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 predict the development of enteric perforation in children with
study was a retrospective case control analysis of children admitted for
typhoid fever without or without enteric perforation over a three year period
in a newly established teaching hospital in Kannur. Forty seven children with
typhoid fever and enteric perforation (cases) were compared with 94 controls
(those without 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 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 ideal perforation in children,
thereby helping in recognition of high risk cases and drawing up of screening
tool to facilitate effective and prompt management.
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