Single Deranged Physiologic Parameters Are Associated With Mortality in a Low-Income Country
2015 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 43, no 10, 2171-2179 p.Article in journal (Refereed) Published
Karolinska Univ Hosp, Dept Anaesthesia Intens Care & Surg Serv, S-17176 Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Div Anaesthesiol & Intens Care Med, Stockholm, Sweden.;Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden..
Karolinska Univ Hosp, Dept Anaesthesia Intens Care & Surg Serv, S-17176 Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Div Anaesthesiol & Intens Care Med, Stockholm, Sweden..
Muhimbili Univ Hlth & Allied Sci, Dept Anaesthesia & Intens Care, Dar Es Salaam, Tanzania..
Schell, Carl Otto
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Sormland Cty Council, Nykoping Hosp, Dept Internal Med, Nykoping, Sweden..
Objective: To investigate whether deranged physiologic parameters at admission to an ICU in Tanzania are associated with in-hospital mortality and compare single deranged physiologic parameters to a more complex scoring system. Design: Prospective, observational cohort study of patient notes and admission records. Data were collected on vital signs at admission to the ICU, patient characteristics, and outcomes. Cutoffs for deranged physiologic parameters were defined a priori and their association with in-hospital mortality was analyzed using multivariable logistic regression. Setting: ICU at Muhimbili National Hospital, Dar es Salaam, Tanzania. Patients: All adults admitted to the ICU in a 15-month period. Measurements and Main Results: Two hundred sixty-nine patients were included: 54% female, median age 35 years. In-hospital mortality was 50%. At admission, 69% of patients had one or more deranged physiologic parameter. Sixty-four percent of the patients with a deranged physiologic parameter died in hospital compared with 18% without (p < 0.001). The presence of a deranged physiologic parameter was associated with mortality (adjusted odds ratio, 4.64; 95% CI, 1.95-11.09). Mortality increased with increasing number of deranged physiologic parameters (odds ratio per deranged physiologic parameter, 2.24 [1.53-3.26]). Every individual deranged physiologic parameter was associated with mortality with unadjusted odds ratios between 1.92 and 16.16. A National Early Warning Score of greater than or equal to 7 had an association with mortality (odds ratio, 2.51 [1.23-5.14]). Conclusion: Single deranged physiologic parameters at admission are associated with mortality in a critically ill population in a low-income country. As a measure of illness severity, single deranged physiologic parameters are as useful as a compound scoring system in this setting and could be termed danger signs. Danger signs may be suitable for the basis of routines to identify and treat critically ill patients.
Place, publisher, year, edition, pages
2015. Vol. 43, no 10, 2171-2179 p.
critical care, developing countries, global health, hospital mortality, quality of health care, vital signs
IdentifiersURN: urn:nbn:se:uu:diva-264601DOI: 10.1097/CCM.0000000000001194ISI: 000361358900016PubMedID: 26154933OAI: oai:DiVA.org:uu-264601DiVA: diva2:866049
FunderThe Karolinska Institutet's Research Foundation