Simplified prognostic model of overall intrahospital mortality of children in central Africa

摘要

OBJECTIVES: To find a simple mortality prediction model based on nutritional and infection indicators for the assessment of the care of children admitted to hospital in central Africa. METHOD: Cohort study of 414 children admitted at Goma Hospital between 1.4.2003 and 31.3.2004. We conducted univariate analysis and logistic regression, computed adjusted odds ratios and constructed a prognostic score from the coefficients of logistic regression. The performance of logistic model and score were evaluated by the calculation of areas under the ROC curves. RESULTS: The intrahospital mortality rate reached 15.9%. In univariate analysis, age, WAZ, arm circumference, neurological status (Blantyre coma score), stiff neck, subcostal indrawning, and infection were significantly associated with mortality. Logistic regression model analysis and adjusted odds ratios (AOR) confirmed higher risks of death for young (AOR 3.4 (1.4-8.8) and underweight children (WAZ -2->-3 and WAZ < or = -3, AOR 3.2 (1.4-7.6) and AOR 4.4(1.7-11.2)), for children with arm circumference under 115 mm (AOR 3.4 (1.5-7.3)), impaired consciousness (AOR 9.6 (3.1-29.9)) and bloodstream infections (AOR 6.6 (2.1-21.1)). The area under the ROC curve of the prognostic model is 0.83 (0.78-0.88), that of the prognostic score, 0.80 (0.75-0.86). CONCLUSION: This study provides a simple mortality prediction model for hospitalised children in central Africa, based on age, weight for age or arm circumference, neurological status (Blantyre coma score), and infection. This model and scoring system can be used to evaluate programs set up to reduce intrahospital mortality in this region.