Clinical predictors of circulatory failure and coexisting morbidities in children seen in an emergency room in Southern Nigeria

Abstract

Background: Circulatory failure (shock) is a life‑threatening emergency referring to a state of poor tissue perfusion and resultant anaerobic respiration at a cellular level. It is a common pathway for several severe pediatric morbidities. Aim: We evaluated the clinical predictors of shock and coexisting morbidities in acutely‑ill children. Patients and Methods: This was a descriptive, cross‑sectional study. Data were collected using a researcher‑administered questionnaire eliciting demography, clinical features, diagnoses/differentials, and comorbidities. After binary analysis, multiple logistic regression identified variables that independently predict circulatory failure in the participants, using odds ratio (OR) and 95% confidence intervals (CI). Results: Five hundred and fifty‑four children took part in the study. Their median age was 60 (IQR: 24–132) months, mean weight 16.3 ± 13.6 kg and mean height was 90.8 ± 33.2 cm; 53.7% of them were males while 46.3% were females. The incidence of shock was 14.3% among the participants on arrival at the emergency room. Febrile seizure (14.9%), dehydration (4.7%), pallor (3.1%), and coma (1.8%) were the clinical findings significantly associated with shock (P < 0.05). Leading underlying diagnoses and comorbidities associated with shock were severe malaria (85.4%) and severe sepsis (25.0%) (P ≤ 0.01). Also, seizure (OR = 0.07, 95% CI: 0.04–0.13; P ≤ 0.001) and severe sepsis (OR = 0.31, 95% CI: 0.15–0.65; P = 0.002) were independent predictors of circulatory failure. Conclusion: The presence of acute neurologic morbidities and severe infection predicts circulatory failure in the pediatric emergency setting. Early detection and prompt treatment will forestall shock‑related complications in affected children.