Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania

Background: Over 40% of the global burden of sepsis occurs in children under 5 years of age, making pediatric sepsis the top cause of death for this age group. Prior studies have shown that outcomes in children with sepsis improve by minimizing the time between symptom onset and treatment. This is a...

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Autores principales:	Audrey Marilyn Smith, Hendry R. Sawe, Michael A. Matthay, Brittany Lee Murray, Teri Reynolds, Teresa Bleakly Kortz
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	pediatric sepsis pediatric critical care global health pediatric emergency medicine sub-Saharan Africa health disparities Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/a5b6b048b2b44fc0be3263f80214ed93
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spelling	oai:doaj.org-article:a5b6b048b2b44fc0be3263f80214ed932021-12-01T18:34:02ZDelayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania2296-236010.3389/fped.2021.764163https://doaj.org/article/a5b6b048b2b44fc0be3263f80214ed932021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.764163/fullhttps://doaj.org/toc/2296-2360Background: Over 40% of the global burden of sepsis occurs in children under 5 years of age, making pediatric sepsis the top cause of death for this age group. Prior studies have shown that outcomes in children with sepsis improve by minimizing the time between symptom onset and treatment. This is a challenge in resource-limited settings where access to definitive care is limited.Methods: A secondary analysis was performed on data from 1,803 patients (28 days−14 years old) who presented to the emergency department (ED) at Muhimbili National Hospital (MNH) from July 1, 2016 to June 30, 2017 with a suspected infection and ≥2 clinical systemic inflammatory response syndrome criteria. The objective of this study was to determine the relationship between delayed presentation to definitive care (>48 h between fever onset and presentation to the ED) and mortality, as well as the association between socioeconomic status (SES) and delayed presentation. Multivariable logistic regression models tested the two relationships of interest. We report both unadjusted and adjusted odds ratios and 95% confidence intervals.Results: During the study period, 11.3% (n = 203) of children who presented to MNH with sepsis died inhospital. Delayed presentation was more common in non-survivors (n = 90/151, 60%) compared to survivors (n = 614/1,353, 45%) (p ≤ 0.01). Children who had delayed presentation to definitive care, compared to those who did not, had an adjusted odds ratio for mortality of 1.85 (95% CI: 1.17–3.00).Conclusions: Delayed presentation was an independent risk factor for mortality in this cohort, emphasizing the importance of timely presentation to care for pediatric sepsis patients. Potential interventions include more efficient referral networks and emergency transportation systems to MNH. Additional clinics or hospitals with pediatric critical care may reduce pediatric sepsis mortality in Tanzania, as well as parental education programs for recognizing pediatric sepsis.Audrey Marilyn SmithHendry R. SaweMichael A. MatthayBrittany Lee MurrayTeri ReynoldsTeresa Bleakly KortzTeresa Bleakly KortzFrontiers Media S.A.articlepediatric sepsispediatric critical careglobal healthpediatric emergency medicinesub-Saharan Africahealth disparitiesPediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	pediatric sepsis pediatric critical care global health pediatric emergency medicine sub-Saharan Africa health disparities Pediatrics RJ1-570
spellingShingle	pediatric sepsis pediatric critical care global health pediatric emergency medicine sub-Saharan Africa health disparities Pediatrics RJ1-570 Audrey Marilyn Smith Hendry R. Sawe Michael A. Matthay Brittany Lee Murray Teri Reynolds Teresa Bleakly Kortz Teresa Bleakly Kortz Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania
description	Background: Over 40% of the global burden of sepsis occurs in children under 5 years of age, making pediatric sepsis the top cause of death for this age group. Prior studies have shown that outcomes in children with sepsis improve by minimizing the time between symptom onset and treatment. This is a challenge in resource-limited settings where access to definitive care is limited.Methods: A secondary analysis was performed on data from 1,803 patients (28 days−14 years old) who presented to the emergency department (ED) at Muhimbili National Hospital (MNH) from July 1, 2016 to June 30, 2017 with a suspected infection and ≥2 clinical systemic inflammatory response syndrome criteria. The objective of this study was to determine the relationship between delayed presentation to definitive care (>48 h between fever onset and presentation to the ED) and mortality, as well as the association between socioeconomic status (SES) and delayed presentation. Multivariable logistic regression models tested the two relationships of interest. We report both unadjusted and adjusted odds ratios and 95% confidence intervals.Results: During the study period, 11.3% (n = 203) of children who presented to MNH with sepsis died inhospital. Delayed presentation was more common in non-survivors (n = 90/151, 60%) compared to survivors (n = 614/1,353, 45%) (p ≤ 0.01). Children who had delayed presentation to definitive care, compared to those who did not, had an adjusted odds ratio for mortality of 1.85 (95% CI: 1.17–3.00).Conclusions: Delayed presentation was an independent risk factor for mortality in this cohort, emphasizing the importance of timely presentation to care for pediatric sepsis patients. Potential interventions include more efficient referral networks and emergency transportation systems to MNH. Additional clinics or hospitals with pediatric critical care may reduce pediatric sepsis mortality in Tanzania, as well as parental education programs for recognizing pediatric sepsis.
format	article
author	Audrey Marilyn Smith Hendry R. Sawe Michael A. Matthay Brittany Lee Murray Teri Reynolds Teresa Bleakly Kortz Teresa Bleakly Kortz
author_facet	Audrey Marilyn Smith Hendry R. Sawe Michael A. Matthay Brittany Lee Murray Teri Reynolds Teresa Bleakly Kortz Teresa Bleakly Kortz
author_sort	Audrey Marilyn Smith
title	Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania
title_short	Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania
title_full	Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania
title_fullStr	Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania
title_full_unstemmed	Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania
title_sort	delayed presentation and mortality in children with sepsis in a public tertiary care hospital in tanzania
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/a5b6b048b2b44fc0be3263f80214ed93
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Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania

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