title: Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models.
abstract: OBJECTIVE
  To derive a model of paediatric postdischarge mortality following acute infectious illness.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  2 hospitals in South-western Uganda.
  
  
  METHODS
  1307 children of 6 months to 5 years of age were admitted with a proven or suspected infection. 1242 children were discharged alive and followed up 6 months following discharge. The 6-month follow-up rate was 98.3%.
  
  
  METHODS
  None.
  
  
  METHODS
  The primary outcome was postdischarge mortality within 6 months following the initial hospital discharge.
  
  
  RESULTS
  64 children died during admission (5.0%) and 61 died within 6 months of discharge (4.9%). Of those who died following discharge, 31 (51%) occurred within the first 30 days. The final adjusted model for the prediction of postdischarge mortality included the variables mid-upper arm circumference (OR 0.95, 95% CI 0.94 to 0.97, per 1 mm increase), time since last hospitalisation (OR 0.76, 95% CI 0.61 to 0.93, for each increased period of no hospitalisation), oxygen saturation (OR 0.96, 95% CI 0.93 to 0·99, per 1% increase), abnormal Blantyre Coma Scale score (OR 2.39, 95% CI 1·18 to 4.83), and HIV-positive status (OR 2.98, 95% CI 1.36 to 6.53). This model produced a receiver operating characteristic curve with an area under the curve of 0.82. With sensitivity of 80%, our model had a specificity of 66%. Approximately 35% of children would be identified as high risk (11.1% mortality risk) and the remaining would be classified as low risk (1.4% mortality risk), in a similar cohort.
  
  
  CONCLUSIONS
  Mortality following discharge is a poorly recognised contributor to child mortality. Identification of at-risk children is critical in developing postdischarge interventions. A simple prediction tool that uses 5 easily collected variables can be used to identify children at high risk of death after discharge. Improved discharge planning and care could be provided for high-risk children.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: M O
authors.initials: MO
authors.lastname: Wiens
authors.affiliation: Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: E
authors.initials: E
authors.lastname: Kumbakumba
authors.affiliation: Center for International Child Health, BC Children's Hospital, Child and Family Research Institute, Vancouver, Canada.
authors.forename: C P
authors.initials: CP
authors.lastname: Larson
authors.affiliation: Department of Pediatric Anesthesiology, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: Ansermino
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada Canadian HIV Trials Network, St. Paul's Hospital and University of British Columbia, Vancouver, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Singer
authors.affiliation: Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Kissoon
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Wong
authors.affiliation: Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: A
authors.initials: A
authors.lastname: Ndamira
authors.affiliation: Maternal, Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: J
authors.initials: J
authors.lastname: Kabakyenga
authors.affiliation: Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: J
authors.initials: J
authors.lastname: Kiwanuka
authors.affiliation: Department of Statistics, University of British Columbia, Vancouver, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Zhou
mesh_terms: D000208:Acute Disease; D019540:Area Under Curve; D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007239:Infections / Q000401:mortality*; D008297:Male; D008954:Models, Biological; D010351:Patient Discharge; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology
keywords: EPIDEMIOLOGY; PAEDIATRICS