Table 2.
Frequency of children presenting with signs of impaired circulation or shock to hospital in low-resource settings
| Reference | Study design | Study site | Sample | Inclusion criteria | WHO shock and mortality | Number with ≥ 2 signs of impaired circulation |
|---|---|---|---|---|---|---|
| Tamburlini, 1999 | Prospective cohort | Brazil | 3837 | Children 7 days to 5 years old presenting to emergency room | 4 (0.13%) 100% mortality |
ETAT emergency signs (severe respiratory distress, shock, coma/convulsions or severe dehydration) in 98 children |
| Robertson, 2001 | Prospective cohort | QEQH Blantyre, Malawi |
2281 | Emergency room triage Children aged < 5 years |
Not reported | Emergencies (n = 92); only 7–11 had delayed CRT (staff differed in assessments) |
| Ahmad, 2010 | Prospective cohort study | QECH Blantyre, Malawi |
583 | “Critically ill” children presenting to emergency room | Did not report WHO shock triad | 247 (42%) |
| Maitland, 2011 | Phase III RCT | 6 hospitals Kenya, Uganda and Tanzania |
3141 | FEAST trial inclusion criteria | 65 (2%) 41.5% mortality |
3076 (98%) by inclusion criteria |
| Mbevi, 2016, | Retrospective analysis | 14 hospitals Kenya |
42,937 | Admissions in children aged > 30 days to < 5 years (excluded patients with burns or malnutrition) | 41 (0.1%) Mortality not reported |
3219 (7.5%)a |
| CPGH, 2017, unpublished | Prospective cohort | CPGH, Mombasa, Kenya | 26,104 | Admissions <=6 years over 6 years |
27 (0.1%) 85% mortality |
3403 (13.04%) – mortality 31% |
| KDH, 2017, unpublished | Prospective cohort | KDH, Kilifi, Kenya | 22,911 | Admissions <=6 years over 6 years |
33 (0.14%) 58% mortality |
9788 (42.72%) – mortality 7.24% |
ETAT Emergency Triage, Assessment And Treatment, WHO World Health Organization, CRT capillary refill time, KDH Kilifi District Hospital, CPGH Coast Provincial General Hospital, QECH Queen Elizabeth Central Hospital
aShock-associated mortality was more broadly defined: a clinician’s indication that the child had shock as a problem accompanying diarrhoea and dehydration (an indication of the severity of fluid loss); a diagnosis of shock associated with an underlying cause (e.g. septic shock); or use of rapid bolus fluid therapy in a child irrespective of diagnosis