Objectives 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. Methods 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–18 years) 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. Results 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. Conclusions 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.

中文翻译：

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低（中）收入国家儿童休克的病因、病理生理学和死亡率：系统评价

目标 休克是低收入和中等收入国家（LMIC）儿童的一种危及生命的疾病，存在一些争议。本系统评价总结了 LMIC 儿童休克的病因、病理生理学和死亡率。方法 我们在 PubMed、Embase 和滚雪球（截至 2019 年 10 月 1 日）中检索了报告中低收入国家休克儿童的研究。包括在 LMIC 进行的报告儿童（1 个月至 18 岁）休克的研究。我们排除了仅包含新生儿、心脏手术患者或医源性原因数据的研究。我们提供了患病率数据、汇总死亡率估计值，并按定义、地区和疾病进行了亚组分析。系统地收集了病因学和病理生理学数据。结果 我们确定了 959 项研究，包括 59 项研究，其中 6 项主要研究休克。用于休克的定义分为五组。休克的患病率从儿科医院人群的 1.5% 到危重儿童的 44.3% 不等。五个定义组的合并死亡率估计在 3.9-33.3% 之间。重要的病因包括肠胃炎、败血症、疟疾和严重贫血，这些疾病常常同时发生。病理生理学研究很少，但表明除了低血容量外，分离性休克和心源性休克在 LMIC 中很常见。结论 休克与 LMIC 住院儿童的高死亡率相关。尽管很重要，但很少有研究调查休克，因此有关休克的病因和病理生理学的数据有限。