Pediatric post-discharge mortality in resource poor countries: a systematic review.

<h4>Objectives</h4>Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estim...

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Autores principales:	Matthew O Wiens, Shane Pawluk, Niranjan Kissoon, Elias Kumbakumba, J Mark Ansermino, Joel Singer, Andrew Ndamira, Charles Larson
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7f77edc0840143efa41a00c69fd343ba
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spelling	oai:doaj.org-article:7f77edc0840143efa41a00c69fd343ba2021-11-18T07:40:10ZPediatric post-discharge mortality in resource poor countries: a systematic review.1932-620310.1371/journal.pone.0066698https://doaj.org/article/7f77edc0840143efa41a00c69fd343ba2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23825556/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objectives</h4>Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for death.<h4>Search strategy</h4>MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from the inception date to October, 2012. Key word searches using Google Scholar™ and hand searching of references of retrieved articles was also performed. Studies from developing countries reporting mortality following hospital discharge among a pediatric population were considered for inclusion.<h4>Results</h4>Thirteen studies that reported mortality rates following discharge were identified. Studies varied significantly according to design, underlying characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly between studies (1%-18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition, multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during the post-discharge period. Follow-up care was examined in only one study examining malaria prophylaxis in children discharged following an admission secondary to malaria, which showed no significant benefit on post-discharge mortality.<h4>Conclusions</h4>The months following hospital discharge carry significant risk for morbidity and mortality. While several characteristics are strongly associated with post-discharge mortality, no validated tools are available to aid health workers or policy makers in the systematic identification of children at high risk of post-discharge mortality. Future research must focus on both the creation of tools to aid in defining groups of children most likely to benefit from post-discharge interventions, and formal assessment of the effectiveness of such interventions in reducing morbidity and mortality in the first few months following hospital discharge.Matthew O WiensShane PawlukNiranjan KissoonElias KumbakumbaJ Mark AnserminoJoel SingerAndrew NdamiraCharles LarsonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 6, p e66698 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Matthew O Wiens Shane Pawluk Niranjan Kissoon Elias Kumbakumba J Mark Ansermino Joel Singer Andrew Ndamira Charles Larson Pediatric post-discharge mortality in resource poor countries: a systematic review.
description	<h4>Objectives</h4>Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for death.<h4>Search strategy</h4>MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from the inception date to October, 2012. Key word searches using Google Scholar™ and hand searching of references of retrieved articles was also performed. Studies from developing countries reporting mortality following hospital discharge among a pediatric population were considered for inclusion.<h4>Results</h4>Thirteen studies that reported mortality rates following discharge were identified. Studies varied significantly according to design, underlying characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly between studies (1%-18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition, multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during the post-discharge period. Follow-up care was examined in only one study examining malaria prophylaxis in children discharged following an admission secondary to malaria, which showed no significant benefit on post-discharge mortality.<h4>Conclusions</h4>The months following hospital discharge carry significant risk for morbidity and mortality. While several characteristics are strongly associated with post-discharge mortality, no validated tools are available to aid health workers or policy makers in the systematic identification of children at high risk of post-discharge mortality. Future research must focus on both the creation of tools to aid in defining groups of children most likely to benefit from post-discharge interventions, and formal assessment of the effectiveness of such interventions in reducing morbidity and mortality in the first few months following hospital discharge.
format	article
author	Matthew O Wiens Shane Pawluk Niranjan Kissoon Elias Kumbakumba J Mark Ansermino Joel Singer Andrew Ndamira Charles Larson
author_facet	Matthew O Wiens Shane Pawluk Niranjan Kissoon Elias Kumbakumba J Mark Ansermino Joel Singer Andrew Ndamira Charles Larson
author_sort	Matthew O Wiens
title	Pediatric post-discharge mortality in resource poor countries: a systematic review.
title_short	Pediatric post-discharge mortality in resource poor countries: a systematic review.
title_full	Pediatric post-discharge mortality in resource poor countries: a systematic review.
title_fullStr	Pediatric post-discharge mortality in resource poor countries: a systematic review.
title_full_unstemmed	Pediatric post-discharge mortality in resource poor countries: a systematic review.
title_sort	pediatric post-discharge mortality in resource poor countries: a systematic review.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/7f77edc0840143efa41a00c69fd343ba
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Pediatric post-discharge mortality in resource poor countries: a systematic review.

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