637 - Predictive Value of Clinician Impression for Post-Discharge Mortality and Readmission among Neonates, Infants, and Children in Dar es Salaam, Tanzania and Monrovia, Liberia

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 637
Publication Number: 637.316

Chris A. Rees, Emory University School of Medicine, ATLANTA, GA, United States; Readon C. Ideh, JFK Memorial Medical Center, Monrovia, Montserrado, Liberia; Julia Wisner. Kamara, John F. Kennedy Hospital, Monrovia, Montserrado, Liberia; Ye-Jeung G.. Coleman-Nekar, J.F.K Medical Center, Monrovia, Montserrado, Liberia; Abraham B H. Samma, Emory University School of Medicine, GLOUCESTER, England, United Kingdom; Evance Godfrey, MUHAS, Dar es salaam, Dar es Salaam, Tanzania; Hussein K. Manji, The Aga Khan Hospital, Dar-es-salaam, Dar es Salaam, Tanzania; Christopher Sudfeld, Harvard TH Chan School of Public Health, Boston, MA, United States; Adrianna Westbrook, Emory University School of Medicine, Atlanta, GA, United States; Michelle Niescierenko, Boston Children's Hospital, Boston, MA, United States; Claudia R.. Morris, Emory, Atlanta, GA, United States; Cynthia G.. Whitney, Emory University, Atlanta, GA, United States; Robert F. Breiman, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Karim P. Manji, MUHAS, Dar-es-Salaam, Dar es Salaam, Tanzania; Christopher P. Duggan, Boston Children's Hospital, Boston, MA, United States

Presenting Author(s)

Chris A. Rees, MD, MPH (he/him/his)

Assistant Professor
Emory University School of Medicine
ATLANTA, Georgia, United States

Background: The period of time after an inpatient hospital admission is particularly vulnerable in the life of a child in sub-Saharan Africa, where readmissions are common and where more than half of the 5 million annual deaths among children aged < 5 years occur. There are no validated clinical decision aids to identify neonates and young children at risk of hospital readmission or post-discharge mortality, leaving the decision to discharge a child up to a clinician’s impression.

Objective: To determine the accuracy of clinician impression to identify neonates and young children at risk for 60-day, unplanned hospital readmission and 60-day post-discharge mortality.

Design/Methods: We conducted a prospective observational cohort study in which neonates and children aged 1-59 months discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania and John F. Kennedy Medical Center in Monrovia, Liberia were followed up to 60 days after hospital discharge. Clinicians who discharged each enrolled patient were surveyed at the time of discharge to determine their perceived probability of the patient’s risk of 60-day, unplanned hospital readmission and 60-day post-discharge mortality. Caregivers of enrolled patients received phone calls from research staff at 7, 14, 30, 45, and 60 days after hospital discharge to identify outcomes. We calculated the area under the receiver operating characteristic curve (AUC) to determine the accuracy of clinician impression for both outcomes.

Results: Of 4,247 discharged patients, 3,896 (91.7%) had available clinician surveys: 187 (4.8%) were readmitted and 120 (3.1%) died within 60 days of hospital discharge (Table 1). Clinician impression had poor discriminatory value in identifying neonates and young children at risk of 60-day, unplanned hospital readmission overall (AUC 0.46, 95% confidence interval [CI] 0.43 to 0.49) (Table 2) and 60-day post-discharge mortality (AUC 0.53, 95% CI 0.50 to 0.55) (Table 3). 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).

Conclusion(s):

Given the poor discriminatory value of clinician impression alone to identify neonates and young children at risk of 60-day, unplanned hospital readmission and 60-day post-discharge mortality, validated and objective clinical decision aids are urgently needed.