Smart Discharges to improve pediatric post-discharge survival
- Description:
Background: In Sub-Saharan Africa, pediatric post-discharge death is increasingly recognized as an important contributor to mortality. Current studies evaluating interventional approaches for post-discharge mortality focus on pharmacologic therapy, though only malaria prophylaxis post-discharge appears effective. Approaches to reduce vulnerability through health system strengthening approaches may further help to improve outcomes. This study aimed to evaluate the impact of a risk-differentiated approach to improved peri-discharge care on post-discharge mortality among children under 60 months.
Methods: We conducted a prospective parallel cluster crossover trial at 6 hospitals in Uganda. Children <60 months admitted due to suspected infectious illness were eligible for enrollment. Phase 1 was a comparative control. During phase 2, enrolled children were screened for post-discharge mortality risk at admission using a multivariable risk algorithm. All children received counselling on post-discharge care practices during admission and at discharge. High-risk children received referrals and automated SMS engagement at 2, 7 and 14 days at a clinic of their choice, or by a community health worker. Survival analysis, adjusting for age, sex, site, period time and predicted risk of mortality was used to estimate the effect of the intervention on 6-month all-cause post-discharge mortality.
Findings: 13,050 patients were enrolled (phase 1: n=6954; phase 2: n=6096) and had complete 6-month follow-up. Baseline characteristics were similar between groups. The median age was 0.8 months (IQR: 0.2-1.7), with 56% of participants male. The multivariable risk algorithm gave a mean predicted risk of post-discharge mortality of 6.1% in phase 1 and 5.9% in phase 2. The rate of post-discharge mortality was 6.0% during phase 1 and 4.9% during phase 2, with an adjusted hazard ratio of 0.77 (95% CI – 0.90), favoring the intervention. Additional sensitivity analysis using different sets of covariates in the model showed similar results.
Ethics Declaration: These studies were approved by the Mbarara University of Science and Technology (No. 15/10-16), the Uganda National Council for Science and Technology (HS 2207), and the University of British Columbia (H16-02679).
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Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at sepsiscolab@bcchr.ca or visit our website.- Wiens, Matthew O, , , , , , , , , , , , andInstitute for Global Health, BC Children's and Women's Hospitals
- Contributor(s):
- Trawin, Jessica and Wiens, Matthew O
- Source Repository:
- UBC Dataverse
- Series:
- Pediatric Sepsis Data CoLab // Clinical studies // Smart Discharges // Smart Discharges - Manuscripts
- Publisher(s):
- Borealis
- Access:
- Restricted
- License:
- CC BY-NC-SA 4.0
- URL:
- https://doi.org/10.5683/SP3/BGSQKD
- Publication date:
- 2024-07-22
- Subjects:
- Keywords:
- Identifier:
- https://doi.org/10.5683/SP3/BGSQKD
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