Triage of Children with Severe Acute Malnutrition and its Outcome: Single Centre Cross-sectional Study

摘要

World Health Organisation (WHO), Emergency Triage, Assessment and Treatment (ETAT) guidelines categorised three most common presentations of sick children at admission; these are Respiratory distress and Hypoxemia, Severely impaired circulation or Shock and Seizures with Altered consciousness. Limited data is available on triage in sick children with Severe Acute Malnutrition (SAM).Aim: To describe the triage of children with SAM at time of hospitalisation and its outcome.Materials and Methods: This was a prospective cross- sectional study, conducted on malnourished children recruited from September 2017 to August 2018, over one year period at Department of Paediatrics, Banaras Hindu University. The inclusion criteria were children aged 6 to 60 months fulfilling the WHO criteria of SAM. Triage of SAM children was done in paediatric emergency by resident on duty and A (airway), B (breathing), C (circulation, coma and convulsion), D (severe dehydration) model was used to identify the presence of emergency sign. Outcome was defined as discharge and/or death. Criteria used to indentify the clinical status were taken from WHO-ETAT2016. The demographic characteristics, clinical information is presented as frequencies with percentages. All data were entered into excel sheet and analysed by using SPSS version 18.Results: There were 122 SAM children, out of these, almost two third children (63.2%) were male and most common affected age group of children was less than 3 year (77%). The common emergency sign was hypoxemia (37.96%) followed by dehydration (32.40%), hypoglycemia (21.29%), shock (18.51%), severe respiratory distress (18.5%), and convulsion (10.18%). SAM children with fatal outcome were 11.29 times more likely to have shock (0.001), 10.2 times more likely to have dehydration (<0.001), 7.2 times more likely to have severe respiratory distress (<0.001). There was presence of three or more emergency signs in SAM children who died.Conclusion: Early recognition of clinical signs of shock, severe respiratory distress and dehydration would identify SAM children who are at risk of early death on arrival to facility.