1
|
Shimelis T, Vaz Nery S, Tadesse BT, Bartlett AW, Belay FW, Schierhout G, Dittrich S, Crump JA, Kaldor JM. Clinical management and outcomes of acute febrile illness in children attending a tertiary hospital in southern Ethiopia. BMC Infect Dis 2022; 22:434. [PMID: 35509024 PMCID: PMC9069758 DOI: 10.1186/s12879-022-07424-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The management of febrile illnesses is challenging in settings where diagnostic laboratory facilities are limited, and there are few published longitudinal data on children presenting with fever in such settings. We have previously conducted the first comprehensive study of infectious aetiologies of febrile children presenting to a tertiary care facility in Ethiopia. We now report on clinicians’ prescribing adherence with guidelines and outcomes of management in this cohort. Methods We consecutively enrolled febrile children aged 2 months and under 13 years, who were then managed by clinicians based on presentation and available laboratory and radiologic findings on day of enrolment. We prospectively collected outcome data on days 7 and 14, and retrospectively evaluated prescribing adherence with national clinical management guidelines. Results Of 433 children enrolled, the most common presenting syndromes were pneumonia and acute diarrhoea, diagnosed in 177 (40.9%) and 82 (18.9%), respectively. Antibacterial agents were prescribed to 360 (84.7%) of 425 children, including 36 (34.0%) of 106 children without an initial indication for antibacterials according to guidelines. Antimalarial drugs were prescribed to 47 (11.1%) of 425 children, including 30 (7.3%) of 411 children with negative malaria microscopy. Fever had resolved in 357 (89.7%) of 398 children assessed at day 7, and in-hospital death within 7 days occurred in 9 (5.9%) of 153 admitted patients. Among children with pneumonia, independent predictors of persisting fever or death by 7 days were young age and underweight for age. Antibacterial prescribing in the absence of a guideline-specified indication (overprescribing) was more likely among infants and those without tachypnea, while overprescribing antimalarials was associated with older age, anaemia, absence of cough, and higher fevers. Conclusion Our study underscores the need for improving diagnostic support to properly guide management decisions and enhance adherence by clinicians to treatment guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07424-0.
Collapse
Affiliation(s)
- Techalew Shimelis
- Kirby Institute, University of New South Wales, Sydney, Australia. .,College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Adam W Bartlett
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Gill Schierhout
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sabine Dittrich
- Foundation for Innovative New Diagnostics, Geneva, Switzerland.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
2
|
Henry R, Ghafil C, Pott E, Liasidis PK, Golden A, Henry RN, Matsushima K, Clark D, Inaba K, Strumwasser A. Selective Computed Tomography (CT) Imaging is Superior to Liberal CT Imaging in the Hemodynamically Normal Pediatric Blunt Trauma Patient. J Surg Res 2021; 266:284-291. [PMID: 34038850 DOI: 10.1016/j.jss.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/12/2021] [Accepted: 04/10/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The optimal imaging strategy in hemodynamically stable pediatric blunt trauma remains to be defined. The purpose of this study was to determine the differences between selective and liberal computed tomography (CT) strategy in a pediatric trauma population with respect to radiation exposure and outcomes. METHODS We performed a retrospective analysis of hemodynamically stable blunt pediatric trauma patients (≤16 y) who were admitted to a Level I trauma center between 2013-2016. Patients were stratified into selective and liberal imaging cohorts. Univariate and multivariate regression analyses were used to compare outcomes between the groups. Outcomes included radiation dose, hospital and ICU length of stay, complications and mortality. RESULTS Of the 485 patients included, 176 underwent liberal and 309 selective CT imaging. The liberal cohort were more likely to be severely injured (ISS>15: 34.1 versus 8.4%, P< 0.001). The odds of exposure to a radiation dose of >15 mSv were higher with liberal scanning in patients with both ISS > 15 (OR 2.78, 95% CI 1.76-5.19, P< 0.001) and ISS ≤ 15 (OR 3.41, 95% CI 2.19-8.44, P < 0.001). Adjusted outcomes regarding mortality, ICU length of stay, and complications were similar between the cohorts. CONCLUSION Selective CT imaging in hemodynamically stable blunt pediatric trauma patients was associated with reduced radiation exposure and similar outcomes when compared to a liberal CT strategy.
Collapse
Affiliation(s)
- Reynold Henry
- Division of Acute Care Surgery, University of Southern California; Los Angeles, CA.
| | - Cameron Ghafil
- Division of Acute Care Surgery, University of Southern California; Los Angeles, CA
| | - Emily Pott
- Department of Emergency Medicine, University of California, San Diego, CA
| | | | - Adam Golden
- Division of Acute Care Surgery, University of Southern California; Los Angeles, CA
| | - Rachel N Henry
- Division of Acute Care Surgery, University of Southern California; Los Angeles, CA
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, University of Southern California; Los Angeles, CA
| | - Damon Clark
- Division of Acute Care Surgery, University of Southern California; Los Angeles, CA
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California; Los Angeles, CA
| | - Aaron Strumwasser
- Division of Acute Care Surgery, University of Southern California; Los Angeles, CA
| |
Collapse
|
3
|
Guan Y, Wang X, Chen X, Yi D, Chen L, Jiang X. Assessment of the timeliness and robustness for predicting adult sepsis. iScience 2021; 24:102106. [PMID: 33659874 PMCID: PMC7895752 DOI: 10.1016/j.isci.2021.102106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/09/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
Sepsis is a leading cause of death among inpatients at hospitals. However, with early detection, death rate can drop substantially. In this study, we present the top-performing algorithm for Sepsis II prediction in the DII National Data Science Challenge using the Cerner Health Facts data involving more than 100,000 adult patients. This large sample size allowed us to dissect the predictability by age-groups, race, genders, and care settings and up to 192 hr of sepsis onset. This large data collection also allowed us to conclude that the last six biometric records on average are informative to the prediction of sepsis. We identified biomarkers that are common across the treatment time and novel biomarkers that are uniquely presented for early prediction. The algorithms showed meaningful signals days ahead of sepsis onset, supporting the potential of reducing death rate by focusing on high-risk populations identified from heterogeneous data integration.
Collapse
Affiliation(s)
- Yuanfang Guan
- Department of Computational Medicine and Bioinformatics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Xueqing Wang
- Department of Computational Medicine and Bioinformatics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Xianghao Chen
- Department of Computational Medicine and Bioinformatics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daiyao Yi
- Department of Computational Medicine and Bioinformatics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Luyao Chen
- UTHealth School of Biomedical Informatics (SBMI), University of Texas, Houston, TX, USA
| | - Xiaoqian Jiang
- UTHealth School of Biomedical Informatics (SBMI), University of Texas, Houston, TX, USA
| |
Collapse
|
4
|
|
5
|
Anh NT, Hong NTT, Nhu LNT, Thanh TT, Lau CY, Limmathurotsakul D, Deng X, Rahman M, Chau NVV, van Doorn HR, Thwaites G, Delwart E, Tan LV. Viruses in Vietnamese Patients Presenting with Community-Acquired Sepsis of Unknown Cause. J Clin Microbiol 2019; 57:e00386-19. [PMID: 31217274 PMCID: PMC6711913 DOI: 10.1128/jcm.00386-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/12/2019] [Indexed: 12/28/2022] Open
Abstract
Community-acquired (CA) sepsis is a major public health problem worldwide, yet the etiology remains unknown for >50% of the patients. Here we applied metagenomic next-generation sequencing (mNGS) to characterize the human virome in 492 clinical samples (384 sera, 92 pooled nasal and throat swabs, 10 stools, and 6 cerebrospinal fluid samples) from 386 patients (213 adults and 173 children) presenting with CA sepsis who were recruited from 6 hospitals across Vietnam between 2013 and 2015. Specific monoplex PCRs were used subsequently to confirm the presence of viral sequences detected by mNGS. We found sequences related to 47 viral species belonging to 21 families in 358 of 386 (93%) patients, including viruses known to cause human infections. After PCR confirmation, human viruses were found in 52 of 386 patients (13.4%); picornavirus (enteroviruses [n = 14], rhinovirus [n = 5], and parechovirus [n = 2]), hepatitis B virus (n = 10), cytomegalovirus (n = 9), Epstein-Barr virus (n = 5), and rotavirus A (n = 3) were the most common viruses detected. Recently discovered viruses were also found (gemycircularvirus [n = 5] and WU polyomavirus, Saffold virus, salivirus, cyclovirus-VN, and human pegivirus 2 [HPgV2] [n, 1 each]), adding to the growing literature about the geographic distribution of these novel viruses. Notably, sequences related to numerous viruses not previously reported in human tissues were also detected. To summarize, we identified 21 viral species known to be infectious to humans in 52 of 386 (13.4%) patients presenting with CA sepsis of unknown cause. The study, however, cannot directly impute sepsis causation to the viruses identified. The results highlight the fact that it remains a challenge to establish the causative agents in CA sepsis patients, especially in tropical settings such as Vietnam.
Collapse
Affiliation(s)
- Nguyen To Anh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Chuen-Yen Lau
- Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Xutao Deng
- Blood Systems Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | - Motiur Rahman
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Eric Delwart
- Blood Systems Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| |
Collapse
|