Unplanned discharges and their impact on postdischarge mortality in Ugandan children: a multisite cohort study.

Abstract

Unplanned discharges are an important risk factor for adverse outcomes in children. We aimed to assess the impact of unplanned discharge on postdischarge outcomes and to identify key clinical and socioeconomic risk factors. We conducted a secondary analysis of a multisite observational study in six Ugandan hospitals. Children aged 0-60 months admitted with suspected sepsis were enrolled (July 2017-April 2020) and followed for 6 months after discharge. Multivariable logistic regression adjusted for demographic, clinical and socioeconomic factors (including age, sex and site) identified risk factors for unplanned discharge and Cox proportional hazards regression similarly adjusted for demographic, clinical and socioeconomic factors assessed its impact on readmission and mortality. Of 6189 children who survived to discharge, 5403 (87.2%) had a planned discharge and 786 (12.8%) had an unplanned discharge with no unascertained cases. Among children with planned discharge, 271 (5.1%) of 5312 died within 6 months of discharge, compared with 105 (13.4%) of 760 among children with unplanned discharge. Unplanned discharge was associated with higher mortality (HR=2.6, 95% CI 1.9 to 3.5) and readmission (HR=2.4, 95% CI 1.4 to 4.2). In analyses identifying factors associated with unplanned discharge, risk factors included malnutrition, HIV and anaemia, as well as lower maternal education, greater distance from hospital and father-led presentation. Unplanned discharges are common and strongly associated with postdischarge mortality and readmission. Interventions targeting children at high risk of unplanned discharge, including those facing clinical, socioeconomic and structural barriers to care, are urgently needed to improve outcomes.