Pediatric post-discharge mortality rates in resource-poor countries varied from 1% to 18%, often exceeding in-hospital mortality rates, with young age, malnutrition, and multiple previous hospitalizations as key risk factors.
Systematic Review
What is the rate and what are the risk factors for post-discharge mortality in children in developing countries?
Post-discharge mortality in children in developing countries is high (1-18%), often exceeding in-hospital mortality, highlighting a critical period for intervention.
OBJECTIVES: Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for death. SEARCH STRATEGY: MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from the inception date to October, 2012. Key word searches using Google Scholar™ and hand searching of references of retrieved articles was also performed. Studies from developing countries reporting mortality following hospital discharge among a pediatric population were considered for inclusion. RESULTS: Thirteen studies that reported mortality rates following discharge were identified. Studies varied significantly according to design, underlying characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly between studies (1%-18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition, multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during the post-discharge period. Follow-up care was examined in only one study examining malaria prophylaxis in children discharged following an admission secondary to malaria, which showed no significant benefit on post-discharge mortality. CONCLUSIONS: The months following hospital discharge carry significant risk for morbidity and mortality. While several characteristics are strongly associated with post-discharge mortality, no validated tools are available to aid health workers or policy makers in the systematic identification of children at high risk of post-discharge mortality. Future research must focus on both the creation of tools to aid in defining groups of children most likely to benefit from post-discharge interventions, and formal assessment of the effectiveness of such interventions in reducing morbidity and mortality in the first few months following hospital discharge.
Wiens et al. (Tue,) conducted a systematic review in Pediatric post-discharge mortality. Hospital discharge was evaluated on Post-discharge mortality rate. Pediatric post-discharge mortality rates in resource-poor countries varied from 1% to 18%, often exceeding in-hospital mortality rates, with young age, malnutrition, and multiple previous hospitalizations as key risk factors.