Patterns, Predictors and Outcome of Time to Presentation Among Critically ill Paediatric Patients at Emergency Department of Muhimbili National Hospital, Dar es Salaam, Tanzania
Journal – Research Square
Article type – Pre-print – Clinical research
Publication date – Nov – 2021
Authors – Alphonce N Simbila, Said S. Kilindimo, Hendry R. Sawe, Zawadi E. Kalezi, Amne O. Yussuf, Hussein K. Manji, Germana Leyna, Juma A. Mfinanga, Ellen J. Weber
Keywords – critically ill, delay, mortality, Paediatric patient
Open access – Yes
Speciality – Emergency surgery, Paediatric surgery
World region Eastern Africa
Language – English
Submitted to the One Surgery Index on November 20, 2021 at 4:12 am
Background: Mortality among under-five children in Tanzania remains high. While early presentation for treatment increases likelihood of survival, delays to care are common and factors causing delay to presentation among critically ill children are unknown.
Methodology: This was a prospective cohort study of critically ill children aged 28days to 14 years attending emergency department (ED) at Muhimbili National Hospital in Tanzania from September 2019 to January 2020. We documented demographics, time to ED presentation, ED interventions and 30-day outcome. The primary outcome was delay (>48 hours) from the onset of illness to ED presentation. Logistic regression and relative risk were calculated to measure the strength of the predictor and relationship between delay and mortality respectively.
Results: We enrolled 440 (59.1%) critically ill children, their median age was 12 [IQR =9-60] months and 63.9% were males. The median time to ED arrival was 3 days [IQR=1-5] and more than half (56.6%) of critically ill children presented to ED in > 48 hours where by being an infant, self-referral and belonging to poor family were independent predictors of delay. Infants and those referred from other facilities had 2.2 (95% CI 1.3-3.8) and 1.7 (95% CI 1.1-2.7) times increased odds of presenting late to the ED respectively. The overall 30-day in-hospital mortality was 26.5% in which those who presented late were 1.3 more likely to die than those who presented early (RR=1.3, CI: 0.9-1.9). Majority died >24 hours of ED arrival (P-value=0.021).
Conclusion: Delayed ED presentation of more than 48 hours from onset of illness was associated with in-hospital mortality. A larger study is needed to evaluate the care pathway of critically ill paediatric patients to identify preventable course of delay to tertiary care facility
OSI Number – 21357