Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort study
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...
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12873-019-0235-4 |
| _version_ | 1819158918283132928 |
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| author | Biita Muhanuzi Hendry R. Sawe Said S. Kilindimo Juma A. Mfinanga Ellen J. Weber |
| author_facet | Biita Muhanuzi Hendry R. Sawe Said S. Kilindimo Juma A. Mfinanga Ellen J. Weber |
| author_sort | Biita Muhanuzi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-22T16:32:17Z |
| format | Article |
| id | doaj.art-de252518bef84a8aa7b7c76efe33d668 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-22T16:32:17Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-de252518bef84a8aa7b7c76efe33d6682022-12-21T18:20:01ZengBMCBMC Emergency Medicine1471-227X2019-02-011911710.1186/s12873-019-0235-4Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort studyBiita Muhanuzi0Hendry R. Sawe1Said S. Kilindimo2Juma A. Mfinanga3Ellen J. Weber4Emergency Medicine Department, Muhimbili University of Health and Allied SciencesEmergency Medicine Department, Muhimbili University of Health and Allied SciencesEmergency Medicine Department, Muhimbili University of Health and Allied SciencesEmergency Medicine Department, Muhimbili University of Health and Allied SciencesDepartment of Emergency Medicine, University of CaliforniaAbstract 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.http://link.springer.com/article/10.1186/s12873-019-0235-4Respiratory compromiseEmergency medicineTanzaniaRespiratory distressPaediatricsEmergency care |
| spellingShingle | Biita Muhanuzi Hendry R. Sawe Said S. Kilindimo Juma A. Mfinanga Ellen J. Weber Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort study BMC Emergency Medicine Respiratory compromise Emergency medicine Tanzania Respiratory distress Paediatrics Emergency care |
| title | Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort study |
| title_full | Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort study |
| title_fullStr | Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort study |
| title_full_unstemmed | Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort study |
| title_short | Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort study |
| title_sort | respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in tanzania a descriptive cohort study |
| topic | Respiratory compromise Emergency medicine Tanzania Respiratory distress Paediatrics Emergency care |
| url | http://link.springer.com/article/10.1186/s12873-019-0235-4 |
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