title: Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital.
abstract: OBJECTIVE
  To investigate whether the outpatient, syndrome-based approach of the Integrated Management of Childhood Illness (IMCI) protocol could be extended to the inpatient arena to give clear and simple minimum standards of care for poorly resourced facilities.
  
  
  METHODS
  A prospective, one-year admission cohort retrospectively compared hypothetical performance of syndrome-based management with paediatrician-defined final diagnosis. Admission syndrome definitions were based on local adaptations to the IMCI protocol that encompassed 20 clinical features, measurement of oxygen saturation, and malaria microscopy.
  
  
  RESULTS
  After 315 children with clinically obvious diagnoses (e.g. sickle cell disease and burns) were excluded, 3705 admission episodes were studied. Of these, 2334 (63%) met criteria for at least one severe syndrome (mortality 8% vs <1% for "non-severe" cases), and half of these had features of two or more severe syndromes. No cases of measles were seen. Syndrome-based treatment would have been appropriate (sensitivity >95%) for severe pneumonia, severe malaria, and diarrhoea with severe dehydration, and probably for severe malnutrition (sensitivity 71%). Syndrome-directed treatment suggested the use of broad-spectrum antibiotics in 75/133 (56% sensitivity) children with bacteraemic and 63/71 (89% sensitivity) children with meningitis.
  
  
  CONCLUSIONS
  Twenty clinical features, oxygen saturation measurements, and results of malaria blood slides could be used for inpatient, syndrome-based management of acute paediatric admissions. The addition of microscopy of the cerebrospinal fluid and haemoglobin measurements would improve syndrome-directed treatment considerably. This approach might rationalize admission policy and standardize inpatient paediatric care in resource-poor countries, although the clinical detection of bacteraemia remains a problem.
authors.affiliation: Centre for Geographic Medicine Research, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kilifi, Kenya. menglish@kilifi.mimcom.net
authors.forename: Mike
authors.initials: M
authors.lastname: English
authors.forename: James
authors.initials: J
authors.lastname: Berkley
authors.forename: Isiah
authors.initials: I
authors.lastname: Mwangi
authors.forename: Shebbe
authors.initials: S
authors.lastname: Mohammed
authors.forename: Maimuna
authors.initials: M
authors.lastname: Ahmed
authors.forename: Faith
authors.initials: F
authors.lastname: Osier
authors.forename: Neema
authors.initials: N
authors.lastname: Muturi
authors.forename: Bernhards
authors.initials: B
authors.lastname: Ogutu
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
authors.forename: Charles R J C
authors.initials: CR
authors.lastname: Newton
mesh_terms: D000208:Acute Disease / Q000145:classification*; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002673:Child, Hospitalized; D002675:Child, Preschool; D020000:Decision Support Systems, Clinical; D003951:Diagnostic Errors / Q000517:prevention & control; D003954:Diagnostic Services / Q000592:standards*; D005260:Female; D006767:Hospitals, District / Q000592:standards*; D006801:Humans; D007223:Infant; D007630:Kenya; D008297:Male; D010343:Patient Admission; D010372:Pediatrics / Q000592:standards*; D011446:Prospective Studies; D013577:Syndrome; D013812:Therapeutics / Q000592:standards*
chemical_list: D000900:Anti-Bacterial Agents