BMJ 2003;326:361 ( 15 February )

Papers

Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study

J A Berkley, clinical research fellow,  A Ross, statistician,  I Mwangi, clinical researcher,  F H A Osier, clinical researcher,  M Mohammed, research clinical officer,  M Shebbe, research clinical officer,  B S Lowe, laboratory manager,  K Marsh, professor,  C R J C Newton, senior clinical research fellow. 

KEMRI Centre for Geographic Medicine Research (Coast), PO Box 230, Kilifi, Kenya

Correspondence to: J A Berkley jberkley{at}kilifi.mimcom.net

Objectives: To identify clinical indicators of immediate, early, and late mortality in children at admission to a sub-Saharan district hospital and to develop prognostic scores.
Design: Prospective cohort study.
Setting: One district hospital in Kenya.
Participants: Children aged over 90 days admitted to hospital from 1 July 1998 to 30 June 2001.
Main outcome measures: Prognostic indicators of mortality.
Results: Of 8091 children admitted up to 1 June 2000, 436 (5%) died. Sixty (14%) died within four hours after admission (immediate), 193 (44%) after 4-48 hours (early), and 183 (42%) after 48 hours (late). There were marked differences in the clinical features associated with immediate, early, and late death. Seven indicators (neurological status, respiratory distress (subcostal indrawing or deep breathing), nutritional status (wasting or kwashiorkor), severe anaemia, jaundice, axillary temperature, and length of history) were included in simplified prognostic scores. Data from 4802 children admitted from 1 July 2000 to 30 June 2001 were used to validate the scores. For simplified prognostic scores the areas under the receiver operating characteristic curves were 0.93 (95% confidence interval 0.92 to 0.94), 0.82 (0.80 to 0.83), and 0.82 (0.81 to 0.84) for immediate, early, and late death, respectively.
Conclusion: In children admitted to a sub-Saharan hospital, the prognostic indicators of early and late deaths differ but a small number of simple clinical signs predict outcome well.

What is already known on this topic Prognostic indicators have been described for individual diseasesincluding malaria, lower respiratory tract infection, diarrhoea, and malnutritionin African children Making a single diagnosis is often difficult or inappropriate as many children are admitted with several coexisting problems, the clinical features of common illnesses may be indistinguishable, and laboratory facilities are often inadequate What this study adds The signs that are prognostic of immediate, early, and late deaths in children admitted to hospital in Africa differ A small number of simple clinical signs have good sensitivity and specificity for predicting outcome and could be used for risk assessment in individuals or groups

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© 2003 BMJ Publishing Group Ltd
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Rapid Responses:

Read all Rapid Responses

Physical Semeiotics must be to-day fortunately re-evaluated.

Sergio Stagnaro
bmj.com, 14 Feb 2003 [Full text]

That "African" thing

David H Bass
bmj.com, 18 Feb 2003 [Full text]