Published online December 1, 2004
PEDIATRICS Vol. 114 No. 6 December 2004, pp. 1738 (doi:10.1542/peds.2004-1908)
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Mortality Among Kenyan Children Admitted to a Rural District Hospital on Weekends as Compared With Weekdays: In Reply

James Marcin, MD, MPH
Douglas Taylor, MD, PhD
Department of Pediatrics
University of California Davis Children's Hospital
Sacramento, CA 95817

In Reply.—

The data and comments provided by Dr Berkley et al are greatly appreciated. Using their previously published mortality prediction model,1 these researchers demonstrate that mortality among pediatric patients admitted to a hospital during the weekend are at higher risk of death compared with similar patients admitted during the weekday. The increased death rate was present within the first 48 hours after admission, after adjusting for severity of illness, age, bacteremia, and parasitemia. Although these data are not directly comparable with our evaluation of death rates within the first 24 hours after admission and do not address differences in daytime versus nighttime admissions, they identify a time-dependent mortality disparity within the hospital. It would be important to know if the increased early death rate observed by these investigators is isolated to specific admission diagnoses as ours were to shock, congenital cardiovascular disease, and cardiopulmonary arrest. Regardless, the identification of factors that underlie this observation is necessary to focus attention for future improvements in health care delivery systems. It is particularly important to know if time-dependent death-rate differences observed in North America2,3 and Africa have a common etiology. In the absence of clearly identified causality, it remains incumbent on researchers to follow prospectively the impact of any interventions. We look forward to these results from Dr Berkley et al.

REFERENCES

  1. Berkley JA, Ross A, Mwangi I, et al. Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. BMJ. 2003;326 :361[Abstract/Free Full Text]
  2. Arias Y, Taylor DS, Marcin JP. Association between evening admissions and higher mortality rates in the pediatric intensive care unit. Pediatrics. 2004;113(6) . Available at: www.pediatrics.org/cgi/content/full/113/6/e530
  3. Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2001;345 :663 –668[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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Mortality Among Kenyan Children Admitted to a Rural District Hospital on Weekends as Compared With Weekdays
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