15 research outputs found
Predicting Mortality among Hospitalized Children with Respiratory Illness in Western Kenya, 2009–2012
<div><p>Background</p><p>Pediatric respiratory disease is a major cause of morbidity and mortality in the developing world. We evaluated a modified respiratory index of severity in children (mRISC) scoring system as a standard tool to identify children at greater risk of death from respiratory illness in Kenya.</p><p>Materials and Methods</p><p>We analyzed data from children <5 years old who were hospitalized with respiratory illness at Siaya District Hospital from 2009–2012. We used a multivariable logistic regression model to identify patient characteristics predictive for in-hospital mortality. Model discrimination was evaluated using the concordance statistic. Using bootstrap samples, we re-estimated the coefficients and the optimism of the model. The mRISC score for each child was developed by adding up the points assigned to each factor associated with mortality based on the coefficients in the multivariable model.</p><p>Results</p><p>We analyzed data from 3,581 children hospitalized with respiratory illness; including 218 (6%) who died. Low weight-for-age [adjusted odds ratio (aOR) = 2.1; 95% CI 1.3–3.2], very low weight-for-age (aOR = 3.8; 95% CI 2.7–5.4), caretaker-reported history of unconsciousness (aOR = 2.3; 95% CI 1.6–3.4), inability to drink or breastfeed (aOR = 1.8; 95% CI 1.2–2.8), chest wall in-drawing (aOR = 2.2; 95% CI 1.5–3.1), and being not fully conscious on physical exam (aOR = 8.0; 95% CI 5.1–12.6) were independently associated with mortality. The positive predictive value for mortality increased with increasing mRISC scores.</p><p>Conclusions</p><p>A modified RISC scoring system based on a set of easily measurable clinical features at admission was able to identify children at greater risk of death from respiratory illness in Kenya.</p></div
Bivariate associations between demographic characteristics, hospital admission clinical signs and clinical symptoms and mortality among children <5 years hospitalized with a respiratory illness in Siaya District Hospital, August 2009–July 2012.
a<p>Defined as per the WHO IMCI case definition: Cough or difficult breathing and elevated respiratory rate;</p>b<p>Defined as per the WHO IMCI case definition: Cough or difficult breathing and any general danger sign or chest in-drawing or stridor in calm child;</p>c<p>Elevated respiratory rate for age based on WHO IMCI algorithm; <2 months, >60 breaths/minute; 2–11 months, >50 breaths/minute;12–59 months, >40 breaths/minute;</p>d<p>Combines responds to voice commands, responds to mild pain and unresponsive/unconscious;</p><p>*All admissions including deaths;</p>Ŧ<p>Enrolled in research studies conducted by KEMRI/CDC (Malaria and TB studies);</p>¥<p>Variables that were not statistically significant at α = 0.05 are not shown on the table.</p
Children included in, and excluded from, the evaluation of mRISC score.
<p>Children included in, and excluded from, the evaluation of mRISC score.</p
Modified Respiratory Index of Severity in Children (mRISC) scoring.
<p>Modified Respiratory Index of Severity in Children (mRISC) scoring.</p
Receiver operating curve (ROC) for the scoring model.
<p>Receiver operating curve (ROC) for the scoring model.</p
Observed mortality (with 95% CI) and mean predicted mortality by severity score.
<p>Observed mortality (with 95% CI) and mean predicted mortality by severity score.</p
Factors associated with mortality among children <5 years hospitalized with a respiratory illness in Siaya District Hospital, August 2009–July 2012.
a<p>Interaction between malaria and chest wall in-drawing;</p>b<p>Combines responds to voice commands, responds to mild pain and unresponsive/unconscious;</p>Ŧ<p>Adjusted for enrollment in clinical research studies, treatment.</p
Crude and adjusted incidence rates of NTS bacteremia among rural and urban populations of Kenya, 2006–2009.
<p>*Pyo = person-years of observation.</p><p>**Extrapolated for patients meeting indication for blood culture who were not cultured in the clinic.</p><p>***Extrapolated for patients meeting indication for blood culture who were not cultured in the clinic and those with same illness syndromes at the home visit who sought care at area clinics besides Lwak and Tabitha clinics.</p
NTS and <i>S.</i> Typhi cases by age category, rural and urban Kenya, 2006–2009.
<p>NTS and <i>S.</i> Typhi cases by age category, rural and urban Kenya, 2006–2009.</p
Numbers of NTS bacteremia, smear-positive malaria cases and blood cultures done by quarter of the year, rural western Kenya, 2006–2009.
<p>A. All persons (spearman rank correlation coefficient, 0.87, p = 0.0003). B. Children <5 years old (spearman rank correlation coefficient, 0.66, p = 0.018). C. Persons ≥5 years of age (spearman rank correlation coefficient, 0.43, p = 0.18).</p