Pediatric post-discharge mortality in resource poor countries: a systematic review.
<h4>Objectives</h4>Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estim...
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0066698 |
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| author | Matthew O Wiens Shane Pawluk Niranjan Kissoon Elias Kumbakumba J Mark Ansermino Joel Singer Andrew Ndamira Charles Larson |
| author_facet | Matthew O Wiens Shane Pawluk Niranjan Kissoon Elias Kumbakumba J Mark Ansermino Joel Singer Andrew Ndamira Charles Larson |
| author_sort | Matthew O Wiens |
| collection | DOAJ |
| description | <h4>Objectives</h4>Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for death.<h4>Search strategy</h4>MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from the inception date to October, 2012. Key word searches using Google Scholar™ and hand searching of references of retrieved articles was also performed. Studies from developing countries reporting mortality following hospital discharge among a pediatric population were considered for inclusion.<h4>Results</h4>Thirteen studies that reported mortality rates following discharge were identified. Studies varied significantly according to design, underlying characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly between studies (1%-18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition, multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during the post-discharge period. Follow-up care was examined in only one study examining malaria prophylaxis in children discharged following an admission secondary to malaria, which showed no significant benefit on post-discharge mortality.<h4>Conclusions</h4>The months following hospital discharge carry significant risk for morbidity and mortality. While several characteristics are strongly associated with post-discharge mortality, no validated tools are available to aid health workers or policy makers in the systematic identification of children at high risk of post-discharge mortality. Future research must focus on both the creation of tools to aid in defining groups of children most likely to benefit from post-discharge interventions, and formal assessment of the effectiveness of such interventions in reducing morbidity and mortality in the first few months following hospital discharge. |
| format | Article |
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| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-7f77edc0840143efa41a00c69fd343ba2025-08-20T03:16:45ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0186e6669810.1371/journal.pone.0066698Pediatric post-discharge mortality in resource poor countries: a systematic review.Matthew O WiensShane PawlukNiranjan KissoonElias KumbakumbaJ Mark AnserminoJoel SingerAndrew NdamiraCharles Larson<h4>Objectives</h4>Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for death.<h4>Search strategy</h4>MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from the inception date to October, 2012. Key word searches using Google Scholar™ and hand searching of references of retrieved articles was also performed. Studies from developing countries reporting mortality following hospital discharge among a pediatric population were considered for inclusion.<h4>Results</h4>Thirteen studies that reported mortality rates following discharge were identified. Studies varied significantly according to design, underlying characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly between studies (1%-18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition, multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during the post-discharge period. Follow-up care was examined in only one study examining malaria prophylaxis in children discharged following an admission secondary to malaria, which showed no significant benefit on post-discharge mortality.<h4>Conclusions</h4>The months following hospital discharge carry significant risk for morbidity and mortality. While several characteristics are strongly associated with post-discharge mortality, no validated tools are available to aid health workers or policy makers in the systematic identification of children at high risk of post-discharge mortality. Future research must focus on both the creation of tools to aid in defining groups of children most likely to benefit from post-discharge interventions, and formal assessment of the effectiveness of such interventions in reducing morbidity and mortality in the first few months following hospital discharge.https://doi.org/10.1371/journal.pone.0066698 |
| spellingShingle | Matthew O Wiens Shane Pawluk Niranjan Kissoon Elias Kumbakumba J Mark Ansermino Joel Singer Andrew Ndamira Charles Larson Pediatric post-discharge mortality in resource poor countries: a systematic review. PLoS ONE |
| title | Pediatric post-discharge mortality in resource poor countries: a systematic review. |
| title_full | Pediatric post-discharge mortality in resource poor countries: a systematic review. |
| title_fullStr | Pediatric post-discharge mortality in resource poor countries: a systematic review. |
| title_full_unstemmed | Pediatric post-discharge mortality in resource poor countries: a systematic review. |
| title_short | Pediatric post-discharge mortality in resource poor countries: a systematic review. |
| title_sort | pediatric post discharge mortality in resource poor countries a systematic review |
| url | https://doi.org/10.1371/journal.pone.0066698 |
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