PDF(Pubmed)
Abstract：
UNASSIGNED: Under-five mortality remains concentrated in resource-poor countries. Post-discharge mortality is becoming increasingly recognized as a significant contributor to overall child mortality. With a substantial recent expansion of research and novel data synthesis methods, this study aims to update the current evidence base by providing a more nuanced understanding of the burden and associated risk factors of pediatric post-discharge mortality after acute illness.
UNASSIGNED: Eligible studies published between January 1, 2017 and January 31, 2023, were retrieved using MEDLINE, Embase, and CINAHL databases. Studies published before 2017 were identified in a previous review and added to the total pool of studies. Only studies from countries with low or low-middle Socio-Demographic Index with a post-discharge observation period greater than seven days were included. Risk of bias was assessed using a modified version of the Joanna Briggs Institute critical appraisal tool for prevalence studies. Studies were grouped by patient population, and 6-month post-discharge mortality rates were quantified by random-effects meta-analysis. Secondary outcomes included post-discharge mortality relative to in-hospital mortality, pooled risk factor estimates, and pooled post-discharge Kaplan-Meier survival curves. PROSPERO study registration: #CRD42022350975.
UNASSIGNED: Of 1963 articles screened, 42 eligible articles were identified and combined with 22 articles identified in the previous review, resulting in 64 total articles. These articles represented 46 unique patient cohorts and included a total of 105,560 children. For children admitted with a general acute illness, the pooled risk of mortality six months post-discharge was 4.4% (95% CI: 3.5%-5.4%, I2 = 94.2%, n = 11 studies, 34,457 children), and the pooled in-hospital mortality rate was 5.9% (95% CI: 4.2%-7.7%, I2 = 98.7%, n = 12 studies, 63,307 children). Among disease subgroups, severe malnutrition (12.2%, 95% CI: 6.2%-19.7%, I2 = 98.2%, n = 10 studies, 7760 children) and severe anemia (6.4%, 95% CI: 4.2%-9.1%, I2 = 93.3%, n = 9 studies, 7806 children) demonstrated the highest 6-month post-discharge mortality estimates. Diarrhea demonstrated the shortest median time to death (3.3 weeks) and anemia the longest (8.9 weeks). Most significant risk factors for post-discharge mortality included unplanned discharges, severe malnutrition, and HIV seropositivity.
UNASSIGNED: Pediatric post-discharge mortality rates remain high in resource-poor settings, especially among children admitted with malnutrition or anemia. Global health strategies must prioritize this health issue by dedicating resources to research and policy innovation.
UNASSIGNED: No specific funding was received.
UNASSIGNED: Eligible studies published between January 1, 2017 and January 31, 2023, were retrieved using MEDLINE, Embase, and CINAHL databases. Studies published before 2017 were identified in a previous review and added to the total pool of studies. Only studies from countries with low or low-middle Socio-Demographic Index with a post-discharge observation period greater than seven days were included. Risk of bias was assessed using a modified version of the Joanna Briggs Institute critical appraisal tool for prevalence studies. Studies were grouped by patient population, and 6-month post-discharge mortality rates were quantified by random-effects meta-analysis. Secondary outcomes included post-discharge mortality relative to in-hospital mortality, pooled risk factor estimates, and pooled post-discharge Kaplan-Meier survival curves. PROSPERO study registration: #CRD42022350975.
UNASSIGNED: Of 1963 articles screened, 42 eligible articles were identified and combined with 22 articles identified in the previous review, resulting in 64 total articles. These articles represented 46 unique patient cohorts and included a total of 105,560 children. For children admitted with a general acute illness, the pooled risk of mortality six months post-discharge was 4.4% (95% CI: 3.5%-5.4%, I2 = 94.2%, n = 11 studies, 34,457 children), and the pooled in-hospital mortality rate was 5.9% (95% CI: 4.2%-7.7%, I2 = 98.7%, n = 12 studies, 63,307 children). Among disease subgroups, severe malnutrition (12.2%, 95% CI: 6.2%-19.7%, I2 = 98.2%, n = 10 studies, 7760 children) and severe anemia (6.4%, 95% CI: 4.2%-9.1%, I2 = 93.3%, n = 9 studies, 7806 children) demonstrated the highest 6-month post-discharge mortality estimates. Diarrhea demonstrated the shortest median time to death (3.3 weeks) and anemia the longest (8.9 weeks). Most significant risk factors for post-discharge mortality included unplanned discharges, severe malnutrition, and HIV seropositivity.
UNASSIGNED: Pediatric post-discharge mortality rates remain high in resource-poor settings, especially among children admitted with malnutrition or anemia. Global health strategies must prioritize this health issue by dedicating resources to research and policy innovation.
UNASSIGNED: No specific funding was received.
摘要：
■五岁以下儿童死亡率仍然集中在资源匮乏的国家。出院后死亡率越来越被认为是总体儿童死亡率的重要因素。随着研究的大量扩展和新的数据合成方法，本研究旨在通过更细致地了解儿科急性疾病后出院后死亡率的负担和相关危险因素来更新现有的证据基础.
■2017年1月1日至2023年1月31日之间发表的合格研究是使用MEDLINE检索的，Embase,和CINAHL数据库。2017年之前发表的研究在先前的审查中被确定，并被添加到研究的总库中。仅包括来自低或中低社会人口指数国家的研究，其出院后观察期大于7天。使用用于患病率研究的JoannaBriggs研究所关键评估工具的修订版评估偏倚风险。研究按患者群体分组，出院后6个月死亡率通过随机效应荟萃分析进行量化.次要结局包括出院后死亡率相对于院内死亡率，汇总风险因素估计，合并出院后Kaplan-Meier存活曲线。PROSPERO研究注册：#CRD42022350975。
■筛选的1963年文章，确定了42篇符合条件的文章，并结合了先前审查中确定的22篇文章，共64篇文章。这些文章代表了46个独特的患者队列，总共包括105,560名儿童。对于患有一般急性疾病的儿童，出院后六个月的合并死亡风险为4.4%(95%CI:3.5%-5.4%，I2=94.2%，n=11项研究，34,457名儿童），合并住院死亡率为5.9%(95%CI：4.2%-7.7%，I2=98.7%,n=12项研究，63,307名儿童)。在疾病亚组中，严重营养不良(12.2%，95%CI：6.2%-19.7%，I2=98.2%，n=10项研究，7760名儿童）和严重贫血（6.4%，95%CI：4.2%-9.1%，I2=93.3%，n=9项研究，7806名儿童）显示出最高的出院后6个月死亡率估计值。腹泻显示最短的中位死亡时间（3.3周）和贫血最长（8.9周）。出院后死亡的最重要危险因素包括非计划出院，严重的营养不良,和艾滋病毒血清阳性。
■在资源匮乏的环境中，儿科出院后死亡率仍然很高，尤其是营养不良或贫血的儿童。全球卫生战略必须通过将资源用于研究和政策创新来优先考虑这一卫生问题。
■没有收到具体资金。
■2017年1月1日至2023年1月31日之间发表的合格研究是使用MEDLINE检索的，Embase,和CINAHL数据库。2017年之前发表的研究在先前的审查中被确定，并被添加到研究的总库中。仅包括来自低或中低社会人口指数国家的研究，其出院后观察期大于7天。使用用于患病率研究的JoannaBriggs研究所关键评估工具的修订版评估偏倚风险。研究按患者群体分组，出院后6个月死亡率通过随机效应荟萃分析进行量化.次要结局包括出院后死亡率相对于院内死亡率，汇总风险因素估计，合并出院后Kaplan-Meier存活曲线。PROSPERO研究注册：#CRD42022350975。
■筛选的1963年文章，确定了42篇符合条件的文章，并结合了先前审查中确定的22篇文章，共64篇文章。这些文章代表了46个独特的患者队列，总共包括105,560名儿童。对于患有一般急性疾病的儿童，出院后六个月的合并死亡风险为4.4%(95%CI:3.5%-5.4%，I2=94.2%，n=11项研究，34,457名儿童），合并住院死亡率为5.9%(95%CI：4.2%-7.7%，I2=98.7%,n=12项研究，63,307名儿童)。在疾病亚组中，严重营养不良(12.2%，95%CI：6.2%-19.7%，I2=98.2%，n=10项研究，7760名儿童）和严重贫血（6.4%，95%CI：4.2%-9.1%，I2=93.3%，n=9项研究，7806名儿童）显示出最高的出院后6个月死亡率估计值。腹泻显示最短的中位死亡时间（3.3周）和贫血最长（8.9周）。出院后死亡的最重要危险因素包括非计划出院，严重的营养不良,和艾滋病毒血清阳性。
■在资源匮乏的环境中，儿科出院后死亡率仍然很高，尤其是营养不良或贫血的儿童。全球卫生战略必须通过将资源用于研究和政策创新来优先考虑这一卫生问题。
■没有收到具体资金。
