Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study
Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a r...
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| Autor*in: |
Ambrose Agweyu, PhD [verfasserIn] Prof Richard J Lilford, PhD [verfasserIn] Prof Mike English, MD [verfasserIn] Grace Irimu [verfasserIn] Philip Ayieko [verfasserIn] Sam Akech [verfasserIn] David Githanga [verfasserIn] Fred Were [verfasserIn] Barnabas Kigen [verfasserIn] Samuel Ng'arng'ar [verfasserIn] Nick Aduro [verfasserIn] Rachel Inginia [verfasserIn] Beatrice Mutai [verfasserIn] Grace Ochieng [verfasserIn] Lydia Thuranira [verfasserIn] Francis Kanyingi [verfasserIn] Magdalene Kuria [verfasserIn] Sam Otido [verfasserIn] Kigondu Rutha [verfasserIn] Peris Njiiri [verfasserIn] Martin Chabi [verfasserIn] Charles Nzioki [verfasserIn] Joan Ondere [verfasserIn] Caren Emadau [verfasserIn] Cecelia Mutiso [verfasserIn] Loice Mutai [verfasserIn] Christine Manyasi [verfasserIn] David Kimutai [verfasserIn] Celia Muturi [verfasserIn] Agnes Mithamo [verfasserIn] Anne Kamunya [verfasserIn] Alice Kariuki [verfasserIn] Grace Wachira [verfasserIn] Melab Musabi [verfasserIn] Sande Charo [verfasserIn] Naomi Muinga [verfasserIn] Mercy Chepkirui [verfasserIn] Timothy Tuti [verfasserIn] Boniface Makone [verfasserIn] Wycliffe Nyachiro [verfasserIn] George Mbevi [verfasserIn] Thomas Julius [verfasserIn] Susan Gachau [verfasserIn] Morris Ogero [verfasserIn] Michael Bitok [verfasserIn] James Wafula [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2018 |
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| Übergeordnetes Werk: |
In: The Lancet Global Health - Elsevier, 2013, 6(2018), 1, Seite e74-e83 |
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| Übergeordnetes Werk: |
volume:6 ; year:2018 ; number:1 ; pages:e74-e83 |
| Links: |
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| DOI / URN: |
10.1016/S2214-109X(17)30448-5 |
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| Katalog-ID: |
DOAJ076275876 |
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| 520 | |a Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. Methods: We did a retrospective cohort study of children aged 2–59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). Findings: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1–6·8), mild to moderate pallor (3·4, 3·0–3·8), and weight-for-age Z score (WAZ) less than −3 SD (3·8, 3·4–4·3). Additional factors that were independently associated with death were: WAZ less than −2 to −3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. Interpretation: In settings of high mortality, WAZ less than −3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. Funding: Wellcome Trust. | ||
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10.1016/S2214-109X(17)30448-5 doi (DE-627)DOAJ076275876 (DE-599)DOAJ212904c3dbae42fa876b03c631113f69 DE-627 ger DE-627 rakwb eng RA1-1270 Ambrose Agweyu, PhD verfasserin aut Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. Methods: We did a retrospective cohort study of children aged 2–59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). Findings: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1–6·8), mild to moderate pallor (3·4, 3·0–3·8), and weight-for-age Z score (WAZ) less than −3 SD (3·8, 3·4–4·3). Additional factors that were independently associated with death were: WAZ less than −2 to −3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. Interpretation: In settings of high mortality, WAZ less than −3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. Funding: Wellcome Trust. Public aspects of medicine Prof Richard J Lilford, PhD verfasserin aut Prof Mike English, MD verfasserin aut Grace Irimu verfasserin aut Philip Ayieko verfasserin aut Sam Akech verfasserin aut David Githanga verfasserin aut Fred Were verfasserin aut Barnabas Kigen verfasserin aut Samuel Ng'arng'ar verfasserin aut Nick Aduro verfasserin aut Rachel Inginia verfasserin aut Beatrice Mutai verfasserin aut Grace Ochieng verfasserin aut Lydia Thuranira verfasserin aut Francis Kanyingi verfasserin aut Magdalene Kuria verfasserin aut Sam Otido verfasserin aut Kigondu Rutha verfasserin aut Peris Njiiri verfasserin aut Martin Chabi verfasserin aut Charles Nzioki verfasserin aut Joan Ondere verfasserin aut Caren Emadau verfasserin aut Cecelia Mutiso verfasserin aut Loice Mutai verfasserin aut Christine Manyasi verfasserin aut David Kimutai verfasserin aut Celia Muturi verfasserin aut Agnes Mithamo verfasserin aut Anne Kamunya verfasserin aut Alice Kariuki verfasserin aut Grace Wachira verfasserin aut Melab Musabi verfasserin aut Sande Charo verfasserin aut Naomi Muinga verfasserin aut Mercy Chepkirui verfasserin aut Timothy Tuti verfasserin aut Boniface Makone verfasserin aut Wycliffe Nyachiro verfasserin aut George Mbevi verfasserin aut Thomas Julius verfasserin aut Susan Gachau verfasserin aut Morris Ogero verfasserin aut Michael Bitok verfasserin aut James Wafula verfasserin aut In The Lancet Global Health Elsevier, 2013 6(2018), 1, Seite e74-e83 (DE-627)751863181 (DE-600)2723488-5 2214109X nnns volume:6 year:2018 number:1 pages:e74-e83 https://doi.org/10.1016/S2214-109X(17)30448-5 kostenfrei https://doaj.org/article/212904c3dbae42fa876b03c631113f69 kostenfrei http://www.sciencedirect.com/science/article/pii/S2214109X17304485 kostenfrei https://doaj.org/toc/2214-109X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 6 2018 1 e74-e83 |
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10.1016/S2214-109X(17)30448-5 doi (DE-627)DOAJ076275876 (DE-599)DOAJ212904c3dbae42fa876b03c631113f69 DE-627 ger DE-627 rakwb eng RA1-1270 Ambrose Agweyu, PhD verfasserin aut Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. Methods: We did a retrospective cohort study of children aged 2–59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). Findings: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1–6·8), mild to moderate pallor (3·4, 3·0–3·8), and weight-for-age Z score (WAZ) less than −3 SD (3·8, 3·4–4·3). Additional factors that were independently associated with death were: WAZ less than −2 to −3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. Interpretation: In settings of high mortality, WAZ less than −3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. Funding: Wellcome Trust. Public aspects of medicine Prof Richard J Lilford, PhD verfasserin aut Prof Mike English, MD verfasserin aut Grace Irimu verfasserin aut Philip Ayieko verfasserin aut Sam Akech verfasserin aut David Githanga verfasserin aut Fred Were verfasserin aut Barnabas Kigen verfasserin aut Samuel Ng'arng'ar verfasserin aut Nick Aduro verfasserin aut Rachel Inginia verfasserin aut Beatrice Mutai verfasserin aut Grace Ochieng verfasserin aut Lydia Thuranira verfasserin aut Francis Kanyingi verfasserin aut Magdalene Kuria verfasserin aut Sam Otido verfasserin aut Kigondu Rutha verfasserin aut Peris Njiiri verfasserin aut Martin Chabi verfasserin aut Charles Nzioki verfasserin aut Joan Ondere verfasserin aut Caren Emadau verfasserin aut Cecelia Mutiso verfasserin aut Loice Mutai verfasserin aut Christine Manyasi verfasserin aut David Kimutai verfasserin aut Celia Muturi verfasserin aut Agnes Mithamo verfasserin aut Anne Kamunya verfasserin aut Alice Kariuki verfasserin aut Grace Wachira verfasserin aut Melab Musabi verfasserin aut Sande Charo verfasserin aut Naomi Muinga verfasserin aut Mercy Chepkirui verfasserin aut Timothy Tuti verfasserin aut Boniface Makone verfasserin aut Wycliffe Nyachiro verfasserin aut George Mbevi verfasserin aut Thomas Julius verfasserin aut Susan Gachau verfasserin aut Morris Ogero verfasserin aut Michael Bitok verfasserin aut James Wafula verfasserin aut In The Lancet Global Health Elsevier, 2013 6(2018), 1, Seite e74-e83 (DE-627)751863181 (DE-600)2723488-5 2214109X nnns volume:6 year:2018 number:1 pages:e74-e83 https://doi.org/10.1016/S2214-109X(17)30448-5 kostenfrei https://doaj.org/article/212904c3dbae42fa876b03c631113f69 kostenfrei http://www.sciencedirect.com/science/article/pii/S2214109X17304485 kostenfrei https://doaj.org/toc/2214-109X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 6 2018 1 e74-e83 |
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10.1016/S2214-109X(17)30448-5 doi (DE-627)DOAJ076275876 (DE-599)DOAJ212904c3dbae42fa876b03c631113f69 DE-627 ger DE-627 rakwb eng RA1-1270 Ambrose Agweyu, PhD verfasserin aut Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. Methods: We did a retrospective cohort study of children aged 2–59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). Findings: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1–6·8), mild to moderate pallor (3·4, 3·0–3·8), and weight-for-age Z score (WAZ) less than −3 SD (3·8, 3·4–4·3). Additional factors that were independently associated with death were: WAZ less than −2 to −3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. Interpretation: In settings of high mortality, WAZ less than −3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. Funding: Wellcome Trust. Public aspects of medicine Prof Richard J Lilford, PhD verfasserin aut Prof Mike English, MD verfasserin aut Grace Irimu verfasserin aut Philip Ayieko verfasserin aut Sam Akech verfasserin aut David Githanga verfasserin aut Fred Were verfasserin aut Barnabas Kigen verfasserin aut Samuel Ng'arng'ar verfasserin aut Nick Aduro verfasserin aut Rachel Inginia verfasserin aut Beatrice Mutai verfasserin aut Grace Ochieng verfasserin aut Lydia Thuranira verfasserin aut Francis Kanyingi verfasserin aut Magdalene Kuria verfasserin aut Sam Otido verfasserin aut Kigondu Rutha verfasserin aut Peris Njiiri verfasserin aut Martin Chabi verfasserin aut Charles Nzioki verfasserin aut Joan Ondere verfasserin aut Caren Emadau verfasserin aut Cecelia Mutiso verfasserin aut Loice Mutai verfasserin aut Christine Manyasi verfasserin aut David Kimutai verfasserin aut Celia Muturi verfasserin aut Agnes Mithamo verfasserin aut Anne Kamunya verfasserin aut Alice Kariuki verfasserin aut Grace Wachira verfasserin aut Melab Musabi verfasserin aut Sande Charo verfasserin aut Naomi Muinga verfasserin aut Mercy Chepkirui verfasserin aut Timothy Tuti verfasserin aut Boniface Makone verfasserin aut Wycliffe Nyachiro verfasserin aut George Mbevi verfasserin aut Thomas Julius verfasserin aut Susan Gachau verfasserin aut Morris Ogero verfasserin aut Michael Bitok verfasserin aut James Wafula verfasserin aut In The Lancet Global Health Elsevier, 2013 6(2018), 1, Seite e74-e83 (DE-627)751863181 (DE-600)2723488-5 2214109X nnns volume:6 year:2018 number:1 pages:e74-e83 https://doi.org/10.1016/S2214-109X(17)30448-5 kostenfrei https://doaj.org/article/212904c3dbae42fa876b03c631113f69 kostenfrei http://www.sciencedirect.com/science/article/pii/S2214109X17304485 kostenfrei https://doaj.org/toc/2214-109X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 6 2018 1 e74-e83 |
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10.1016/S2214-109X(17)30448-5 doi (DE-627)DOAJ076275876 (DE-599)DOAJ212904c3dbae42fa876b03c631113f69 DE-627 ger DE-627 rakwb eng RA1-1270 Ambrose Agweyu, PhD verfasserin aut Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. Methods: We did a retrospective cohort study of children aged 2–59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). Findings: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1–6·8), mild to moderate pallor (3·4, 3·0–3·8), and weight-for-age Z score (WAZ) less than −3 SD (3·8, 3·4–4·3). Additional factors that were independently associated with death were: WAZ less than −2 to −3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. Interpretation: In settings of high mortality, WAZ less than −3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. Funding: Wellcome Trust. Public aspects of medicine Prof Richard J Lilford, PhD verfasserin aut Prof Mike English, MD verfasserin aut Grace Irimu verfasserin aut Philip Ayieko verfasserin aut Sam Akech verfasserin aut David Githanga verfasserin aut Fred Were verfasserin aut Barnabas Kigen verfasserin aut Samuel Ng'arng'ar verfasserin aut Nick Aduro verfasserin aut Rachel Inginia verfasserin aut Beatrice Mutai verfasserin aut Grace Ochieng verfasserin aut Lydia Thuranira verfasserin aut Francis Kanyingi verfasserin aut Magdalene Kuria verfasserin aut Sam Otido verfasserin aut Kigondu Rutha verfasserin aut Peris Njiiri verfasserin aut Martin Chabi verfasserin aut Charles Nzioki verfasserin aut Joan Ondere verfasserin aut Caren Emadau verfasserin aut Cecelia Mutiso verfasserin aut Loice Mutai verfasserin aut Christine Manyasi verfasserin aut David Kimutai verfasserin aut Celia Muturi verfasserin aut Agnes Mithamo verfasserin aut Anne Kamunya verfasserin aut Alice Kariuki verfasserin aut Grace Wachira verfasserin aut Melab Musabi verfasserin aut Sande Charo verfasserin aut Naomi Muinga verfasserin aut Mercy Chepkirui verfasserin aut Timothy Tuti verfasserin aut Boniface Makone verfasserin aut Wycliffe Nyachiro verfasserin aut George Mbevi verfasserin aut Thomas Julius verfasserin aut Susan Gachau verfasserin aut Morris Ogero verfasserin aut Michael Bitok verfasserin aut James Wafula verfasserin aut In The Lancet Global Health Elsevier, 2013 6(2018), 1, Seite e74-e83 (DE-627)751863181 (DE-600)2723488-5 2214109X nnns volume:6 year:2018 number:1 pages:e74-e83 https://doi.org/10.1016/S2214-109X(17)30448-5 kostenfrei https://doaj.org/article/212904c3dbae42fa876b03c631113f69 kostenfrei http://www.sciencedirect.com/science/article/pii/S2214109X17304485 kostenfrei https://doaj.org/toc/2214-109X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 6 2018 1 e74-e83 |
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10.1016/S2214-109X(17)30448-5 doi (DE-627)DOAJ076275876 (DE-599)DOAJ212904c3dbae42fa876b03c631113f69 DE-627 ger DE-627 rakwb eng RA1-1270 Ambrose Agweyu, PhD verfasserin aut Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. Methods: We did a retrospective cohort study of children aged 2–59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). Findings: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1–6·8), mild to moderate pallor (3·4, 3·0–3·8), and weight-for-age Z score (WAZ) less than −3 SD (3·8, 3·4–4·3). Additional factors that were independently associated with death were: WAZ less than −2 to −3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. Interpretation: In settings of high mortality, WAZ less than −3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. Funding: Wellcome Trust. Public aspects of medicine Prof Richard J Lilford, PhD verfasserin aut Prof Mike English, MD verfasserin aut Grace Irimu verfasserin aut Philip Ayieko verfasserin aut Sam Akech verfasserin aut David Githanga verfasserin aut Fred Were verfasserin aut Barnabas Kigen verfasserin aut Samuel Ng'arng'ar verfasserin aut Nick Aduro verfasserin aut Rachel Inginia verfasserin aut Beatrice Mutai verfasserin aut Grace Ochieng verfasserin aut Lydia Thuranira verfasserin aut Francis Kanyingi verfasserin aut Magdalene Kuria verfasserin aut Sam Otido verfasserin aut Kigondu Rutha verfasserin aut Peris Njiiri verfasserin aut Martin Chabi verfasserin aut Charles Nzioki verfasserin aut Joan Ondere verfasserin aut Caren Emadau verfasserin aut Cecelia Mutiso verfasserin aut Loice Mutai verfasserin aut Christine Manyasi verfasserin aut David Kimutai verfasserin aut Celia Muturi verfasserin aut Agnes Mithamo verfasserin aut Anne Kamunya verfasserin aut Alice Kariuki verfasserin aut Grace Wachira verfasserin aut Melab Musabi verfasserin aut Sande Charo verfasserin aut Naomi Muinga verfasserin aut Mercy Chepkirui verfasserin aut Timothy Tuti verfasserin aut Boniface Makone verfasserin aut Wycliffe Nyachiro verfasserin aut George Mbevi verfasserin aut Thomas Julius verfasserin aut Susan Gachau verfasserin aut Morris Ogero verfasserin aut Michael Bitok verfasserin aut James Wafula verfasserin aut In The Lancet Global Health Elsevier, 2013 6(2018), 1, Seite e74-e83 (DE-627)751863181 (DE-600)2723488-5 2214109X nnns volume:6 year:2018 number:1 pages:e74-e83 https://doi.org/10.1016/S2214-109X(17)30448-5 kostenfrei https://doaj.org/article/212904c3dbae42fa876b03c631113f69 kostenfrei http://www.sciencedirect.com/science/article/pii/S2214109X17304485 kostenfrei https://doaj.org/toc/2214-109X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 6 2018 1 e74-e83 |
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Ambrose Agweyu, PhD @@aut@@ Prof Richard J Lilford, PhD @@aut@@ Prof Mike English, MD @@aut@@ Grace Irimu @@aut@@ Philip Ayieko @@aut@@ Sam Akech @@aut@@ David Githanga @@aut@@ Fred Were @@aut@@ Barnabas Kigen @@aut@@ Samuel Ng'arng'ar @@aut@@ Nick Aduro @@aut@@ Rachel Inginia @@aut@@ Beatrice Mutai @@aut@@ Grace Ochieng @@aut@@ Lydia Thuranira @@aut@@ Francis Kanyingi @@aut@@ Magdalene Kuria @@aut@@ Sam Otido @@aut@@ Kigondu Rutha @@aut@@ Peris Njiiri @@aut@@ Martin Chabi @@aut@@ Charles Nzioki @@aut@@ Joan Ondere @@aut@@ Caren Emadau @@aut@@ Cecelia Mutiso @@aut@@ Loice Mutai @@aut@@ Christine Manyasi @@aut@@ David Kimutai @@aut@@ Celia Muturi @@aut@@ Agnes Mithamo @@aut@@ Anne Kamunya @@aut@@ Alice Kariuki @@aut@@ Grace Wachira @@aut@@ Melab Musabi @@aut@@ Sande Charo @@aut@@ Naomi Muinga @@aut@@ Mercy Chepkirui @@aut@@ Timothy Tuti @@aut@@ Boniface Makone @@aut@@ Wycliffe Nyachiro @@aut@@ George Mbevi @@aut@@ Thomas Julius @@aut@@ Susan Gachau @@aut@@ Morris Ogero @@aut@@ Michael Bitok @@aut@@ James Wafula @@aut@@ |
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<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">DOAJ076275876</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230503005136.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230228s2018 xx |||||o 00| ||eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1016/S2214-109X(17)30448-5</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)DOAJ076275876</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)DOAJ212904c3dbae42fa876b03c631113f69</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="050" ind1=" " ind2="0"><subfield code="a">RA1-1270</subfield></datafield><datafield tag="100" ind1="0" ind2=" "><subfield code="a">Ambrose Agweyu, PhD</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2018</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. Methods: We did a retrospective cohort study of children aged 2–59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). Findings: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1–6·8), mild to moderate pallor (3·4, 3·0–3·8), and weight-for-age Z score (WAZ) less than −3 SD (3·8, 3·4–4·3). Additional factors that were independently associated with death were: WAZ less than −2 to −3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. Interpretation: In settings of high mortality, WAZ less than −3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. 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R - Medicine |
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Ambrose Agweyu, PhD |
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Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study |
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Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study |
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Ambrose Agweyu, PhD |
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The Lancet Global Health |
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Ambrose Agweyu, PhD Prof Richard J Lilford, PhD Prof Mike English, MD Grace Irimu Philip Ayieko Sam Akech David Githanga Fred Were Barnabas Kigen Samuel Ng'arng'ar Nick Aduro Rachel Inginia Beatrice Mutai Grace Ochieng Lydia Thuranira Francis Kanyingi Magdalene Kuria Sam Otido Kigondu Rutha Peris Njiiri Martin Chabi Charles Nzioki Joan Ondere Caren Emadau Cecelia Mutiso Loice Mutai Christine Manyasi David Kimutai Celia Muturi Agnes Mithamo Anne Kamunya Alice Kariuki Grace Wachira Melab Musabi Sande Charo Naomi Muinga Mercy Chepkirui Timothy Tuti Boniface Makone Wycliffe Nyachiro George Mbevi Thomas Julius Susan Gachau Morris Ogero Michael Bitok James Wafula |
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Ambrose Agweyu, PhD |
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10.1016/S2214-109X(17)30448-5 |
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appropriateness of clinical severity classification of new who childhood pneumonia guidance: a multi-hospital, retrospective, cohort study |
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Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study |
| abstract |
Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. Methods: We did a retrospective cohort study of children aged 2–59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). Findings: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1–6·8), mild to moderate pallor (3·4, 3·0–3·8), and weight-for-age Z score (WAZ) less than −3 SD (3·8, 3·4–4·3). Additional factors that were independently associated with death were: WAZ less than −2 to −3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. Interpretation: In settings of high mortality, WAZ less than −3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. Funding: Wellcome Trust. |
| abstractGer |
Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. Methods: We did a retrospective cohort study of children aged 2–59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). Findings: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1–6·8), mild to moderate pallor (3·4, 3·0–3·8), and weight-for-age Z score (WAZ) less than −3 SD (3·8, 3·4–4·3). Additional factors that were independently associated with death were: WAZ less than −2 to −3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. Interpretation: In settings of high mortality, WAZ less than −3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. Funding: Wellcome Trust. |
| abstract_unstemmed |
Background: Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. Methods: We did a retrospective cohort study of children aged 2–59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). Findings: We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1–6·8), mild to moderate pallor (3·4, 3·0–3·8), and weight-for-age Z score (WAZ) less than −3 SD (3·8, 3·4–4·3). Additional factors that were independently associated with death were: WAZ less than −2 to −3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. Interpretation: In settings of high mortality, WAZ less than −3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital should not be denied to children with these signs and we urge clinicians to consider these risk factors in addition to WHO criteria in their decision making. Funding: Wellcome Trust. |
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Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study |
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https://doi.org/10.1016/S2214-109X(17)30448-5 https://doaj.org/article/212904c3dbae42fa876b03c631113f69 http://www.sciencedirect.com/science/article/pii/S2214109X17304485 https://doaj.org/toc/2214-109X |
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Prof Richard J Lilford, PhD Prof Mike English, MD Grace Irimu Philip Ayieko Sam Akech David Githanga Fred Were Barnabas Kigen Samuel Ng'arng'ar Nick Aduro Rachel Inginia Beatrice Mutai Grace Ochieng Lydia Thuranira Francis Kanyingi Magdalene Kuria Sam Otido Kigondu Rutha Peris Njiiri Martin Chabi Charles Nzioki Joan Ondere Caren Emadau Cecelia Mutiso Loice Mutai Christine Manyasi David Kimutai Celia Muturi Agnes Mithamo Anne Kamunya Alice Kariuki Grace Wachira Melab Musabi Sande Charo Naomi Muinga Mercy Chepkirui Timothy Tuti Boniface Makone Wycliffe Nyachiro George Mbevi Thomas Julius Susan Gachau Morris Ogero Michael Bitok James Wafula |
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Prof Richard J Lilford, PhD Prof Mike English, MD Grace Irimu Philip Ayieko Sam Akech David Githanga Fred Were Barnabas Kigen Samuel Ng'arng'ar Nick Aduro Rachel Inginia Beatrice Mutai Grace Ochieng Lydia Thuranira Francis Kanyingi Magdalene Kuria Sam Otido Kigondu Rutha Peris Njiiri Martin Chabi Charles Nzioki Joan Ondere Caren Emadau Cecelia Mutiso Loice Mutai Christine Manyasi David Kimutai Celia Muturi Agnes Mithamo Anne Kamunya Alice Kariuki Grace Wachira Melab Musabi Sande Charo Naomi Muinga Mercy Chepkirui Timothy Tuti Boniface Makone Wycliffe Nyachiro George Mbevi Thomas Julius Susan Gachau Morris Ogero Michael Bitok James Wafula |
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