Predictors of expedited hospital discharge in pediatric patients with acute meningoencephalitis admitted to a tertiary care hospital in Karachi, Pakistan
DOI:
https://doi.org/10.61529/idjp.v34i2.375Abstract
Background: Early/expedited discharge (ED) has been investigated for reducing hospital costs and improved patient outcomes in various medical conditions. Owing to high burden of hospitalization due to meningoencephalitis (ME) in pediatric patients, we evaluated predictors of ED at a tertiary care hospital in Karachi, Pakistan.
Material and Methods: This retrospective cross-sectional study was conducted at a tertiary care hospital in Karachi, May 2017 to January 2023 Pakistan. All patients <18 years admitted with suspicion of acute infectious ME who underwent CSF multiplex PCR panel (MenP) testing were included. Demographic, clinical and laboratory data were extracted from electronic medical records. Factors contributing to ED were identified by multivariate logistic regression using STATA 13.1 (Stata Corp, College Station, TX, USA).
Results: Among 631 patients, 190 (30 %) achieved early discharge (ED). Viral pathogens were identified in 131 (21 %), tripling the odds of ED (OR 2.99, 95 % CI 1.92–4.66; p < 0.001). Infants <1 month (OR 0.23, 95 % CI 0.08–0.68), altered consciousness (OR 0.30, 95 % CI 0.17–0.67), positive blood cultures, and higher CSF protein (OR 0.99 per unit, 95 % CI 0.98–0.99) independently reduced ED likelihood in multivariate analysis.
Conclusion: Diagnosis of a viral etiology in older children expedites hospital discharge. Thus, CSF molecular testing, particularly enterovirus PCR should be performed in pediatric patients with acute ME.
Keywords: CSF, Early discharge, Enterovirus, Meningoencephalitis, Multiplex PCR, Pediatric, Viral etiology
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