Specialty services for children with special health care needs: supplement not supplant the medical home

Graham, Robert J.

doi:10.1136/adc.2007.129999

Cited by 11 publications

(5 citation statements)

References 21 publications

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“…[2], [4], [12], [13] This picture as seen in developing countries defers with reports emanating from developed countries where there is a balance between pediatric surgical admissions and available resources. [14], [15] The LAMA (Left against medical advice) rate in this report is 4.2% which is significantly lower than previously reported. [2] …”

Section: Discussioncontrasting

confidence: 53%

Pattern and Outcome of Paediatric Surgical Admissions in a New Tertiary Hospital in Northwestern Nigeria

Akau¹

2017

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Abstract:The pattern and outcome of pediatric surgical admissions may be crucial to policy formulation in a new tertiary hospital. This study reports the pattern and outcome of pediatric surgical admissions in Northwestern Nigeria. This is a retrospective review of all medical records of patients admitted with pediatric surgical pathologies over a 14 months period. Data was extracted from the admission records and case notes of children admitted in the hospital during the study period. Information obtained included the patients' age, sex, diagnosis, duration of admission and outcome. The data obtained was analyzed using SPSS version 15.0 for Windows. There were 191 pediatric surgical admissions representing 12.5% of the total pediatric admissions with a mean age of 71 months and a male to female ratio of 1.2:1 (M 105: F86). Sixty percent of the patients were admitted to female surgical ward, others were admitted to neonatal intensive care unit, male surgical ward, pediatric medical ward and emergency pediatric unit due to shortage of manpower and lack of pediatric surgical facilities. The most common diagnostic categories were congenital anomalies 35.1% (67/191), trauma 30.9% (59/191) and surgical infections 29.8% (57/191). Eighty percent of our patients did well and were discharged. However, we recorded a mortality rate of 9.9%. Our report shows that wide spectrums of pediatric surgical conditions are seen in our hospital with congenital anomalies being the most common. Most of our patients were treated and discharged.

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Section: Discussioncontrasting

confidence: 53%

Pattern and Outcome of Paediatric Surgical Admissions in a New Tertiary Hospital in Northwestern Nigeria

Akau¹

2017

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“…We adopted pragmatic definitions of mild hypoxia (SaO 2 <95% and/or documented oxygen therapy) and severe hypoxia (SaO 2 <90% and/or SaO 2 <92% despite documented oxygen therapy), and defined a ‘risk factor for infection’ as a documented history of any condition known to increase a child's risk of invasive bacterial infection. Developmental delay was included separately as a potential risk factor, since several studies have documented an increased rate and severity of acute illness including infection among this group 17 18. Other definitions reflected those commonly used in clinical practice (table 1); data collected routinely on all children included level of consciousness, capillary refill time, hydration status, and presence and type of rash.…”

Section: Methodsmentioning

confidence: 99%

Risk score to stratify children with suspected serious bacterial infection: observational cohort study

Brent

Lakhanpaul

Thompson

et al. 2011

Archives of Disease in Childhood

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ObjectivesTo derive and validate a clinical score to risk stratify children presenting with acute infection.Study design and participantsObservational cohort study of children presenting with suspected infection to an emergency department in England. Detailed data were collected prospectively on presenting clinical features, laboratory investigations and outcome. Clinical predictors of serious bacterial infection (SBI) were explored in multivariate logistic regression models using part of the dataset, each model was then validated in an independent part of the dataset, and the best model was chosen for derivation of a clinical risk score for SBI. The ability of this score to risk stratify children with SBI was then assessed in the entire dataset.Main outcome measureFinal diagnosis of SBI according to criteria defined by the Royal College of Paediatrics and Child Health working group on Recognising Acute Illness in Children.ResultsData from 1951 children were analysed. 74 (3.8%) had SBI. The sensitivity of individual clinical signs was poor, although some were highly specific for SBI. A score was derived with reasonable ability to discriminate SBI (area under the receiver operator characteristics curve 0.77, 95% CI 0.71 to 0.83) and risk stratify children with suspected SBI.ConclusionsThis study demonstrates the potential utility of a clinical score in risk stratifying children with suspected SBI. Further work should aim to validate the score and its impact on clinical decision making in different settings, and ideally incorporate it into a broader management algorithm including additional investigations to further stratify a child's risk.

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“…Increasing access to surgery and quality of surgical intervention may help to achieve healthy and more productive generations and as well to reduce the potential pediatric age mortality rate [14].…”

Section: Problem Of Statementmentioning

confidence: 99%

Pediatric Surgical Admissions and Their Outcomes at Adama Hospital Medical College: A Facility Based Cross Sectional Study

Ketema¹,

Abeya²,

Abdela³

et al. 2017

AJP

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Pediatric surgical admissions dramatically increased throughout the world as a result of increased trauma, emergency diseases and survival of congenital diseases. So, Facility based cross sectional study was conducted to identify the common pediatric (Age ≤ 15 years) surgical admissions and their outcomes at Adama Hospital Medical College. All admitted surgical patients from Jun 1, 2014 to June 30, 2015 were included in the study. Data abstraction tool was constructed to retrieve information from charts. Data was entered to SPSS version 20. Descriptive and analytic studies were performed. P value ≤ 0.05 with 95% confidence interval (CI) was used to interpret the findings. The mean age of study participants was 6 years ± 4.5 SD. Males were 276 (71.9%) making male to female ratio of 2.5:1. Gastrointestinal conditions (33.8%) were commonest causes of admissions followed by trauma (25.5%) and congenital anomalies (19%). There were five deaths resulting in a mortality rate of 1.3%. Factors associated with death were: delay in presentation, prolonged length of stay in hospital and delay in intervention. Shorter time of presentation to intervention (< 6 hrs) was found to be significantly associated with the favorable outcomes [Adjusted Odds Ratio (AOR): 36.4, 95% CI: 3.7, 38]. Those who stayed < 7 days in the hospital were more likely to have favorable outcome (AOR: 1.7, 95% CI: 1.6, 16.8) compared to their counterparts. Delayed intervention, prolonged hospital stay and trauma are independent predictors of patient outcomes. Death in Pediatric patients with surgical conditions can be averted by avoiding these delays. Efforts to shorten length of stay in the hospital could also improve patient outcomes.

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Specialty services for children with special health care needs: supplement not supplant the medical home

Cited by 11 publications

References 21 publications

Pattern and Outcome of Paediatric Surgical Admissions in a New Tertiary Hospital in Northwestern Nigeria

Pattern and Outcome of Paediatric Surgical Admissions in a New Tertiary Hospital in Northwestern Nigeria

Risk score to stratify children with suspected serious bacterial infection: observational cohort study

Pediatric Surgical Admissions and Their Outcomes at Adama Hospital Medical College: A Facility Based Cross Sectional Study

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