Abstract:
Background: Altered mental status (AMS) in children is defined as the failure to respond to physical or verbal stimulation as appropriate to the child’s development level. AMS has many causes, but in general results from physical or metabolic insult to the brain, making this an emergency condition. Alteration of mental status in a child can indicate a life threatening problem such ashypoglycemia or hypoxia thatrequires early resuscitation, diagnosis and treatment.
Also AMS can develop over time during another illness if the patient deteriorates. Thus altered mental status is often due to the progression of an underlying illness that needs to be diagnosed.
While the causes of altered mental status in HIC’s have been described, the causes of AMSin limited income countries (LICs) have not been described adequately. As a result, the management, diagnosis and outcome of children with AMS in resource poor settingsis inadequate.
Aim:To determine the clinical profiles and outcomes of paediatric patients presenting with AMS to the Emergency Department of Muhimbili National Hospital and MUHAS Academic Medical Centre Dar es salaam.
Methodology:This was a prospective cohort study of children aged one month to eighteen years presenting with AMS to the EMDs of MNH and MAMC from June 2018 to December 2018. AVPU was used to assess the level of consciousness and any child who responded to pain, voice or unresponsive was enrolled in the study. Case report form (CRF) was used to collect data demographics, clinical presentation, management and outcomes. Data was imported andanalysed with SPSS. Descriptive data waspresented as means and medians with measures of spread, and frequency and proportions.
Results:Total of 1273 children were screened,median age of those eligible and enrolled in the study was 24months(interquartile range 8-60 months).320(25.1%) childrenmet the inclusion criteria and were enrolled.198(61.9%) were male,188(58.8%) were referred from peripheral hospitals.The EMD-MNH diagnoses were pneumonia63(19.6%),sepsis 37(11.5%),congenital heart disease 33(10.3%),malaria 24(7.5%) and meningitis 19(5.9%). The most common interventions provided at the EMD were intravenous fluids (90.6%) antibiotics (82.5%),oxygen therapy (54.4%) and antimalarials(12.5%).From the EMD 8(2.5%) were discharged home,212(66.3%) were admitted to the general ward,83(25.9%) were admitted to the ICU,and 17(5.3%) were taken to theatre from the EMD.In-hospital mortality at 24 hours was 15.8%.
Conclusion:Altered mental status was a common presentation amongst paediatric patients presenting to these twoEDs in Dar es Salaam Tanzania.Children presenting with AMS have significant morbidity and mortality as evidenced by very high admission rate and overall twenty four hours hospital mortality of 15.8%.
