Cooper E S, Smartt V
Department of Child Health, U.W.I.
West Indian Med J. 1996 Mar;45(1):22-4.
The case fatality ratio (CFR) in acute protein-energy malnutrition (PEM) achieved in the Tropical Metabolism Research Unit (TMRU) was compared with that of other tertiary care facilities in Kingston. Trends in admission and fatality rates, case severity and complications were also examined. From ward admission registers for Bustamante Hospital for Children (BHC), the University Hospital of the West Indies (UHWI), children's wards and the TMRU all cases of PEM admitted from 1982 through 1991 were enumerated and there was a docket search for random subsamples. Ten-year mean CFR% for BHC was 8.8 (n = 1948); for UHWI wards 5.5 (n = 658); for TMRU 7.1 (n = 662). BHC has the least restrictions on admission and showed most clearly that the peak time in Kingston for admission of PEM was around 1985, falling to a minimum in 1988-1990 and rising again in 1991; however, the other sites also showed similar trends. BHC had a range of CFR% p.a. of 20.0 to 3.0, with a striking fall in the second half of the decade. There was no temporal CFR trend for the UHWI or TMRU. The latter institution had the highest proportion of admissions with marasmic-kwashiorkor and the lowest proportion with recorded infection. The annual variation in numbers of PEM deaths at BHC was best accounted for by (a) percentage change in consumer price index and (b) percentage change in the US$ value of the Jamaican $, in the preceding year, and (c) annual number of admissions, together. Generally, our findings suggest a minor role for expert in-patient management in reducing deaths from PEM.
将热带代谢研究组（TMRU）治疗急性蛋白质 - 能量营养不良（PEM）的病死率（CFR）与金斯敦其他三级护理机构的病死率进行了比较。还研究了入院率和死亡率的趋势、病例严重程度及并发症情况。从 Bustamante 儿童医院（BHC）、西印度群岛大学医院（UHWI）的病房入院登记册以及 TMRU 的儿童病房中，统计了 1982 年至 1991 年期间所有入院的 PEM 病例，并对随机抽取的子样本进行了病历检索。BHC 的十年平均病死率为 8.8%（n = 1948）；UHWI 病房为 5.5%（n = 658）；TMRU 为 7.1%（n = 662）。BHC 对入院的限制最少，最清楚地表明金斯敦 PEM 入院的高峰时间约在 1985 年，1988 - 1990 年降至最低，1991 年又再次上升；不过，其他机构也呈现出类似趋势。BHC 的年病死率范围为 20.0%至 3.0%，在这十年的后半期显著下降。UHWI 或 TMRU 没有随时间变化的病死率趋势。后一个机构中消瘦 - 夸希奥科病入院比例最高，记录感染比例最低。BHC 的 PEM 死亡人数的年度变化最能由以下因素共同解释：（a）消费价格指数的百分比变化；（b）前一年牙买加元美元价值的百分比变化；（c）年度入院人数。总体而言，我们的研究结果表明，专家住院管理在降低 PEM 死亡方面作用较小。
