaplan-Meier生存曲线。PROSPERO研究注册号：#CRD42022350975。
在筛选的1963篇文章中，识别出42篇符合条件的文章，并与之前综述中识别出的22篇文章合并，共64篇文章。这些文章代表46个独特的患者队列，共纳入105560名儿童。对于因一般急性疾病入院的儿童，出院后6个月的汇总死亡风险为4.4%（95%置信区间：3.5%-5.4%，I² = 94.2%，n = 11项研究，34457名儿童），汇总住院死亡率为5.9%（95%置信区间：4.2%-7.7%，I² = 98.7%，n = 12项研究，63307名儿童）。在疾病亚组中，重度营养不良（12.2%，95%置信区间：6.2%-19.7%，I² = 98.2%，n = 10项研究，7760名儿童）和重度贫血（6.4%，95%置信区间：4.2%-9.1%，I² = 93.3%，n = 9项研究，7806名儿童）的出院后6个月死亡率估计最高。腹泻的中位死亡时间最短（3.3周），贫血最长（8.9周）。出院后死亡的最显著风险因素包括非计划出院、重度营养不良和HIV血清阳性。
在资源匮乏地区，儿科出院后死亡率仍然很高，尤其是在因营养不良或贫血入院的儿童中。全球卫生战略必须通过投入资源进行研究和政策创新，将这一健康问题作为优先事项。
未获得特定资金。
Zotero 插件
