Incidence and Risk Factors for Paediatric Mortality within 24-Hours of Presentation at Emergency Medicine Department Muhimbili National Hospital

Abstract

Background: In 2017 around 6.3 million children and young adolescents died, commonly due to reversible causes worldwide. A child in Sub-Saharan Africa (SSA) is 15 times more likely to die than a child in a high income country and children under five have higher mortality than adolescents. A significant number of children presenting in critical condition to our emergency department but their actual proportion and risk factors of early mortality are not known. Materials and methods: This was consecutive convenience prospective cohort study of all pediatric patients (aged 28 days and 14 years) presenting to the MNH ED in Dar es Salaam Tanzania from August 2019 to January 2020. For each eligible patient, a structured case report form (CRF) was used for documenting demographic information, clinical presentation, other diagnostic evaluation, EMD treatment, outcome and disposition. Patients were followed up from day of the admission up to the end of study period. The study mortality rate and risk factors were summarized with descriptive statistics, including median with IQR, RR with 95% and P value, as appropriate. Results: We enrolled 989 (27.4%) pediatric patients pediatric patients attended at ED-MNH when research assistance was available. 602(60.9%) were male, median age of 2 years IQR= 1-5) and 42.2% (n=437) of the enrolled patients were below 1year. 51.2 %( n=507) of the group enrolled were transferred from another health care facility. For all enrolled patients in ED 7.2% had congenital heart disease followed by sickle cell disease 4.2%. Of the 276 (27.9) were stable and discharged home from ED, 33 (3.3%) died in ED. Among admitted patients 623(63%) were admitted in the general wards and 57(5.7%) admitted in Pediatric ICU. Five (0.5%) patients died within 24hours from ED presentation and 52 (5.3%) died more than 24hours. Altered level of consciousness 85(8.6%) with a RR of 21.7(CI: 11.4-41.5), low random blood glucose 22(2.2%), RR 3.8(CI: 1.3-11.3), raised creatinine 22(2.2%), RR 8.2(CI: 3.8-17.6) and raised lactate above 2 were 134(13.5%) RR of 6.4(CI: 3.5-11.7) were among factors observed to be associated with 24hours mortality. Conclusion: This study revealed lactate levels above 2, altered levels of consciousness, low random blood glucose levels, low hemoglobin levels and raised creatinine has been shown to determine the twenty fours Mortality from ED presentation and mortality rate of 3.8%.