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Shi T, Millington T, Robertson C, Jeffrey K, Katikireddi SV, McCowan C, Simpson CR, Woolford L, Daines L, Kerr S, Swallow B, Fagbamigbe A, Vallejos CA, Weatherill D, Jayacodi S, Marsh K, McMenamin J, Rudan I, Ritchie LD, Mueller T, Kurdi A, Sheikh A, on behalf of Public Health Scotland and the EAVE II Collaborators. Risk of winter hospitalisation and death from acute respiratory infections in Scotland: national retrospective cohort study. J R Soc Med 2024; 117:232-246. [PMID: 38345538 PMCID: PMC11450722 DOI: 10.1177/01410768231223584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/10/2023] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVES We undertook a national analysis to characterise and identify risk factors for acute respiratory infections (ARIs) resulting in hospitalisation during the winter period in Scotland. DESIGN A population-based retrospective cohort analysis. SETTING Scotland. PARTICIPANTS The study involved 5.4 million residents in Scotland. MAIN OUTCOME MEASURES Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between risk factors and ARI hospitalisation. RESULTS Between 1 September 2022 and 31 January 2023, there were 22,284 (10.9% of 203,549 with any emergency hospitalisation) ARI hospitalisations (1759 in children and 20,525 in adults) in Scotland. Compared with the reference group of children aged 6-17 years, the risk of ARI hospitalisation was higher in children aged 3-5 years (aHR = 4.55; 95% CI: 4.11-5.04). Compared with those aged 25-29 years, the risk of ARI hospitalisation was highest among the oldest adults aged ≥80 years (aHR = 7.86; 95% CI: 7.06-8.76). Adults from more deprived areas (most deprived vs. least deprived, aHR = 1.64; 95% CI: 1.57-1.72), with existing health conditions (≥5 vs. 0 health conditions, aHR = 4.84; 95% CI: 4.53-5.18) or with history of all-cause emergency admissions (≥6 vs. 0 previous emergency admissions, aHR = 7.53; 95% CI: 5.48-10.35) were at a higher risk of ARI hospitalisations. The risk increased by the number of existing health conditions and previous emergency admission. Similar associations were seen in children. CONCLUSIONS Younger children, older adults, those from more deprived backgrounds and individuals with greater numbers of pre-existing conditions and previous emergency admission were at increased risk for winter hospitalisations for ARI.
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Affiliation(s)
- Ting Shi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Tristan Millington
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XQ, Scotland, UK
- Public Health Scotland, Glasgow, G2 6QE, Scotland, UK
| | - Karen Jeffrey
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, KY16 9AJ, Scotland, UK
| | - Colin R Simpson
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, 6140, New Zealand
| | - Lana Woolford
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Luke Daines
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Steven Kerr
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Ben Swallow
- School of Mathematics and Statistics, University of St Andrews, St Andrews, KY16 9SS, Scotland, UK
| | - Adeniyi Fagbamigbe
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 2ZD, Scotland, UK
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan 200132, Nigeria
| | - Catalina A Vallejos
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, Scotland, UK
- The Alan Turing Institute, London, NW1 2DB, UK
| | - David Weatherill
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Sandra Jayacodi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | | | - Jim McMenamin
- Public Health Scotland, Glasgow, G2 6QE, Scotland, UK
| | - Igor Rudan
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Lewis Duthie Ritchie
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 2ZD, Scotland, UK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, Scotland, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, Scotland, UK
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, South Africa
- Department of Clinical Pharmacy, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - on behalf of Public Health Scotland and the EAVE II Collaborators
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XQ, Scotland, UK
- Public Health Scotland, Glasgow, G2 6QE, Scotland, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK
- School of Medicine, University of St Andrews, St Andrews, KY16 9AJ, Scotland, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, 6140, New Zealand
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
- School of Mathematics and Statistics, University of St Andrews, St Andrews, KY16 9SS, Scotland, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 2ZD, Scotland, UK
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan 200132, Nigeria
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, Scotland, UK
- The Alan Turing Institute, London, NW1 2DB, UK
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, Scotland, UK
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, South Africa
- Department of Clinical Pharmacy, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
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Wilkes C, Bava M, Graham HR, Duke T, ARI Review group DukeTrevorGrahamHamishGrahamSteveGrayAmyGweeAmandavon MollendorfClaireMulhollandKimRussellFionaHume-NixonMaeveKaziSaniyaKevatPriyaNealEleanorNguyenCattramQuachAliciaReyburnRitaRyanKathleenWalkerPatrickWilkesChrisChuaPohNisarYasirSimonJonathonWereWilson. What are the risk factors for death among children with pneumonia in low- and middle-income countries? A systematic review. J Glob Health 2023; 13:05003. [PMID: 36825608 PMCID: PMC9951126 DOI: 10.7189/jogh.13.05003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Background Knowledge of the risk factors for and causes of treatment failure and mortality in childhood pneumonia is important for prevention, diagnosis, and treatment at an individual and population level. This review aimed to identify the most important risk factors for mortality among children aged under ten years with pneumonia. Methods We systematically searched MEDLINE, EMBASE, and PubMed for observational and interventional studies reporting risk factors for mortality in children (aged two months to nine years) in low- and middle-income countries (LMICs). We screened articles according to specified inclusion and exclusion criteria, assessed risk of bias using the EPHPP framework, and extracted data on demographic, clinical, and laboratory risk factors for death. We synthesized data descriptively and using Forest plots and did not attempt meta-analysis due to the heterogeneity in study design, definitions, and populations. Findings We included 143 studies in this review. Hypoxaemia (low blood oxygen level), decreased conscious state, severe acute malnutrition, and the presence of an underlying chronic condition were the risk factors most strongly and consistently associated with increased mortality in children with pneumonia. Additional important clinical factors that were associated with mortality in the majority of studies included particular clinical signs (cyanosis, pallor, tachypnoea, chest indrawing, convulsions, diarrhoea), chronic comorbidities (anaemia, HIV infection, congenital heart disease, heart failure), as well as other non-severe forms of malnutrition. Important demographic factors associated with mortality in the majority of studies included age <12 months and inadequate immunisation. Important laboratory and investigation findings associated with mortality in the majority of studies included: confirmed Pneumocystis jirovecii pneumonia (PJP), consolidation on chest x-ray, pleural effusion on chest x-ray, and leukopenia. Several other demographic, clinical and laboratory findings were associated with mortality less consistently or in a small numbers of studies. Conclusions Risk assessment for children with pneumonia should include routine evaluation for hypoxaemia (pulse oximetry), decreased conscious state (e.g. AVPU), malnutrition (severe, moderate, and stunting), and the presence of an underlying chronic condition as these are strongly and consistently associated with increased mortality. Other potentially useful risk factors include the presence of pallor or anaemia, chest indrawing, young age (<12 months), inadequate immunisation, and leukopenia.
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Affiliation(s)
- Chris Wilkes
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Mohamed Bava
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Hamish R Graham
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Trevor Duke
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, Victoria, Australia
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Windsor WJ, Lamb MM, Dominguez SR, Mistry RD, Rao S. Clinical characteristics and illness course based on pathogen among children with respiratory illness presenting to an emergency department. J Med Virol 2022; 94:6103-6110. [PMID: 35882541 DOI: 10.1002/jmv.28031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/05/2022] [Accepted: 07/23/2022] [Indexed: 01/06/2023]
Abstract
Upper respiratory illnesses due to viruses are the most common reason for pediatric emergency department (ED) visits in the United States. We explored the clinical characteristics, hospitalization risk, and symptom duration of children in an ED setting by respiratory pathogen including coinfections. A retrospective analysis was conducted from a randomized controlled trial evaluating a rapid molecular pathogen panel among 931 children 1 month to 18 years of age with acute respiratory illness. We assessed hospitalization risk by pathogen using multivariable Poisson regression with robust variance. Symptom duration was assessed using multivariable Cox proportional hazards models. Among 931 children, 702 (75%) were aged 0-5 years and 797 (85%) tested positive for a respiratory pathogen. Children with respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and human rhinovirus/enterovirus (HRV/EV) had higher hospitalization risk compared with influenza (adjusted risk ratio [aRR]: 2.95, 95% confidence interval [CI]: 1.17-7.45; 3.56, 95% CI: 1.05-12.02; aRR: 2.58, 95% CI: 1.05-6.35, respectively). Children with RSV, parainfluenza and atypical bacterial pathogens had longer illness duration compared with influenza (adjusted hazards ratio [aHR]: 2.16 95% CI: 1.41-3.29; aHR: 1.67, 95% CI:1.06-2.64; aHR: 2.60 95% CI: 1.30-5.19, respectively). Children with RSV, hMPV, and atypical bacterial pathogens had higher illness severity and duration compared with other respiratory pathogens. Coinfection was not associated with increased illness severity.
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Affiliation(s)
- W Jon Windsor
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado, USA
| | - Molly M Lamb
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado, USA
| | - Samuel R Dominguez
- Department of Pediatrics (Infectious Diseases and Epidemiology, Pathology and Laboratory Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rakesh D Mistry
- Department of Pediatrics (Emergency Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Suchitra Rao
- Department of Pediatrics (Infectious Diseases, Epidemiology and Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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Awad S, Hatim R, Khader Y, Alyahya M, Harik N, Rawashdeh A, Qudah W, Khasawneh R, Hayajneh W, Yusef D. Bronchiolitis clinical practice guidelines implementation: surveillance study of hospitalized children in Jordan. Multidiscip Respir Med 2020; 15:673. [PMID: 33117531 PMCID: PMC7569331 DOI: 10.4081/mrm.2020.673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/08/2020] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Bronchiolitis is a leading cause of hospital admissions and death in young children. Clinical practice guidelines (CPG) to diagnose and manage bronchiolitis have helped healthcare providers to avoid unnecessary investigations and interventions and to provide evidence-based treatment. Aim of this study is to determine the effect of implementing CPG for the diagnosis and management of bronchiolitis in a tertiary hospital in Jordan. METHODS The study compared children (age <24 months) diagnosed with bronchiolitis and who required admission to King Abdullah University Hospital in Irbid during the winter of 2017 (after CPG implementation) and age-matched children admitted in the winter of 2016. The proportion of patients receiving diagnostic tests and treatments in the two groups were compared. RESULTS Eighty-eight and 91 patients were diagnosed with bronchiolitis before and after CPG implementation, respectively. Respiratory syncytial virus rapid antigen detection testing decreased after CPG implementation [n=64 (72.7%) vs n=46 (50.5%), p=0.002]. However, there was no significant change in terms of other diagnostic tests. The use of nebulized salbutamol [n=44 (50%) vs n=29 (31.9%), p=0.01], hypertonic saline [n=39 (44.3%) vs n=8 (8.8%), p<0.001], and inappropriate antibiotics [n=31 (35.2%) vs n=15 (16.5%), p=0.004] decreased after CPG implementation. There was no difference in mean LOS (standard deviation; SD) between the pre- and post-CPG groups [3.5(2) vs 4 (3.4) days, p=0.19]. The mean cost of stay (SD) was 449.4 (329.1) US dollars for pre-CPG compared to 507.3 (286.1) US dollars for the post-CPG group (p=0.24). CONCLUSION We observed that the implementation of CPG for bronchiolitis diagnosis and management helped change physicians' behavior toward evidence-based practices. However, adherence to guidelines must be emphasized to improve practices in developing countries, focusing on the rational use of diagnostic testing, and avoiding use of unnecessary medications when managing children with a diagnosis of bronchiolitis.
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Affiliation(s)
- Samah Awad
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rawan Hatim
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nada Harik
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington DC, USA
| | - Ahmad Rawashdeh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Walaa Qudah
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ruba Khasawneh
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Wail Hayajneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Dawood Yusef
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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