Predictors of intestinal perforation in children with typhoid fever

Abstract

Typhoid fever is a major public health problem globally; the greater burden however occurs in the developing countries because of lack of potable water and proper waste management. The disease is associated with a high mortality rate especially in those with enteric perforation or intestinal hemorrhage. The goal of this study was to identify the clinical and laboratory factors that predicts the development of enteric perforation in children with typhoid fever. This study was a retrospective case-control analysis of children admitted for typhoid fever with or without enteric perforation over a three – year period in a newly established teaching hospital in southwestern Nigeria. Forty-seven children with typhoid fever and enteric perforation (cases) were compared with 94 controls (those with typhoid fever but without enteric perforation). Multivariate analysis using logistic regression was applied to all the factors that were initially significantly associated with enteric perforation. Male sex (Odd Ratio, OR = 3.10, p = 0.003); inadequate treatment (OR = 3.03, p < 0.001); short duration of illness (OR = 2.36, p = 0.030); neutrophilia (OR = 2.92, p = 0.013) and elevated erythrocyte sedimentation rate (ESR) (OR = 1.07, p = 0.041) were found to have independently contributed to development of perforation in children with typhoid fever. This study has attempted to outline the factors that may predict typhoid ileal perforation in children, thereby helping in recognition of high risk cases and drawing up of screening tool to facilitate effective and prompt management.

Keywords

Children - clinical - laboratory - perforation - predictors - typhoid