Résumé :
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[BDSP. Notice produite par INIST 1dMTOR0x. Diffusion soumise à autorisation]. Context In the setting of famine, infection is likely to cause mortality among severely malnourished persons. Although clinical signs are likely to be useful prognostic indicators in this setting, use of a clinical assessment model has not been studied. Objective To examine the use of clinical signs in the prediction of short-term mortality in severely malnourished adults and adolescents during famine. Design Retrospective cohort study. Setting Concern Worldwide Adult Therapeutic Feeding Center in Baidoa, Somalia. Patients Data from the clinical records of 383 adult and adolescent inpatients admitted to the center between November 1992 through March 1993 who were aged 15 years or older and had a body mass index (BMI) of 13.5 kg/m2 or less or any signs of edematous malnutrition. Main Outcome Measures Association of mortality with presence or absence of 8 clinical signs (edema, hydration, ascites, dysentery, diarrhea, anemia, chest infection, and ability to stand) and BMI at admission, and sensitivity and specificity of models including a count of clinical signs and BMI in the prediction of mortality at the center. Results Ninety-one patients (23.8%) died, with a median time to death of 8 days from admission. Of the 8 clinical signs, severe edema (unadjusted odds ratio [OR], 2.45 ; 95% confidence interval [Cl], 1.41-4.27), apparent dehydration (unadjusted OR, 2.73 ; 95% Cl, 1.60-4.66), and inability to stand (unadjusted OR, 2.96 ; 95% Cl, 1.40-6. (...)
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