Download PDF
CC BY 4.0 · Journal of Child Science 2021; 11(01): e193-e198
DOI: 10.1055/s-0041-1731334
Original Article

The Clinical Profile, Early Warning Score, and Outcome of Children Aged 0–12 Years Referred to a Tertiary Care Hospital in North India

Brinda Eswaramoorthy
1   Department of Pediatrics, Manipal Hospitals, Bengaluru, Karnataka, India
,
Ratan Gupta
2   Department of Pediatrics, Vardhman Mahavir Medical College, New Delhi, India
,
Meenakshi Bhatt 
2   Department of Pediatrics, Vardhman Mahavir Medical College, New Delhi, India
,
Manas Pratim Roy
3   Department of Pediatrics, Ministry of Health and Family Welfare, Delhi, India
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Pediatric patients are referred for multiple reasons, either for better therapeutic services or diagnostic purposes. The clinical condition of patients at the time of referral can significantly affect the outcome of such patients and there is not much data on this aspect. The overall objective of this study was to study the demographic and clinical profile, the causes for referral, and the outcome of pediatric patients being referred to a single tertiary care hospital. This was a prospective observational study done in the Department of Pediatrics of a single tertiary care hospital in North India over the course of 1 year. Patients referred from other health facilities in the age group 0 to 12 years who were admitted in the pediatric ward of the hospital were enrolled. The primary objective was to study the clinical profile and outcome (mortality) of these patients. The secondary objectives were to study the referral pattern of the referred patients, causes for referral, and the severity of illness at the time of admission as assessed by Irish Pediatric Early Warning Score (PEWS) and its correlation with the outcome. The outcomes were categorized as: discharge, death, left against medical advice, referred to other centers, others. Early warning scores are useful to measure the severity of disease and to follow patients' progress. The Irish PEWS score was used in this study to provide a rapid measure of the degree of sickness. Respiratory system disorders and neonatal illnesses were the most common illnesses observed. Most patients had low disease severity as per Irish PEWS score. The overall mortality rate among the referred patients was 19.25%. Patients with younger age, higher scores, neonatal illnesses, and neurological disorders had higher risk of mortality. Training of health personnel at primary and secondary levels in the commonly encountered illnesses will improve provision of care at the local level and decrease low risk referrals.

Keywords

referral - Irish PEWS - pediatric - mortality

Ethical Approval

Ethical approval was taken from institutional review board (reference number IEC/VMMC/SJH/Thesis/July/2016/1073, dated June 28, 2018).


Authors' Contributions

B.E., R.G., and M.B. were involved in patient care. All authors were involved in the preparation of manuscript and planning and execution of the study.




Publication History

Received: 08 January 2021

Accepted: 02 May 2021

Article published online:
20 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ma S, Sood NA. Comparison of the Health Systems in China and India. CA: Rand Corporation; 2008
    Google Scholar
  • 2 MOHFW Indian Public Health Standards. Revised guidelines- New Delhi Directorate General of Health Services, Ministry of Health and Family Welfare,. Govt. of India; 2012 . Accessed April 3, 2016 at: http://nrhm.gov.in/nhm/nrhm/guidelines/indian-public-health-standards.html
    PubMedGoogle Scholar
  • 3 Aggarwal KC, Gupta R, Sharma S, Sehgal R, Roy MP. Mortality in newborns referred to tertiary hospital: an introspection. J Family Med Prim Care 2015; 4 (03) 435-438
    CrossrefPubMedGoogle Scholar
  • 4 Singhi S, Singhi S, Gupta G. Comparison of pediatric emergency patients in a tertiary care hospital vs a community hospital. Indian Pediatr 2004; 41 (01) 67-72
    PubMedGoogle Scholar
  • 5 Marcoux D, Nadeau K, McCuaig C, Powell J, Oligny LL. Pediatric anogenital warts: a 7-year review of children referred to a tertiary-care hospital in Montreal, Canada. Pediatr Dermatol 2006; 23 (03) 199-207
    CrossrefPubMedGoogle Scholar
  • 6 Doyle DJ. Clinical early warning scores: new clinical tools in evolution. Open Anaesth J 2018; 12: 26-33
    CrossrefPubMedGoogle Scholar
  • 7 Paediatric Early Warning System (PEWS). Available at: https://www.rcpi.ie/paediatric-early-warning-system/
    PubMed
  • 8 Shahab N, Munir S, Bhatti N. Analysis of pediatric medical admission pattern to a tertiary care hospital. Ann Pak Inst Med Sci 2010; 6 (04) 219-222
    PubMedGoogle Scholar
  • 9 Sankar J, Singh A, Narsaria P, Dev N, Singh P, Dubey N. Prehospital transport practices prevalent among patients presenting to the pediatric emergency of a tertiary care hospital. Indian J Crit Care Med 2015; 19 (08) 474-478
    CrossrefPubMedGoogle Scholar
  • 10 Simba DO, Mbembati NA, Museru LM, Lema LE. Referral pattern of patients received at the national referral hospital: challenges in low income countries. East Afr J Public Health 2008; 5 (01) 6-9
    PubMedGoogle Scholar
  • 11 Saleem M, Iqbal R, Bokhari S, Ali M, Khan Z. Pattern of neonatal admissions & its outcome in a tertiary care hospital of Southern Punjab (a 5 year study). Pakistan J Med Health Sci 2014; 8 (04) 916
    PubMedGoogle Scholar
  • 12 Sanders D, Kravitz J, Lewin S, McKee M. Zimbabwe's hospital referral system: does it work?. Health Policy Plan 1998; 13 (04) 359-370
    CrossrefPubMedGoogle Scholar
  • 13 Ezhumalai G, Jayashree M, Nallasamy K, Bansal A, Bharti B. Referrals to a pediatric emergency department of a tertiary care teaching hospital before and after introduction of a referral education module—a quality improvement study. BMC Health Serv Res 2020; 20 (01) 761
    CrossrefPubMedGoogle Scholar