Objectives
Shock is a life-threatening condition in children in low- and middle-income countries (LMIC), with several controversies. This systematic review summarizes the etiology, pathophysiology and mortality of shock in children in LMIC.
Methods
We searched for studies reporting on children with shock in LMIC in PubMed, Embase and through snowballing (up to 1 October 2019). Studies conducted in LMIC that reported on shock in children (1 month–18 years) were included. We excluded studies only containing data on neonates, cardiac surgery patients or iatrogenic causes. We presented prevalence data, pooled mortality estimates and conducted subgroup analyses per definition, region and disease. Etiology and pathophysiology data were systematically collected.
Results
We identified 959 studies and included 59 studies of which six primarily studied shock. Definitions used for shock were classified into five groups. Prevalence of shock ranged from 1.5% in a pediatric hospital population to 44.3% in critically ill children. Pooled mortality estimates ranged between 3.9-33.3% for the five definition groups. Important etiologies included gastroenteritis, sepsis, malaria and severe anemia, which often coincided. The pathophysiology was poorly studied but suggests that in addition to hypovolemia, dissociative and cardiogenic shock are common in LMIC.
Conclusions
Shock is associated with high mortality in hospitalized children in LMIC. Despite the importance few studies investigated shock and as a consequence limited data on etiology and pathophysiology of shock is available. A uniform bedside definition may help boost future studies unravelling shock etiology and pathophysiology in LMIC.
BACKGROUND AND AIM: Discharge against medical advice (DAMA) is a known risk factor for adverse outcomes in children. An improved understanding of its impact on outcomes and its risk factors is essential to the development of programs to address DAMA. The aim of this study was to (1) assess the impact of DAMA on post-discharge outcomes and (2) to identify key socioeconomic and clinical risk factors for DAMA.
METHOD:This secondary analysis of a multisite observational study included children 6-60 months of age hospitalized with suspected or proven infections enrolled from July, 2017 to July, 2019. Children received follow-up for 6 months after discharge to determine vital status. 77 clinical and socio-demographic variables, collected at admission, were assessed as potential risk factors. Univariate logistic regression was performed to identify significant risk factors for DAMA, as well as its impact on post-discharge readmission and mortality.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.