| Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital. | |
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MedLine Citation:
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PMID: 12764512 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. FINDINGS: 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. |
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Authors:
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Mike English; James Berkley; Isiah Mwangi; Shebbe Mohammed; Maimuna Ahmed; Faith Osier; Neema Muturi; Bernhards Ogutu; Kevin Marsh; Charles R J C Newton |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2003-05-16 |
Journal Detail:
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Title: Bulletin of the World Health Organization Volume: 81 ISSN: 0042-9686 ISO Abbreviation: Bull. World Health Organ. Publication Date: 2003 |
Date Detail:
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Created Date: 2003-05-23 Completed Date: 2003-07-07 Revised Date: 2009-05-29 |
Medline Journal Info:
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Nlm Unique ID: 7507052 Medline TA: Bull World Health Organ Country: Switzerland |
Other Details:
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Languages: eng Pagination: 166-73 Citation Subset: IM |
Affiliation:
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Centre for Geographic Medicine Research, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kilifi, Kenya. menglish@kilifi.mimcom.net |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease
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classification* Algorithms Anti-Bacterial Agents / therapeutic use Child, Hospitalized Child, Preschool Decision Support Systems, Clinical Diagnostic Errors / prevention & control Diagnostic Services / standards* Female Hospitals, District / standards* Humans Infant Kenya Male Patient Admission Pediatrics / standards* Prospective Studies Syndrome Therapeutics / standards* |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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