{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T04:31:07Z","timestamp":1788409867904,"version":"build-2803163510"},"reference-count":93,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T00:00:00Z","timestamp":1657152000000},"content-version":"vor","delay-in-days":31,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Shock is a life-threatening condition in children in low- and middle-income countries (LMIC), with several controversies. This systematic review summarizes the etiology, pathophysiology and mortality of shock in children in LMIC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched for studies reporting on children with shock in LMIC in PubMed, Embase and through snowballing (up to 1 October 2019). Studies conducted in LMIC that reported on shock in children (1 month\u201318\u2009years) were included. We excluded studies only containing data on neonates, cardiac surgery patients or iatrogenic causes. We presented prevalence data, pooled mortality estimates and conducted subgroup analyses per definition, region and disease. Etiology and pathophysiology data were systematically collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 959 studies and included 59 studies of which six primarily studied shock. Definitions used for shock were classified into five groups. Prevalence of shock ranged from 1.5% in a pediatric hospital population to 44.3% in critically ill children. Pooled mortality estimates ranged between 3.9-33.3% for the five definition groups. Important etiologies included gastroenteritis, sepsis, malaria and severe anemia, which often coincided. The pathophysiology was poorly studied but suggests that in addition to hypovolemia, dissociative and cardiogenic shock are common in LMIC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Shock is associated with high mortality in hospitalized children in LMIC. Despite the importance few studies investigated shock and as a consequence limited data on etiology and pathophysiology of shock is available. A uniform bedside definition may help boost future studies unravelling shock etiology and pathophysiology in LMIC.<\/jats:p><\/jats:sec>","DOI":"10.1093\/tropej\/fmac053","type":"journal-article","created":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T14:07:47Z","timestamp":1657202867000},"source":"Crossref","is-referenced-by-count":19,"title":["Etiology, Pathophysiology and Mortality of Shock in Children in Low (Middle) Income Countries: A Systematic Review"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3563-3460","authenticated-orcid":false,"given":"Roxanne","family":"Assies","sequence":"first","affiliation":[{"name":"Amsterdam UMC location University of Amsterdam, PICU, Emma Children\u2019s Hospital, Meibergdreef 9 , Amsterdam, the Netherlands"},{"name":"Amsterdam Centre for Global Child Health , Amsterdam, the Netherlands"},{"name":"Department of Paediatrics and Child Health, Kamuzu University of Health Sciences KUHeS Malawi , Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilse","family":"Snik","sequence":"additional","affiliation":[{"name":"Amsterdam UMC location University of Amsterdam, PICU, Emma Children\u2019s Hospital, Meibergdreef 9 , Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercy","family":"Kumwenda","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Kamuzu University of Health Sciences KUHeS Malawi , Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamikani","family":"Chimalizeni","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Kamuzu University of Health Sciences KUHeS Malawi , Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Langton","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Kamuzu University of Health Sciences KUHeS Malawi , Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2241-7806","authenticated-orcid":false,"given":"Job B M","family":"van Woensel","sequence":"additional","affiliation":[{"name":"Amsterdam UMC location University of Amsterdam, PICU, Emma Children\u2019s Hospital, Meibergdreef 9 , Amsterdam, the Netherlands"},{"name":"Amsterdam Centre for Global Child Health , Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Doctor","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine , Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job C J","family":"Calis","sequence":"additional","affiliation":[{"name":"Amsterdam UMC location University of Amsterdam, PICU, Emma Children\u2019s Hospital, Meibergdreef 9 , Amsterdam, the Netherlands"},{"name":"Amsterdam Centre for Global Child Health , Amsterdam, the Netherlands"},{"name":"Department of Paediatrics and Child Health, Kamuzu University of Health Sciences KUHeS Malawi , Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,7,7]]},"reference":[{"key":"2022102119173054700_fmac053-B1","volume-title":"Updated Guideline: Paediatric Emergency Triage, Assessment and Treatment","year":"2016"},{"key":"2022102119173054700_fmac053-B2","doi-asserted-by":"crossref","first-page":"S88","DOI":"10.1542\/peds.2015-3373C","article-title":"Part 6: pediatric Basic Life Support and Pediatric Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (Reprint)","volume":"136","author":"de 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