Comparative mortality for children at one hospital in Kenya staffed with pediatric emergency medicine specialists

Objectives Three decades ago, in North America, pediatric emergency medicine was an evolving subspecialty of pediatrics, contributing in valuable and life-saving ways to the care of children. Currently, in LMICs (low middle-income countries) pediatric programs are expanding training and education in the subspecialty of pediatric emergency medicine. We aim to determine if care provided by a single institution with dedicated pediatric emergency resources and personnel in Kenya can change mortality rates in children with similar mRISC scores suffering from respiratory illness, as compared to previously published data from the same region of Eastern Africa. As mRISC is used at the time of a child's admission to the hospital to describe the severity of their respiratory illness, we will compare mortality rates by mRISC score to compare groups of patients with similar severities of illness between hospitals. Methods A retrospective chart review was performed using written medical records of pediatric patients 30 days to 5 years of age admitted to AIC Kijabe Hospital, Kenya from 2014 to 2018 for respiratory illness. Of 2692 possible admissions identified in the hospital's pediatric database, 377 admissions were included. 34 data points were recorded for each patient admission including demographic information, information involved in calculating the mRISC score, and additional respiratory information. The primary outcomes were mRISC score and mortality. Results 20 (5%) of included patients represented in-hospital mortalities. Across all mRISC scores, our mortality remained much lower than previously reported in the literature in Kenya. Conclusions Our study does support a positive correlation between pediatric emergency medicine training and skills and decreased childhood mortality; however, correlation does not prove causation. How this decrease in mortality was accomplished was likely a combination of many smaller efforts at quality improvement that add up and make a difference as pediatricians are known to be child advocates.
African relevance • Investment in pediatric emergency medicine trained providers affects pediatric mortality • Additional training programs for pediatric emergency medicine are needed • Pediatric Emergency Trained Providers can be effective advocates for clinical care pathway changes with limited resources.