Family-Assisted Severity of Illness Monitoring for Hospitalized Children in Low-resource settings – a two-arm interventional pilot study

Abstract

IntroductionPediatric mortality remains unacceptably high in many low-resource settings, with inpatient deaths often associated with delayed recognition of clinical deterioration. The Family-Assisted Severe Febrile Illness ThERapy (FASTER) tool has been developed for caregivers to assist in monitoring their hospitalized children and alert clinicians. While utilization of the tool is feasible, the impact on outcomes in low-resource settings has not been studied.MethodsRandomized controlled pilot study at Kenyatta National Hospital, Kenya. Children hospitalized with acute febrile illness with a caregiver at the bedside for 24 hours were enrolled. Caregivers were trained using the FASTER tool (monitors work of breathing, mental status, perfusion, producing color-coded flags to signal illness severity). The primary outcome was the frequency of clinician reassessments between intervention (FASTER) and control (standard care) arms. Secondary outcomes included survey assessments of clinician and caregiver experiences with the tool. The study was registered with ClinicalTrials.govNCT03513861.Results150 patient/caregiver pairs were enrolled, 139 included in the analysis, 74 in the intervention, 65 in the control arm. Patients’ median age was 0.9 (range 0.2-10) and 1.1 years (range 0.2-12) in intervention versus control arms. The most common diagnoses were pneumonia (80[58%]), meningitis (58[38%]) and malaria (34[24%]). 134(96%) caregivers were patients’ mothers. Clinician visits/hour increased with patients’ illness severity in both arms, but without difference in frequency between arms (point estimate for the difference -0.2%, p=0.99). Of the 16 deaths, 8 (four/arm) occurred within 2 days of enrollment. Forty clinicians were surveyed, 33(82%) reporting that FASTER could improve outcomes of very sick children in low-resource settings; 26(65%) rating caregivers as able to adequately capture patients’ severity of illness. Of 70 caregivers surveyed, 63(90%) reported that FASTER training was easy to understand; all(100%) agreed that the intervention would improve care of hospitalized children and help identify sick children in their community.DiscussionAlthough we observed no difference in recorded frequency of clinician visits with FASTER monitoring, the tool was rated positively by caregivers and clinicians. Further research to refine implementation with additional input from all stakeholders might increase the effectiveness of FASTER in detecting and responding to clinical deterioration in low-resource settings.