Spectrum, Treatments and Outcomes of Shock in Acutely-ill Children Seen at the Emergency Room of a Tertiary Hospital in Southern Nigeria

Abstract

Introduction: Shock is a state of inadequate tissue perfusion. The emergency care of shock in children is dynamic but fluid therapy remains its cornerstone, with variable effectiveness. We evaluated the spectrum, therapies and outcomes of shock in our Children Emergency Room. Methods: This was an analytic, cross-sectional study. Data were collected using a structured questionnaire comprising demography, clinical features, shock diagnoses, emergency care and outcomes. Co-existing morbidities in the participants were mainly infection-related. Both descriptive and inferential analyses were done; prognostic factors in children with shock were identified, using odds ratio (OR) and 95% confidence intervals (CI).   Results: Five hundred and fifty-four acutely-ill children participated in the study. Their mean duration of illness was 13.5 days (± 4.7). The incidence of shock was 83 (15.0%). For the types of shock recorded (n = 42), hypovolemic shock was the commonest, 24 (57.1%). Septic shock occurred in 14 (33.3%) children, while cardiogenic shock was seen in 4 (9.6%) children. Among the affected children, 17 (40.5%) were fluid responsive, 5 (11.9%) were fluid refractory, and 20 (47.6%) were fluid refractory and dopamine dependent. The case fatality rate of shock was 57.8%. Children who presented with shock were more likely to die compared to others (OR = 11.811, 95% CI = 6.976–19.998, p < 0.001). Dopamine infusion was significantly associated with lower mortality risk, with an odds ratio of 0.039 (95% CI 0.008-0.196, p < 0.001). Conclusion: Circulatory failure especially hypovolemic shock is common in acutely-ill children with dire consequences. Fluid therapy and catecholamine infusion can improve survival in the emergency setting.