[Analysis of clinical features and early warning indicators of death from hand, foot and mouth disease in Shandong province].
OBJECTIVE
To understand the clinical features of death from hand, foot and mouth disease (HFMD) and to explore the early warning index of HFMD death.


METHODS
A total of 41 HFMD death cases were collected as case group in Shandong province between 2009 and 2011, and another 123 serious HFMD cases were selected as control group according to the similar gender, place of origin and hospital level, with the ratio at 1:3. We investigated the general situation, clinical treatment, past medical history, clinical symptoms and signs of the ill children, and applied the conditional logistic regression to explore early warning index of HFMD death.


RESULTS
The rate of patients who had symptoms in nervous system, digestive system, circulatory system and respiratory system were separately 90.2% (37/41), 58.5% (24/41), 53.7% (22/41) and 90.2% (37/41) in case group; and the proportions were 44.7% (55/123), 13.8% (17/123), 10.6% (13/123) and 12.2% (15/123) respectively in control group. The difference between the two groups showed statistical significance (χ(2) = 25.881, 32.791, 34.011, 86.505, P < 0.05). In case group, 37 patients had neurogenic pulmonary edema, 26 patients got encephalitis, 15 patients had respiratory and circulatory failure, 7 patients got pulmonary hemorrhage, 4 patients had multiple organ failure, 4 patients got myocarditis and 1 patient had cerebral hernia. According to multi-factor logistic regression analysis, the early warning indicators of HFMD death included neck resistance (case group: 34.1% (14/41), control group: 4.1% (5/123); OR = 7.145, 95%CI: 1.748 - 29.204), vomiting (case group: 58.5% (24/41), control group: 13.8% (17/123); OR = 5.632, 95%CI: 1.793 - 17.685) and increase of heart rate (case group: 53.7% (22/41), control group: 10.6% (14/123), OR = 6.370, 95%CI: 1.517 - 26.743).


CONCLUSIONS
In the process of clinical treatment and care, we should interfere the serious HFMD patients with neck resistance, vomiting and increase of heart rate, and thereby reduce the death from HFMD.
Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan 250012, China.
Tao
T
Liu
Bao-fa
BF
Jiang
Wen-ke
WK
Niu
Shu-jun
SJ
Ding
Lian-sen
LS
Wang
Da-peng
DP
Sun
Yao-wen
YW
Pei
Yi
Y
Lin
Jian-xing
JX
Wang
Bo
B
Pang
Xian-jun
XJ
Wang
D002681:China / Q000453:epidemiology; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D015996:Survival Rate