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Paediatric emergencies and related mortality in Nicaragua: results from a multi-site paediatric emergency registry
  1. Silvia Bressan1,
  2. Liviana Da Dalt1,
  3. Miriam Chamorro2,
  4. Raquel Abarca2,
  5. Danila Azzolina3,
  6. Dario Gregori3,
  7. Fabio Sereni4,
  8. Giovanni Montini4,
  9. Gianni Tognoni5
  1. 1 Division of Paediatric Emergency Medicine - Department of Women’s and Child’s Health, Università degli Studi di Padova, Padova, Veneto, Italy
  2. 2 Department of Pediatric Emergency Medicine, Hospital Infantil La Mascota, Managua, Nicaragua
  3. 3 Unit of Biostatistics, Epidemiology and Public Health - Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Veneto, Italy
  4. 4 Paediatric Nephrology, Dialysis and Transplant Unit- Department of Pediatrics, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Universita degli Studi di Milano, Milano, Lombardia, Italy
  5. 5 Departement of Anesthesia, Critical care, Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milan, Lombardy, Italy
  1. Correspondence to Dr Silvia Bressan, Department of Women's and Child's Health, Università degli Studi di Padova, Padova, Veneto, Italy; silviabress{at}


Background We aim to describe the characteristics and outcomes of the severe spectrum of paediatric emergency visits using a multi-site registry developed as part of an international cooperation project.

Methods This observational registry-based study presented descriptive statistics of clinical and outcome data on urgent-emergency paediatric visits from 7 Nicaraguan hospitals, including the national referral paediatric hospital, between January and December 2017. Extensive piloting to ensure data collection feasibility, sustainability and accuracy was carried out in 2016 with substantial input and feedback from local stakeholders.

Results Overall, 3521 visits of patients <15 years of age, of whom two-thirds <5 years, met predefined inclusion criteria of urgent-emergency visits. Respiratory (1619/3498; 46%), gastrointestinal (407/3498; 12%) and neurological (368/3498; 11%) complaints were the most common symptoms. Malnutrition was reported in 18% (610/3448) of presentations. Mortality was 7% (233/3521); 52% (120/233) of deaths occurred in the <1-year subgroup; 32% (71/3521) of deaths occurred within the first 24 hours of presentation. The most common immediate causes of death were septic shock (99/233; 43%), respiratory failure (58/233; 25%) and raised intracranial pressure (24/233; 10%).

Conclusions The mortality rate of urgent-emergency paediatric visits in Nicaragua is high, with younger children being most at risk and the majority of deaths being eventually caused by septic shock or respiratory failure. Our data provide useful information for the development of a Paediatric Emergency Care network to help direct training efforts, resources and logistic/organisational interventions to improve children’s health in an emergency setting in Nicaragua.

  • paediatrics
  • paediatric emergency medicine
  • global health
  • emergency care systems

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Handling editor Gene Yong-Kwang Ong

  • Contributors SB, LDD and GT conceptualised and designed the study, evaluated the data, drafted the initial manuscript, and reviewed and revised the manuscript. MC and RA coordinated and supervised local data collection, evaluated the data, and reviewed and revised the manuscript. GM and FS participated in the design of the study, evaluated the data, and reviewed and revised the manuscript. DG and DA evaluated and analysed the data and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This study was funded by the Regione Lombardia and the Associazione il Bambino Nefropatico (Italy).

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.