Clinical epidemiology, management and outcomes of paediatric patients with respiratory compromise at Muhimbili National Hospital in emergency medicine department 2017.

Abstract

Background: Respiratory compromise is the common causes of paediatric emergency visits and is the leading cause of cardiac arrest among paediatric patients. In Tanzania, as in other low-income countries, little is documented about the clinical epidemiology, management and outcomes of paediatric patients with respiratory compromise attending in acute care settings.

Aim of the study: To describe the clinical epidemiology, management and outcomes of paediatric patients with respiratory compromise presenting to the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH)

Material and methods: This was a prospective cohort study of consecutive paediatric patients (below the age of 18 years) with respiratory compromise presenting to EMD-MNH from July 2017 to November 2017. Informed consent was obtained prior to being enrolled in the study. A standardized case report form with in built online data capture software was used to record study information, including demographics, relevant clinical characteristics and overall patients’ outcomes. The study data was summarized with medians and interquartile ranges, counts and proportions as appropriate.

Results: We enrolled 165 (3.3 %) children with respiratory comprise from 5041 children who presented to EMD-MNH during the study period. The median age was 12 months (Interquartile range: 4-36 months), and 90 (54.4%) were male. Overall 92 (55.8%) of children were in respiratory failure upon arrival to EMD, and the rest 73 (44.2%) were in respiratory distress. Oxygen therapy was initiated at EMD for 143 (86.7%) children, while 21 (14.7%) children received assisted ventilation. Blood gases analysis was done to 90 (54.5%) children at EMD. Also 18 (10.9%) children developed cardiac arrest in the EMD, and only 2 (11.1%) of them survived to hospital discharge. Majority 147 (89.1%) of children were admitted to the hospital, while 14 (8.5%) children died in the EMD. The overall hospital mortality was 51(30.9%)

Conclusion and recommendation: In a cohort of paediatric patients presenting to EMD with respiratory compromise was associated with significant morbidity, as evidenced by the need for assisted ventilation, antibiotics, intubation and high rate of cardiac arrest. The observed mortality rate was 31%. Future studies should focus on identification of predictors of poor outcomes among children with respiratory compromise in EMD.