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|Title: ||Decreased Mortality After Establishing a Pediatric Emergency Unit at an Urban Referral Hospital in Ghana|
|Authors: ||Sylverken, Justice|
Robison, Jeff A.
Nguah, Samuel Blay
|Issue Date: ||2019|
|Publisher: ||Pediatric Emergency Care|
|Citation: ||Pediatric Emergency Care, Volume 00, Number 00|
|Abstract: ||Emergently ill infants and children are often inadequately recognized
and stabilized by health care facilities in low- and middle-income
countries. Limited reports have shown that process improvements and
prioritization of emergency care for children presenting to the hospital can
improve pediatric hospital mortality.
A dedicated pediatric emergency unit (PEU) was established for
nontrauma emergencies at a busy teaching and referral hospital in Kumasi,
Ghana, in response to high inpatient mortality early during hospitalization.
The PEU was designed to identify and separate critically ill children from
more stable children on admission. Locally available hospital resources
were reallocated from other areas of the hospital to prioritize staffing and supplies
for the PEU.
A multiyear data set of nonnewborn inpatient mortality was analyzed
with a change point model to find the point at which mortality changed the
most within the Department of Child Health or the maximum likelihood
estimate. Relative risk of mortality for the periods 1 and 2 years immediately
before and after the implementation of the PEU and each individual
year compared with its preceding year was analyzed to further establish a
temporal correlation of changes in mortality rates to the PEU implementation.
Individual years were also analyzed against preimplementation data to
establish the durability of mortality improvements.
Patient mortality decreased over the analyzed period with the maximum
change point strongly associated with implementation of the PEU. Relative
risk values of mortality 1 year and 2 years immediately before and after
implementation of the PEU were 0.70 (0.62–0.78) and 0.69 (0.64–0.74) respectively,
representing a one-third reduction in mortality. The only other
mortality improvements seen in the year-to-year analysis were between July
2004–June 2005 compared with July 2005–June 2006 with a relative risk of|
|Description: ||This article is published in Pediatric Emergency Care and also available at DOI: 10.1097/PEC.0000000000001865|
|Appears in Collections:||College of Agric and Natural Resources|
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