Table 2.
Care received by patients
| Total (n=3849) | High-income countries (n=896) | Middle-income countries (n=2860) | Low-income countries (n=93) | p value* | |||
|---|---|---|---|---|---|---|---|
| Antenatal care, delivery, transportation to the paediatric surgery centre, and referral site | |||||||
| Antenatal ultrasound | |||||||
| Yes, study condition diagnosed | 881 (22·9%) | 368 (41·1%) | 512 (17·9%) | 1 (1·1%) | <0·0001 | ||
| Yes, problem identified but study condition not diagnosed | 457 (11·9%) | 138 (15·4%) | 311 (10·9%) | 8 (8·6%) | .. | ||
| Yes, no problem identified | 1945 (50·5%) | 343 (38·3%) | 1551 (54·2%) | 51 (54·8%) | .. | ||
| No | 558 (14·5%) | 44 (4·9%) | 482 (16·9%) | 32 (34·4%) | .. | ||
| Missing | 8 (0·2%) | 3 (0·3%) | 4 (0·1%) | 1 (1·1%) | .. | ||
| Gestational age of study condition diagnosis if antenatal, weeks | 25 (20–31) | 21 (16–27) | 28 (21–32) | .. | 0·0002 | ||
| Type of delivery | |||||||
| Vaginal (spontaneous) | 1767 (45·9%) | 373 (41·6%) | 1324 (46·3%) | 70 (75·3%) | <0·0001 | ||
| Vaginal (induced) | 194 (5·0%) | 97 (10·8%) | 92 (3·2%) | 5 (5·4%) | .. | ||
| Caesarean section (elective) | 1022 (26·6%) | 185 (20·6%) | 830 (29·0%) | 7 (7·5%) | .. | ||
| Caesarean section (urgent or non-elective) | 825 (21·4%) | 226 (25·2%) | 591 (20·7%) | 8 (8·6%) | .. | ||
| Unknown | 37 (1·0%) | 14 (1·6%) | 21 (0·7%) | 2 (2·2%) | .. | ||
| Missing | 4 (0·1%) | 1 (0·1%) | 2 (0·1%) | 1 (1·1%) | .. | ||
| Born at the study hospital | |||||||
| Yes | 1011 (26·3%) | 391 (43·6%) | 618 (21·6%) | 2 (2·2%) | <0·0001 | ||
| Missing | 5 (0·1%) | 1 (0·1%) | 4 (0·1%) | 0 (0·0%) | .. | ||
| Mode of transport to hospital if born elsewhere | |||||||
| Ambulance or other transport provided by the health service | 1677 (59·1%) | 430 (85·1%) | 1197 (53·4%) | 50 (54·9%) | <0·0001 | ||
| Patient's own transport | 1156 (40·7%) | 74 (14·7%) | 1041 (46·4%) | 41 (45·1%) | .. | ||
| Missing | 5 (0·2%) | 1 (0·2%) | 4 (0·2%) | 0 | .. | ||
| Location from which patient presented if born elsewhere | |||||||
| District hospital | 1835 (64·7%) | 401 (79·4%) | 1377 (61·4%) | 57 (62·6%) | <0·0001 | ||
| Home | 504 (17·8%) | 51 (10·1%) | 445 (19·8%) | 8 (8·8%) | .. | ||
| Community clinic or general practice | 446 (15·7%) | 44 (8·7%) | 379 (16·9%) | 23 (25·3%) | .. | ||
| From another country | 7 (0·2%) | 3 (0·6%) | 4 (0·2%) | 0 | .. | ||
| From a different specialty within the hospital | 5 (0·2%) | 4 (0·8%) | 0 | 1 (1·1%) | .. | ||
| Unknown | 33 (1·2%) | 1 (0·2%) | 30 (1·3%) | 2 (2·2%) | .. | ||
| Missing | 8 (0·3%) | 1 (0·2%) | 7 (0·3%) | 0 | .. | ||
| Care at the paediatric surgery centre | |||||||
| Resuscitation on arrival | |||||||
| Administration of appropriate antibiotics if septic | |||||||
| n | 660 | 38 | 598 | 24 | .. | ||
| Yes, within 1 h of arrival | 500 (75·8%) | 31 (81·6%) | 454 (75·9%) | 15 (62·5%) | 0·42 | ||
| Yes, within the first day of arrival | 150 (22·7%) | 7 (18·4%) | 135 (22·6%) | 8 (33·3%) | .. | ||
| No | 10 (1·5%) | 0 | 9 (1·5%) | 1 (4·2%) | .. | ||
| Administration of intravenous fluid if hypovolaemic | |||||||
| n | 564 | 75 | 478 | 11 | .. | ||
| Yes, within 1 h of arrival | 440 (78·0%) | 40 (53·3%) | 394 (82·4%) | 6 (54·5%) | <0·0001 | ||
| Yes, within the first day of arrival | 104 (18·4%) | 24 (32·0%) | 76 (15·9%) | 4 (36·4%) | .. | ||
| No | 19 (3·4%) | 10 (13·3%) | 8 (1·7%) | 1 (9·1%) | .. | ||
| Missing | 1 (0·2%) | 1 (1·3%) | 0 | 0 | .. | ||
| Quantity of intravenous fluid given if hypovolaemic | |||||||
| n | 564 | 75 | 478 | 11 | .. | ||
| 10–20 mL/kg | 408 (72·3%) | 36 (48·0%) | 363 (75·9%) | 9 (81·8%) | <0·0001 | ||
| >20 mL/kg | 135 (23·9%) | 28 (37·3%) | 106 (22·2%) | 1 (9·1%) | .. | ||
| Missing | 21 (3·7%) | 11 (14·7%) | 9 (1·9%) | 1 (9·1%) | .. | ||
| Warming of patient to within normal range on arrival if hypothermic | |||||||
| n | 403 | 32 | 358 | 13 | .. | ||
| Yes | 371 (92·1%) | 28 (87·5%) | 330 (92·2%) | 13 (100·0%) | 0·35 | ||
| Primary intervention | |||||||
| Time from arrival at study hospital to primary intervention, h | 24 (7–66) | 22 (5–48) | 24 (8–72) | 34 (10–96) | 0·0001 | ||
| Type of anaesthesia used for primary intervention | |||||||
| General anaesthesia with endotracheal tube or laryngeal airway | 3154 (81·9%) | 772 (86·2%) | 2327 (81·3%) | 55 (59·1%) | <0·0001 | ||
| Intervention without anaesthesia and with or without analgesia | 248 (6·4%) | 67 (7·5%) | 178 (6·2%) | 3 (3·2%) | .. | ||
| Local anaesthesia only | 25 (0·6%) | 1 (0·1%) | 24 (0·8%) | 0 | .. | ||
| Spinal or caudal anaesthesia | 19 (0·5%) | 0 | 19 (0·7%) | 0 | .. | ||
| Ketamine anaesthesia | 9 (0·2%) | 1 (0·1%) | 5 (0·2%) | 3 (3·2%) | .. | ||
| Not applicable (no surgery or primary intervention) | 392 (10·2%) | 55 (6·1%) | 305 (10·7%) | 32 (34·4%) | .. | ||
| Missing | 2 (0·1%) | 0 | 2 (0·1%) | 0 | .. | ||
| Person delivering anaesthetic for primary intervention | |||||||
| Anaesthetic doctor | 3115 (80·9%) | 741 (82·7%) | 2336 (81·7%) | 38 (40·9%) | <0·0001 | ||
| Medical officer, surgeon, or other health-care professional | 86 (2·3%) | 42 (4·7%) | 41 (1·5%) | 3 (3·2%) | .. | ||
| Anaesthetic nurse | 35 (0·9%) | 1 (0·1%) | 17 (0·6%) | 17 (18·3%) | .. | ||
| No anaesthetic | 610 (15·8%) | 112 (12·5%) | 463 (16·2%) | 35 (37·6%) | .. | ||
| Missing | 3 (0·1%) | 0 | 3 (0·1%) | 0 | .. | ||
| Person delivering primary intervention | |||||||
| Paediatric surgeon (or junior with paediatric surgeon assisting or in the room) | 3345 (86·9%) | 825 (92·1%) | 2474 (86·5%) | 46 (49·5%) | <0·0001 | ||
| Junior doctor or other (without a paediatric or general surgeon assisting or in the room) | 59 (1·5%) | 7 (0·8%) | 49 (1·7%) | 3 (3·2%) | .. | ||
| Trainee surgeon (without a paediatric or general surgeon assisting or in the room) | 49 (1·3%) | 7 (0·8%) | 36 (1·3%) | 6 (6·5%) | .. | ||
| General surgeon (or junior with general surgeon assisting or in the room) | 32 (0·8%) | 7 (0·8%) | 18 (0·6%) | 7 (7·5%) | .. | ||
| Not applicable (no surgery or primary intervention) | 361 (9·4%) | 49 (5·5%) | 281 (9·8%) | 31 (33·3%) | .. | ||
| Missing | 3 (0·1%) | 1 (0·1%) | 2 (0·1%) | 0 | .. | ||
| Surgical safety checklist used at the time of primary intervention | |||||||
| Yes | 2569 (66·7%) | 747 (83·4%) | 1791 (62·6%) | 31 (33·3%) | <0·0001 | ||
| No | 693 (18·0%) | 39 (4·4%) | 626 (21·9%) | 28 (30·1%) | .. | ||
| Not applicable (no surgical intervention) | 584 (15·1%) | 109 (12·1%) | 441 (15·4%) | 34 (36·5%) | .. | ||
| Missing | 3 (0·1%) | 1 (0·1%) | 2 (0·1%) | 0 | .. | ||
| Perioperative care | |||||||
| Patient received central venous access | |||||||
| Yes, peripherally inserted central catheter | 1120 (29·1%) | 436 (48·7%) | 678 (23·7%) | 6 (6·5%) | <0·0001 | ||
| Yes, percutaneously inserted central line | 415 (10·8%) | 187 (20·9%) | 228 (8·0%) | 0 | <0·0001 | ||
| Yes, umbilical catheter | 402 (10·4%) | 153 (17·1%) | 249 (8·7%) | 0 | <0·0001 | ||
| Yes, surgically placed central line (open insertion) | 254 (6·6%) | 27 (3·0%) | 227 (7·9%) | 0 | <0·0001 | ||
| No | 1910 (49·6%) | 226 (25·2%) | 1597 (55·8%) | 87 (93·5%) | <0·0001 | ||
| Total duration of antibiotics after primary intervention, days | 7 (3–11) | 3 (1–7) | 7 (3–13) | 3 (0–7) | 0·0001 | ||
| Blood transfusion | |||||||
| Not required | 2448 (63·6%) | 671 (74·9%) | 1708 (59·7%) | 69 (74·2%) | <0·0001 | ||
| Yes | 1348 (35·0%) | 213 (23·8%) | 1114 (38·9%) | 21 (22·6%) | .. | ||
| Required but not available | 47 (1·2%) | 9 (1·0%) | 35 (1·2%) | 3 (3·2%) | .. | ||
| Missing | 6 (0·1%) | 3 (0·3%) | 3 (0·1%) | 0 | .. | ||
| Ventilation | |||||||
| No | 1755 (45·6%) | 258 (28·8%) | 1422 (49·7%) | 75 (80·6%) | <0·0001 | ||
| Yes | 2008 (52·2%) | 637 (71·1%) | 1363 (47·7%) | 8 (8·6%) | .. | ||
| Required but not available | 85 (2·2%) | 1 (0·1%) | 74 (2·6%) | 10 (10·8%) | .. | ||
| Missing | 1 (<0·1%) | 0 | 1 (<0·1%) | 0 | .. | ||
| Duration of ventilation if given, days | 4 (2–8) | 4 (2–9) | 4 (2–8) | 2 (1–3) | 0·0025 | ||
| Time to first enteral feed post-primary intervention, days | 4 (2–8) | 4 (2–8) | 4 (2–8) | 1 (1–3) | <0·0001 | ||
| Time to full enteral feeds post-primary intervention, days | 8 (4–16) | 11 (6–22) | 7 (3–15) | 3 (2–7) | <0·0001 | ||
| Parenteral nutrition | |||||||
| No | 1476 (38·3%) | 212 (23·7%) | 1196 (41·8%) | 68 (73·1%) | <0·0001 | ||
| Yes | 2102 (54·6%) | 683 (76·2%) | 1416 (49·5%) | 3 (3·2%) | .. | ||
| Yes, but less was available than required | 143 (3·7%) | 0 | 143 (5·0%) | 0 | .. | ||
| Required but not available | 125 (3·2%) | 0 | 103 (3·6%) | 22 (23·7%) | .. | ||
| Missing | 3 (0·1%) | 1 (0·1%) | 2 (0·1%) | 0 | .. | ||
| Duration of parenteral nutrition if received, days | 11 (6–20) | 14 (8–24) | 10 (5–18) | 30 (10–30) | 0·0001 | ||
Data are n (%), median (IQR), or n.
*
p values represent univariable testing between country income strata.