Paediatric deaths within the first 24 hours in a metropolitan hospital system, South Africa

Abstract

Background: Paediatric deaths occuring within 24 hours of presentation to hospital contribute substantially to overall in-hospital mortality. The underlying contributors to these early deaths have not been well delineated.

Objectives: To describe the characteristics (demographic features, ascribed aetiologies, predisposing factors) associated with deaths of paediatric patients within the first 24 hours of hospital presentation, and to determine modifiable factors that can be addressed to improve patient care and outcomes.

Design: A secondary data analysis of deaths of paediatric patients within a metropolitan hospital system in South Africa. Data were obtained from the Child Healthcare Problem Identification Program (Child PIP) database for the time period 1 January 2005 through 31 December 2014.

Setting: The three hospitals within a metropolitan hospital system, South Africa.

Results: Of 2080 in-hospital deaths, 563(27%) occurred within 24 hours of hospital arrival. Almost half (48.3%) of these deaths occurred in infants aged 28 days to 1 year. The main causes of early mortality were sepsis (18.6%), acute respiratory illness (17.2%), and gastroenteritis with resultant hypovolemic shock (16.3%).During the initial 5-year time period, 30.5% of children who died were HIV positive. This percentage decreased to 14% in the latter 5-year time period. A majority of deaths were considered avoidable (89.5%). Potentially modifiable contributors to death included delay in seeking care (45.3% of deaths), poor assessment (36.9%), and inadequate management (29.3%) and monitoring (17.0%) of patients.

Conclusions: Deaths within the first 24 hours after presentation to hospital were a major contributor to overall in-hospital mortality. Identified modifiable contributors to death can be addressed through improved education and training of both health care providers and family caregivers.