ArticlePloS one2016
Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death.
Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Critical care delivery models in emergency departments: a systematic review of the literature and meta-analysis of related outcome effects.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Pooled it
- Pooled it
- Service utilisation and outcomes of transfers by a specialised paediatric and neonatal retrieval service in the Western Cape, South Africa.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2025Article
- A validation of machine learning models for the identification of critically ill children presenting to the paediatric emergency room of a tertiary hospital in South Africa: A proof of concept.The Southern African journal of critical care : the official journal of the Critical Care Society · 2024Article
- Healthcare access for children in a low-income area in Cape Town: A mixed-methods case study.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2023Article
- Organisation of care for people receiving drug-resistant tuberculosis treatment in South Africa: a mixed methods study.BMJ open · 2023Article
- Elicitation of domain knowledge for a machine learning model for paediatric critical illness in South Africa.Frontiers in pediatrics · 2023Article
- Doing more with less: The use of non-invasive ventilatory support in a resource-limited setting.PloS one · 2023Article
- Navigating uncertain illness trajectories for young children with serious infectious illness: a modified grounded theory study.BMC health services research · 2022Article
- Predictors and outcome of time to presentation among critically ill paediatric patients at Emergency Department of Muhimbili National Hospital, Dar es Salaam, Tanzania.BMC pediatrics · 2022Article
- A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar.The Southern African journal of critical care : the official journal of the Critical Care Society · 2022Article
- An exploratory assessment of the management of pediatric traumatic brain injury in three centers in Africa.Frontiers in pediatrics · 2022Article
- Development of artificial neural network models for paediatric critical illness in South Africa.Frontiers in pediatrics · 2022Article
- People Welcomed This Innovation with Two Hands: A Qualitative Report of an mHealth Intervention for Community Case Management in Malawi.Annals of global health · 2019Article
- Article
- Assessing the knowledge of emergency medical care personnel in the Free State, South Africa, on aspects of paediatric pre-hospital emergency care.The Pan African medical journal · 2019Article
- Clinical emergency care research in low-income and middle-income countries: opportunities and challenges.BMJ global health · 2019Review
- What's new in PICU in resource limited settings?Intensive care medicine · 2018Article
- A pediatric death audit in a large referral hospital in Malawi.BMC pediatrics · 2018Article
- Salivary biomarkers may measure stress responses in critically ill children.SAGE open medicine · 2018Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
purposeCritically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided.
methodsA year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors.
resultsThe study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children.
conclusionsThe study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care.
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