Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort study

Abstract

Background Respiratory compromise is the leading cause of cardiac arrest and death among paediatric patients. Emergency medicine is a new field in low-income countries (LICs); the presentation, treatment and outcomes of paediatric patients with respiratory compromise is not well studied. We describe the clinical epidemiology, management and outcomes of paediatric patients with respiratory compromise presenting to the first full-capacity Emergency Department in Tanzania. Methods This was a prospective cohort study of paediatric patients (< 18 years) with respiratory compromise (respiratory distress, respiratory failure or respiratory arrest) presenting to the Emergency Medicine Department of Muhimibili National Hospital (EMD-MNH) in Dar es Salaam, from July–November 2017. A standardized case report form was used to record demographics, presenting clinical characteristics, management and outcomes. Primary outcomes were hospital mortality and secondary outcomes were EMD mortality, 24-h mortality, incidence of cardiac arrest in the EMD, length of stay, ICU admission, and risk factors for mortality. Results We enrolled 165 children; their median age was 12 months [IQR: 4–36 months], and 90 (54.4%) were male. At presentation 92 (55.8%) children were in respiratory failure. Oxygen therapy was initiated for 143 (86.7%) children, among which 21 (14.7%) were intubated. The most common aetiologies were pneumonia followed by congenital heart disease and sepsis. The majority 147 (89.1%) of children were admitted to the hospital, with 20 (12%) going to ICU. Four (2%) children were discharged from EMD and 14 (8.5%) died in the EMD. In the EMD, 18 children developed cardiac arrest, with two surviving to hospital discharge. Overall 51 (30.9%) children died; 84% of deaths were in children under five years. Risk of mortality was increased in children presenting with decreased consciousness (RR = 2.2 (1.4–3.4)), hypoxia RR = 2.6 (1.6–4.4)) or bradypnoea (RR = 3.9 (2.9–5.0)), and those who received CPR (RR = 3.7 (2.7–5.2)) and intubation (RR = 3.1 (2.1–4.5)). Conclusions In this EMD of a LICs, respiratory compromise in children carries high mortality, with children of young age being the most vulnerable. Many children arrived in respiratory failure and few children received ICU care. Outcomes can be improved by earlier recognition to prevent cardiac arrest, and more intensive treatment, including ICU and assisted ventilation.

Predictors and outcome of cardiac arrest in paediatric patients presenting to emergency medicine department of tertiary hospitals in Tanzania

“…Therefore, intubation is done at a very late stage in their stay at the EMD and thus carries a high risk of cardiac arrest. Similar to other studies, intubation was found to be independently associated with cardiac arrest [ 9 , 13 ].…”

Cardiopulmonary resuscitation in poorly resourced settings: better to pre-empt than to wait until it is too late

“…Reports from LMIC tend to come from single institutions and reflect their level of care and admission policies. In an emergency department of a Tanzanian teaching hospital, 18/165 (11%) infants <1 year of age required CPR [5]. A report from South India states that 27% (20/75) of children arriving at the hospital with agonal breathing received CPR in the emergency department [6].…”

Clinical emergency care quality indicators in Africa: a scoping review and data summary

“…The 53 studies containing ‘AFEM-CC quality indicators near match’ evidence were split between two groups of publications. The first group included 38 publications, which were identified as containing only ‘AFEM-CC quality indicators near match’ data 57–94. The second group included 15 publications, which were cited above as containing ‘AFEM-CC quality indicators exact match’ data, but which contained additional ‘AFEM-CC quality indicators near match’ data 22 25 26 28 29 31 33 34 39 41 45 46 54–56.…”