Artigo Revisado por pares

Predictors of death in infants hospitalized with pertussis: a case-control study of 16 pertussis deaths in Canada

2003; Elsevier BV; Volume: 143; Issue: 5 Linguagem: Inglês

10.1067/s0022-3476(03)00365-2

ISSN

1097-6833

Autores

Lynda K Mikelova, Scott A. Halperin, David W. Scheifele, Bruce R. Smith, Elizabeth Ford-Jones, Wendy Vaudry, Taj Jadavji, Barbara Law, Dorothy Moore,

Tópico(s)

Vaccine Coverage and Hesitancy

Resumo

Abstract Objectives To describe the clinical course of fatal cases of pertussis and identify predictors of death at the time of presentation for medical care. Methods Case-control study of 16 deaths from pertussis identified by the Immunization Monitoring Program, Active (IMPACT) surveillance network (January 1991-December 2001) matched with 32 nonfatal cases by age, date, and geography. Differences were compared by Fisher exact test and logistic regression. A multivariate model was developed using stepwise logistic regression. Results All 16 fatal cases were ≤6 months old; 13 were <2 months old. Fatal cases were less likely to have had cough complications during pregnancy (48% vs 14%; P =.046) and more likely to have pneumonia (63% vs 16%; P =.0024) before hospital admission and more likely to have seizures, pneumonia, leukocytosis, and hypoxemia after admission ( P <.001 for all comparisons). White blood cell count and pneumonia were independent predictors of fatal outcome in the multivariate model. Conclusions Infants too young to have begun their immunizations are at highest risk of fatal pertussis infection. Leukocytosis and pneumonia are predictors of a poor outcome; however, rapid progression of the disease may make interventions difficult.

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