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The mortality of acutely ill medical patients for up to 60days after admission to a resource poor hospital in sub-Saharan Africa compared with patients of similar illness severity admitted to a Danish Regional Teaching Hospital — An exploratory observational study

Published:December 08, 2015DOI:https://doi.org/10.1016/j.ejim.2015.11.018

      Highlights

      • To our knowledge this is the first study to compare long term outcomes in the developed and developing country.
      • The 7, 30 and 60 days mortality of Ugandan and Danish acutely ill medical patients were compared.
      • More Ugandan than Danish patients died within a week, 30 days and 60 days of admission.
      • Severe derangements in breathing rate and blood pressure were more common in Ugandan patients.
      • Danish patients were more likely to have severely deranged oxygen saturations.
      • Patients without severely deranged vital signs or able to stand unaided had the same outcomes.

      Abstract

      Background

      The outcomes of patients with the same severity of illness in the developed and developing countries have not been compared. Illness severity can now be measured anywhere by the National Early Warning Score (NEWS).

      Methods

      An exploratory observational study that compared the 7, 30 and 60 days mortality of 195 Ugandan and 588 Danish acutely ill medical patients that had a NEWS >6 at the time of their admission to the hospital. The association of vital sign changes, alertness and mobility at admission on subsequent outcome was explored.

      Results

      More Kitovu (34.4%) than Danish patients (22.1%) died within 60 days of admission (OR 1.85, 95% CI 1.27–2.71, p 0.001). However, the survival of non-comatose patients admitted without severely deranged vital signs or who were able to stand without help was identical in both cohorts (Chi square 0.32, p 0.57): these patients made up 50% of all Ugandan and 60% of all Danish patients. In contrast the survival curves of patients admitted in a coma were widely divergent within a week of hospital admission and remained so for a further 60 days (Chi square 10.29, p 0.001).

      Conclusion

      This small hypothesis generating observational study with huge selection and treatment bias found no survival difference at 60 days after admission to resource rich and resource poor hospitals for patients without severely deranged vital signs or who were able to stand without help.

      Keywords

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      References

      1. California Intensive Care Outcomes (CALICO). Project — Final Report. Office of Statewide Health Planning and Development. (Accessed 1 March 2013, at http://www.pdffiller.com/17454003-CALICO_05-07pdf-Final-Report---Office-of-Statewide-Health-Planning-and-Development--Various-Fillable-Forms)

        • Hargrove J.
        • Nguyen H.B.
        Bench-to-bedside review: outcome predictions for critically ill patients in the emergency department.
        Crit Care. 2005; 9: 376-383
        • Opio M.O.
        • Nansubuga G.
        • Kellett J.
        In-hospital mortality of acutely ill medical patients admitted to a resource poor hospital in sub-Saharan Africa and to a Canadian Regional Hospital compared using the abbreviated VitalPAC Early Warning Score.
        Eur J Intern Med. 2014; 25: 142-146
        • Royal College of Physicians
        National Early Warning Score (NEWS): standardising the assessment of acute illness severity in the NHS.
        in: Report of a Working Party. RCP, London2012 (www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news)
        • Prytherch D.R.
        • Smith G.B.
        • Schmidt P.E.
        • et al.
        ViEWS—towards a national early warning score for detecting adult inpatient deterioration.
        Resuscitation. 2010; 81: 932-937
        • Kellett J.
        • Kim A.
        Validation of an abbreviated Vitalpac Early Warning Score (ViEWS) in 75,419 consecutive admissions to a Canadian Regional Hospital.
        Resuscitation. 2012; 83: 297-302
        • Bleyer A.J.
        • Vidya S.
        • Russell G.B.
        • et al.
        Longitudinal analysis of one million vital signs in patients in an academic medical center.
        Resuscitation. 2011; 82: 1387-1392
        • Kellett J.
        • Clifford M.
        • Ridley A.
        • Gleeson M.
        Validation of the VitalPAC Early Warning Score (ViEWS) in acutely ill medical patients admitted.
        Ir Med J. 2013; 106: 318
        • Silcock D.J.
        • Corfield A.R.
        • Gowen P.A.
        • Rooney K.D.
        Validation of the National Early Warning Score in the prehospital setting.
        Resuscitation. 2015; 89: 31-35
        • Alam N.
        • Vegting I.L.
        • Houben E.
        • van Berkel B.
        • Vaughan L.
        • Kramer M.H.H.
        • et al.
        Exploring the performance of the National Early Warning Score (NEWS) in a European emergency department.
        Resuscitation. 2015; 90: 111-115
        • Opio M.O.
        • Nansubuga G.
        • Kellett J.
        Validation of the VitalPAC Early Warning Score (ViEWS) in acutely ill medical patients attending a resource-poor hospital in sub-Saharan Africa.
        Resuscitation. 2013; 84: 743-746
        • Brabrand M.
        • Lassen A.T.
        • Knudsen T.
        • Hallas J.
        Seven-day mortality can be predicted in medical patients by blood pressure, age, respiratory rate, loss of independence, and peripheral oxygen saturation (the PARIS score): a prospective cohort study with external validation.
        PLoS One. 2015; 10e0122480https://doi.org/10.1371/journal.pone.0122480
        • Pedersen C.B.
        The Danish Civil Registration System.
        Scand J Public Health. 2011; 39: 22-25
        • Morandi A.
        • Pandharipande P.
        • Trabucchi M.
        • Rozzini R.
        • Mistraletti G.
        • et al.
        Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients.
        Intensive Care Med. 2008; 34: 1907-1915
        • Yang J.-S.
        • Nam H.-J.
        • Seo M.
        • Han S.K.
        • Choi Y.
        • et al.
        OASIS: online application for the survival analysis of lifespan assays performed in aging research.
        PLoS One. 2011; 6: e23525https://doi.org/10.1371/journal.pone.0023525
        • Landoni G.
        • Comis M.
        • Conte M.
        • Finco G.
        • Mucchetti M.
        • et al.
        Mortality in multicenter critical care trials: an analysis of interventions with a significant effect.
        Crit Care Med. 2015; 43: 1559-1568
        • Brabrand M.
        • Kellett J.
        Mobility measures should be added to the National Early Warning Score (NEWS).
        Resuscitation. 2014; 85: e151