Abstract:
Background: Respiratory compromise is the leading cause of cardiac arrest and death among paediatric patients.
Emergency medicine is a new field in low-income countries (LICs); the presentation, treatment and outcomes of
paediatric patients with respiratory compromise is not well studied. We describe the clinical epidemiology,
management and outcomes of paediatric patients with respiratory compromise presenting to the first full-capacity
Emergency Department in Tanzania.
Methods: This was a prospective cohort study of paediatric patients (< 18 years) with respiratory compromise
(respiratory distress, respiratory failure or respiratory arrest) presenting to the Emergency Medicine Department of
Muhimibili National Hospital (EMD-MNH) in Dar es Salaam, from July–November 2017. A standardized case report
form was used to record demographics, presenting clinical characteristics, management and outcomes. Primary
outcomes were hospital mortality and secondary outcomes were EMD mortality, 24-h mortality, incidence of
cardiac arrest in the EMD, length of stay, ICU admission, and risk factors for mortality.
Results: We enrolled 165 children; their median age was 12 months [IQR: 4–36 months], and 90 (54.4%) were male.
At presentation 92 (55.8%) children were in respiratory failure. Oxygen therapy was initiated for 143 (86.7%)
children, among which 21 (14.7%) were intubated.
The most common aetiologies were pneumonia followed by congenital heart disease and sepsis. The majority 147 (89.1%)
of children were admitted to the hospital, with 20 (12%) going to ICU. Four (2%) children were discharged from EMD and
14 (8.5%) died in the EMD. In the EMD, 18 children developed cardiac arrest, with two surviving to hospital discharge. Overall
51 (30.9%) children died; 84% of deaths were in children under five years. Risk of mortality was increased in children
presenting with decreased consciousness (RR = 2.2 (1.4–3.4)), hypoxia RR = 2.6 (1.6–4.4)) or bradypnoea (RR = 3.9 (2.9–5.0)),
and those who received CPR (RR = 3.7 (2.7–5.2)) and intubation (RR = 3.1 (2.1–4.5)).
Conclusions: In this EMD of a LICs, respiratory compromise in children carries high mortality, with children of young age
being the most vulnerable. Many children arrived in respiratory failure and few children received ICU care. Outcomes can be
improved by earlier recognition to prevent cardiac arrest, and more intensive treatment, including ICU and assisted
ventilation.
