Author Affiliations: Concern Worldwide, Dublin, Ireland (Dr Collins); Center for International Child Health, Institute of Child Health (Dr Collins) and the International Centre for Eye Health, Institute of Ophthalmology, University College London (Mr Myatt), London, England; and Valid International Ltd, Llanidloes, Wales (Dr Collins).
Section Editor: Annette Flanagin, RN, MA,
Managing Senior Editor.
Context In the setting of famine, infection is likely to cause mortality among
severely malnourished persons. Although clinical signs are likely to be useful
prognostic indicators in this setting, use of a clinical assessment model
has not been studied.
Objective To examine the use of clinical signs in the prediction of short-term
mortality in severely malnourished adults and adolescents during famine.
Design Retrospective cohort study.
Setting Concern Worldwide Adult Therapeutic Feeding Center in Baidoa, Somalia.
Patients Data from the clinical records of 383 adult and adolescent inpatients
admitted to the center between November 1992 through March 1993 who were aged
15 years or older and had a body mass index (BMI) of 13.5 kg/m2
or less or any signs of edematous malnutrition.
Main Outcome Measures Association of mortality with presence or absence of 8 clinical signs
(edema, hydration, ascites, dysentery, diarrhea, anemia, chest infection,
and ability to stand) and BMI at admission, and sensitivity and specificity
of models including a count of clinical signs and BMI in the prediction of
mortality at the center.
Results Ninety-one patients (23.8%) died, with a median time to death of 8 days
from admission. Of the 8 clinical signs, severe edema (unadjusted odds ratio
[OR], 2.45; 95% confidence interval [CI], 1.41-4.27), apparent dehydration
(unadjusted OR, 2.73; 95% CI, 1.60-4.66), and inability to stand (unadjusted
OR, 2.96; 95% CI, 1.40-6.26) were independently associated with mortality.
The most useful clinical model was that based on the presence of any 1 of
these 3 signs, with a sensitivity of 77% and a specificity of 59%. Ability
of admission BMI to predict mortality was less than random.
Conclusions Models based on clinical signs predicted death better than BMI. Simple
counts of clinical signs performed as well as more complex models based on
the addition of ORs. Counting relevant clinical signs is an easy and effective
prognostic tool in severe adult and adolescent malnutrition during famine;
however, it is not sensitive enough for use as a screening tool.
Collins S, Myatt M. Short-term Prognosis in Severe Adult and Adolescent Malnutrition During Famine: Use of a Simple Prognostic Model Based on Counting Clinical Signs. JAMA. 2000;284(5):621–626. doi:10.1001/jama.284.5.621
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