Characteristics of children readmitted with severe pneumonia in Kenyan hospitals

Résumé

Abstract Background Pneumonia is a leading cause of childhood morbidity and mortality. Hospital re-admission may signify missed opportunities for care or undiagnosed comorbidities. Methods We conducted a retrospective cohort study including children aged ≥2 months to 14 years hospitalised with severe pneumonia between 2013 and 2021 in a network of 22 primary referral hospitals in Kenya. Severe pneumonia was defined using the World Health Organization criteria, and re-admission was based on clinical documentation from individual patient case notes. We estimated the prevalence of re-admission, described clinical management practices, and modelled risk factors for re-admission and inpatient mortality. Results Among 20,603 children diagnosed with severe pneumonia, 2,274 (11.0%, 95% confidence interval (CI) 10.62 to 11.47) were readmitted. Re-admission was independently associated with age (12-59 months vs 2-11 months: adjusted odds ratio (aOR) 1.70, 95% confidence interval (CI) 1.55 to 1.88; >5 years vs 2-11 months: aOR 1.86, 95% CI 1.55 to 2.23), malnutrition (weight for age z-score (WAZ) < -3SD vs WAZ > -2SD: aOR 2.03, 95%1.83 to 2.28); WAZ -2 to -3 SD vs WAZ> -2SD: aOR 1.37, 95% CI 1.20 to 1.56) and presence of a concurrent neurological disorder (aOR 4.04, 95% CI 1.57 to 10.42) . Chest radiography was ordered more frequently among those readmitted (540/2,274 vs 3,102/18,329, p<0.001). Readmitted patients were more likely to receive second-line antibiotics (808/2,256 vs 5,538/18,173 p<0.001), TB medication (69/2,256 vs 298/18,173 p<0.001), salbutamol (530/2,256 vs 3,707/18,173 p=0.003), and prednisolone (157/2,256 vs 764/18,173 p<0.001). Inpatient mortality was 2,354/18,329 (12.8%) among children admitted with a first episode of severe pneumonia and 269/2,274 (11.8%) among those who were readmitted (adjusted hazard ratio (aHR) 0.94, 95% CI 0.82-1.07). Age (12-59 months vs 2-11 months: aHR 0.62, 95% 0.57 to 0.67), female sex (aHR 1.23, 95% 1.14 to 1.33), malnutrition (WAZ <-3SD vs WAZ> -2SD: aHR 1.90 95% CI 1.74 to 2.08); WAZ -2 to -3 SD vs WAZ> -2SD: aHR 1.48, 95% CI 1.32 to 1.65), incomplete vaccination (aHR 1.43, 95% CI 1.16 to 1.75), and anaemia (aHR 2.16, 95% CI 1.90 to 2.45) were independently associated with mortality. Conclusions Children readmitted with severe pneumonia account for a substantial proportion of pneumonia hospitalisations and deaths. Further research is required to develop evidence-based approaches to screening, case management, and follow-up of children with severe pneumonia, prioritising those with underlying risk factors for readmission and mortality.

Citer ce document

Accès au document

Texte intégral en lecture en ligne, réservé aux abonnés SPHAERO et aux membres de l'institution. Se connecter

Auteur(s)

Statistiques

Consultations : 1

Téléchargements : 0