Date de publication: / Author: Larson, Charles - Lunaris - Découvrez les données de recherche canadiennes Résultats de recherche

Predicting mortality in children with infectious diseases (dataset)~Smart Discharge

Borealis

Lowlaavar, Nasim; Larson, Charles; Kumbakumba, Elias; Zhou, Guohai; Ansermino, Mark; Singer, Joel; Kisson, Niranjan; Wong, Hubert; Ndamira, Andrew; Kabakyenga, Jerome; Kiwanuka, Julius; Wiens, Matthew — 2020-08-19

Smart Discharges to improve post-discharge health outcomes in children: A prospective before-after study with staggered implementation

Borealis

Wiens, Matthew; Kissoon, Niranjan (Tex); Ansermino, J Mark; Barigye, Celestine; Businge, Stephen; Kumbakumba, Elias; Larson, Charles; Moschovis, Peter; Singer, Joel; Lavoie, Pascal; Kabakyenga, Jerome — 2023-04-20 Dataset Description: This dataset contains materials from a parent study within the <a href = "https://bcchr.ca/smart-discharges">Smart Discharges</a> program of research. Materials include the parent study protocol and associated documents. See the Metadata section below for links to related publications and datasets. Background: Substantial mortality occurs after hospital discharge in children under 5 years old with suspected sepsis. A better understanding of risk and ability to mitigate risk for those who are most vulnerable is needed to reduce child mortality in resource limited settings. Methods: This is a prospective before-after study with staggered implementation at six Ugandan hospitals. Phase I is a prospective observational cohort study, while Phase II is a stepped-wedge intervention. The study also includes a long-term follow-up phase. The ultimate outcome to be studied is post-discharge mortality for children < 5 years old by 6 months after admission. The study has two objectives, each corresponding to a phase: <ol><li>Phase I: To refine and externally validate the existing post-discharge mortality prediction model.</li> <li>Phase II: To determine the effectiveness of a Smart Discharge program on post-discharge health seeking behaviour and mortality. We also seek to lay the groundwork to study the long-term effects of sepsis on morbidity over a 10 year period.</li></ol> Data Collection Methods: All data were collected at the point of care using encrypted study tablets. These data were then uploaded to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). At admission, trained study nurses systematically collected data on clinical, social and demographic variables. Following discharge, field officers contacted caregivers at 2 and 4 months by phone, and in-person at 6 months, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for children who had died following discharge. Ethics Declaration: This study was approved by the Mbarara University of Science and Technology Research Ethics Committee (No. 15/10-16; No. 07/01-21), the Uganda National Institute of Science and Technology (HS 2207), and the University of British Columbia / Children & Women’s Health Centre of British Columbia Research Ethics Board (H16-02679). Associated datasets: <a href = "https://borealisdata.ca/dataset.xhtml?persistentId=doi:10.5683/SP3/REPMSY">Post-discharge mortality among children under 5 years admitted with suspected sepsis in Uganda: a prospective multi-site study </a> NOTE for restricted files: If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. 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 on <a href = "https://www.bcchr.ca/pediatric-sepsis-data-colab">this page</a> under "collaborate with the pediatric sepsis colab."

Smart Discharges Uganda Under 5: Phase II clinical data of children 6-60 months - pulse oximetry

Borealis

Wiens, Matthew O; Kabakyenga, Jerome; Kumbakumba, Elias; Kenya-Mugisha, Nathan; Larson, Charles; Moschovis, Peter P; Singer, Joel; Lavoie, Pascal; Dumont, Guy AM; Ansermino, J Mark; Kissoon, Niranjan — 2024-10-22 This data is a subset of the Smart Discharges Uganda Under 5 years parent study and is specific to the Phase II interventional cohort of children aged 6-60 months containing pulse oximetry data. Background: Substantial mortality occurs after hospital discharge in children under 5 years old with suspected sepsis. This study aimed to refine and externally validate a previously developed post-discharge mortality prediction model. Methods: In this prospective observational cohort study, we recruited 0-6-month-old children admitted with suspected sepsis from the community to the paediatric wards of six Ugandan hospitals. The primary outcome was six-month post-discharge mortality among those discharged alive. Data Collection Methods: All data were collected at the point of care using encrypted study tablets and these data were then uploaded to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). At admission, trained study nurses systematically collected data on clinical, social and demographic variables. Following discharge, field officers contacted caregivers at 2 and 4 months by phone, and in-person at 6 months, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for children who had died following discharge. Ethics Declaration: This study was approved by the Mbarara University of Science and Technology Research Ethics Committee (No. 15/10-16), the Uganda National Institute of Science and Technology (HS 2207), and the University of British Columbia / Children & Women’s Health Centre of British Columbia Research Ethics Board (H16-02679). This manuscript adheres to the guidelines for STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). NOTE for restricted files: If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. 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 <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.

Development and Internal Validation of a Predictive Model Including Pulse Oximetry for Hospitalization of Under-Five Children in Bangladesh

Borealis

Raihana, Shahreen; Dunsmuir, Dustin; Huda, Tanvir; Zhou, Guohai; Sadeq-Ur Rahman, Qazi; Garde, Ainara; Moinuddin, Md; Karlen, Walter; Dumont, Guy A; Kissoon, Niranjan; Arifeen, Sharms El; Larson, Charles; Ansermino, J Mark — 2024-11-19 Background: The reduction in the deaths of millions of children who die from infectious diseases requires early initiation of treatment and improved access to care available in health facilities. A major challenge is the lack of objective evidence to guide front line health workers in the community to recognize critical illness in children earlier in their course. Methods: We undertook a prospective observational study of children less than 5 years of age presenting at the outpatient or emergency department of a rural tertiary care hospital between October 2012 and April 2013. Study physicians collected clinical signs and symptoms from the facility records, and with a mobile application performed recordings of oxygen saturation, heart rate and respiratory rate. Facility physicians decided the need for hospital admission without knowledge of the oxygen saturation. Multiple logistic predictive models were tested. Findings: Twenty-five percent of the 3374 assessed children, with a median (interquartile range) age of 1.02 (0.42–2.24), were admitted to hospital. We were unable to contact 20% of subjects after their visit. A logistic regression model using continuous oxygen saturation, respiratory rate, temperature and age combined with dichotomous signs of chest indrawing, lethargy, irritability and symptoms of cough, diarrhea and fast or difficult breathing predicted admission to hospital with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval -CI: 0.87 to 0.90). At a risk threshold of 25% for admission, the sensitivity was 77% (95% CI: 74% to 80%), specificity was 87% (95% CI: 86% to 88%), positive predictive value was 70% (95% CI: 67% to 73%) and negative predictive value was 91% (95% CI: 90% to 92%). Conclusion: A model using oxygen saturation, respiratory rate and temperature in combination with readily obtained clinical signs and symptoms predicted the need for hospitalization of critically ill children. External validation of this model in a community setting will be required before adoption into clinical practice. NOTE for restricted files: If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. 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 <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.

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