Factors associated with hospital admission following traumatic brain injury and infectious encephalopathy in children in four resource limited settings
Rashmi Kumar1, Amelie von Saint Andre-von Arnim1,2, Tigist Bacha3, Abenezer Tirsit Aklilu3, Tsegazeab Laeke Teklemariam3, Shubhada Hooli4,5, Lisine Tuyisenge4, Easmon Otupiri6, Patrick Wilson7,6, Patrick Michael Kochanek8, Robert Tasker9, Ericka Fink8,&
1University of Nairobi, Kenyatta Hospital Nairobi, Kenya, 2University of Washington and Seattle Children’s Hospital, Seattle, Washington, USA, 3Addis Ababa University, Ethiopia, 4University Teaching Hospital of Kigali, Rwanda, 5Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA, 6School of Public Health, Kwame Nkrumah University of Science & Technology, Kumas, Ghana, 7Columbia University Medical Center, New York, New York, USA, 8Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA, 9University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
Ericka Fink, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,
children presenting to the emergency department needing neurocritical care require proper triage in resource limited settings (RLS). We aimed to study pre-hospital, patient, and disease factors related to hospital admission in children presenting with traumatic brain injury (TBI) and infectious encephalopathy (IE) to the emergency department (ED).
we prospectively studied children aged 7 days - 17 years diagnosed with TBI or IE from 130 children from hospitals in Ethiopia (n = 51), Kenya (n = 50), Rwanda (n = 20), and Ghana (n = 7; IE only) over a 4-week period. The primary outcome was patient disposition following ED presentation.
we studied 58 children (45%) with TBI and 72 children (55%) with CNS infection and 109 (84%) had disposition available. Overall, 17 children (16%) were discharged home from the ED and 1 (1% died). Ninety-two children (84%) were admitted to the following locations in the hospital: 76 (69%) ward, 7 (6%) operating theater, 7 (6%) intensive care unit, and other 2 (2%). More children with IE were admitted to the hospital than TBI (54 (98%) vs. 38 (70%), p < 0.001. All children with abnormal heart rates (n = 6, < 60 or > 160bpm), systolic blood pressure (n = 2, <70mmHg), oxygen saturation (<90%), and all but 3/33 (9%) with Glasgow coma scale (GCS) score <15 were admitted to the hospital. Longer duration of transport to the hospital was associated with home vs. hospital disposition (median [interquartile range] 120 [120 - 240] vs. 60 [30 - 90] minutes, p = 0.0006). There was no difference in the number of children transported to the hospital with abnormal GCS by ambulance or other means (22 (52%) vs. 17 (47%), p = 0.821). In a multivariate analysis, younger age (odds ratio [OR] 0.59, p = 0.008), lower GCS (OR 70.25, p = 0.026), shorter transport times (OR 0.98, p = 0.020) but not arrival via emergency services or not (OR 7.93, p = 0.163) were associated with hospital admission
children with physiological derangements in the ED with TBI and IE were nearly all triaged to hospital admission, but almost half of those with altered mental status were taken to the hospital without emergency medical services transport. Access to quality emergency transport services should be available to all children with neurocritical illness.
Dates: 15 Dec 17 - 16 Dec 17
Venue: Hotel Ngor Diarama
Contact person: Dr. Laurent Hiffler (email@example.com)