Predictive value of clinician impression for readmission and postdischarge mortality among neonates and young children in Dar es Salaam, Tanzania and Monrovia, Liberia.

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  • Additional Information
    • Source:
      Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101715309 Publication Model: Print Cited Medium: Internet ISSN: 2399-9772 (Electronic) Linking ISSN: 23999772 NLM ISO Abbreviation: BMJ Paediatr Open Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BMJ Publishing Group, [2017]-
    • Subject Terms:
      Patient Discharge* ; Aftercare*; Infant, Newborn ; Humans ; Child ; Child, Preschool ; Liberia/epidemiology ; Tanzania/epidemiology ; Patient Readmission
    • Abstract:
      Background: There are no validated clinical decision aids to identify neonates and young children at risk of hospital readmission or postdischarge mortality in sub-Saharan Africa, leaving the decision to discharge a child to a clinician's impression. Our objective was to determine the precision of clinician impression to identify neonates and young children at risk for readmission and postdischarge mortality.
      Methods: We conducted a survey study nested in a prospective observational cohort of neonates and children aged 1-59 months followed 60 days after hospital discharge from Muhimbili National Hospital in Dar es Salaam, Tanzania or John F. Kennedy Medical Center in Monrovia, Liberia. Clinicians who discharged each enrolled patient were surveyed to determine their perceived probability of the patient's risk of 60-day hospital readmission or postdischarge mortality. We calculated the area under the precision-recall curve (AUPRC) to determine the precision of clinician impression for both outcomes.
      Results: Of 4247 discharged patients, 3896 (91.7%) had available clinician surveys and 3847 (98.7%) had 60-day outcomes available: 187 (4.8%) were readmitted and 120 (3.1%) died within 60 days of hospital discharge. Clinician impression had poor precision in identifying neonates and young children at risk of hospital readmission (AUPRC: 0.06, 95% CI: 0.04 to 0.08) and postdischarge mortality (AUPRC: 0.05, 95% CI: 0.03 to 0.08). Patients for whom clinicians attributed inability to pay for future medical treatment as the reason for risk for unplanned hospital readmission had 4.76 times the odds hospital readmission (95% CI: 1.31 to 17.25, p=0.02).
      Conclusions: Given the poor precision of clinician impression alone to identify neonates and young children at risk of hospital readmission and postdischarge mortality, validated clinical decision aids are needed to aid in the identification of young children at risk for these outcomes.
      Competing Interests: Competing interests: None declared.
      (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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    • Grant Information:
      K24 DK104676 United States DK NIDDK NIH HHS; P30 DK040561 United States DK NIDDK NIH HHS
    • Contributed Indexing:
      Keywords: health services research; mortality; neonatology
    • Publication Date:
      Date Created: 20230629 Date Completed: 20230703 Latest Revision: 20231121
    • Publication Date:
      20231215
    • Accession Number:
      PMC10314694
    • Accession Number:
      10.1136/bmjpo-2023-001972
    • Accession Number:
      37385735