1. About 1 in 25 children younger than age 15 years died within 90 days of hospital discharge in Southern Mozambique; over half of all mortalities occurred within 30 days of discharge.
2. Risk factors for 90-day post-discharge mortality (PDM) included young age, severe malnutrition, history of diarrhea, and absconding or transferring to a different hospital for higher level care.
Evidence Rating Level: 2 (Good)
Study Rundown: A significant number of pediatric deaths in low-income countries (LICs) occur after discharge from the hospital, particularly during the first 30 days. However, clear recommendations regarding post-discharge follow-up care for high-risk patients are nonexistent. Authors of this study reviewed data on pediatric patients younger than age 15 years in Southern Mozambique who had died within 90 days of hospital discharge; their goal was to quantify the burden of and identify risk factors for PDM. Results show almost 4% of patients died within 90 days of discharge, more than half of whom died within the first 30 days. Several mortality predictors were identified, including young age, severe malnutrition, history of diarrhea, HIV or bacteremia, and history of absconding or transfer to another hospital. For children <3 months of age, PDM risk factors included age <30 days, low weight-for-age Z-score, presence of breathing difficulties, hypothermia or fever, and history of absconding or transfer to another hospital. These findings are limited by potential selection bias and data collection inaccuracies inherent in retrospective studies. Also, clinical variables were collected from the time of admission and may have changed by the time of hospital discharge, which could alter the observed relationship between variable and PDM risk. Nevertheless, results from this study could be used to identify children at high risk of PDM at the time of discharge, allowing the team to develop a more intensive after-visit and follow-up plan.
In-depth [retrospective cohort]: Researchers in this study retrospectively reviewed inpatient records and morbidity surveillance data on children <15 years old (25 632 admissions, 18 023 children) over a 17-year period (January 2000 to December 2016) in Southern Mozambique. The data was analyzed to quantify the burden of PDM during 3 post-discharge periods (days 0 to 30, 31 to 60 and 61 to 90) and to identify potential predictors of PDM. Results showed there were 935 deaths (3.6% of admissions, 783 non-hospital deaths, 152 deaths during readmissions) within 90 days of discharge. Of the 935 deaths, 488 (52.2%) occurred within 30 days of discharge, 265 (28.3%) occurred between days 31 to 60, and 182 (19.5%) occurred between days 61 to 90. The median time to death was 28 days (interquartile range 11-53 days). Several variables were found to be associated with greater risk of PDM, including severe acute malnutrition (hazard ratio [HR] 3.26, 95% CI 2.08-5.12), absconding (HR 5.23, 95% CI 4.22-6.50), transfer to another hospital (HR 4.48, 95% CI 3.31-6.05), and having a history of diarrhea (HR 1.72, 95% CI 1.45-2.03). Having a positive malaria test (HR 0.44, 95% CI 0.36-0.54), a negative HIV test (HR 0.53, 95% CI 0.35-0.80), and nasal flaring (HR 0.69, 95% CI 0.55-0.86) were associated with lower risk of PDM. Infants <3 months had the highest risk of PDM, and increased age was found to be associated with decreased PDM risk (P<.001). A subanalysis on infants <3 months showed predictors of PDM, including age <1 month, hypothermia or fever, low weight-for-age Z score, having oral candidiasis, and having breathing difficulties.
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