Anemia at Intensive Care Unit Admission and Hospital Mortality Among Patients at a Referral Hospital in Malawi

2020 ◽  
pp. 000313482097337
Author(s):  
Meghan Prin ◽  
Shumin Rui ◽  
Stephanie Pan ◽  
Clement Kadyaudzu ◽  
Parth S. Mehta ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Preliminary Evidence ◽  
Sub Saharan Africa ◽  
Icu Admission ◽  
Cumulative Incidence Functions ◽  
Sub Saharan ◽  
Incidence Functions ◽  
Competing Risk Models

Background Anemia is associated with intensive care unit (ICU) outcomes, but data describing this association in sub-Saharan Africa are scarce. Patients in this region are at risk for anemia due to endemic conditions like malaria and because transfusion services are limited. Methods This was a prospective cohort study of ICU patients at Kamuzu Central Hospital (KCH) in Malawi. Exclusion criteria included age <5 years, pregnancy, ICU readmission, or admission for head injury. Cumulative incidence functions and Fine-Gray competing risk models were used to evaluate hemoglobin (Hgb) at ICU admission and hospital mortality. Results Of 499 patients admitted to ICU, 359 were included. The median age was 28 years (interquartile ranges (IQRs) 20-40) and 37.5% were men. Median Hgb at ICU admission was 9.9 g/dL (IQR 7.5-11.4 g/dL; range 1.8-18.1 g/dL). There were 61 (19%) patients with Hgb < 7.0 g/dL, 59 (19%) with Hgb 7.0-8.9 g/dL, and 195 (62%) with Hgb ≥ 9.0 g/dL. Hospital mortality was 51%, 59%, and 54%, respectively. In adjusted analyses, anemia was associated with hospital mortality but was not statistically significant. Conclusions This study provides preliminary evidence that anemia at ICU admission may be an independent predictor of hospital mortality in Malawi. Larger studies are needed to confirm this association.

scholarly journals Trends of critical care management of obstetric patients in a tertiary hospital in sub-Saharan Africa

2019 ◽  
Vol 7 (5) ◽  
pp. 1420
Author(s):  
Fidelis A. Onyekwulu ◽  
Tochukwu C. Okeke
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Maternal Mortality ◽  
Tertiary Hospital ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Obstetric Hemorrhage ◽  
Icu Admission ◽  
Sub Saharan

Background: The maternal mortality rate in sub-Saharan Africa is high compared to other regions of the world. Management of critically ill obstetric patients is very challenging. We therefore evaluate the trends, clinical characteristics and outcome of the obstetric patients admitted into the intensive care unit of a tertiary hospital in sub Saharan Africa.Methods: This was a 9- year retrospective study carried out at the multidisciplinary Intensive Care Unit (ICU) of a University Teaching Hospital which serves as a referral centre for the south east region of the country. Data were collected from the patients’ record, ICU admission and discharge register. Also collected was data concerning labor ward admission and deliveries. Data was analyzed using SPSS Version 17 (SPSS Inc., Chicago, IL, USA).Results: The total admission into the ICU during the study period was 1243 patients of which 73 (5.87%) were obstetric patients. They were between the ages of 17 and 54 years with mean of 32.05±5.96 years. The total number of deliveries within the period was 11224 (1247 per year). The commonest obstetric cases admitted into the ICU were (pre) eclampsia 28.8% followed by obstetric hemorrhage 24.7%. The overall mortality rate in this study was 39.7%. The commonest intervention carried out in the ICU was mechanical ventilation.Conclusions: The two leading indications for ICU admission and maternal mortality are (pre)eclampsia and obstetric hemorrhage.

scholarly journals Respiratory events in ward are associated with later intensive care unit (ICU) admission and hospital mortality in onco-hematology patients not admitted to ICU after a first request

PLoS ONE ◽  
2017 ◽  
Vol 12 (7) ◽  
pp. e0181808 ◽  
Author(s):  
Laure Doukhan ◽  
Magali Bisbal ◽  
Laurent Chow-Chine ◽  
Antoine Sannini ◽  
Jean Paul Brun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Icu Admission ◽  
Respiratory Events

Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model.

1998 ◽  
Vol 16 (2) ◽  
pp. 761-770 ◽  
Author(s):  
J S Groeger ◽  
S Lemeshow ◽  
K Price ◽  
D M Nierman ◽  
P White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
The United States ◽  
Categorical Variables ◽  
Allogeneic Bone ◽  
Icu Admission ◽  
Hospital Survival

PURPOSE To develop prospectively and validate a model for probability of hospital survival at admission to the intensive care unit (ICU) of patients with malignancy. PATIENTS AND METHODS This was an inception cohort study in the setting of four ICUs of academic medical centers in the United States. Defined continuous and categorical variables were collected on consecutive patients with cancer admitted to the ICU. A preliminary model was developed from 1,483 patients and then validated on an additional 230 patients. Multiple logistic regression modeling was used to develop the models and subsequently evaluated by goodness-of-fit and receiver operating characteristic (ROC) analysis. The main outcome measure was hospital survival after ICU admission. RESULTS The observed hospital mortality rate was 42%. Continuous variables used in the ICU admission model are PaO2/FiO2 ratio, platelet count, respiratory rate, systolic blood pressure, and days of hospitalization pre-ICU. Categorical entries include presence of intracranial mass effect, allogeneic bone marrow transplantation, recurrent or progressive cancer, albumin less than 2.5 g/dL, bilirubin > or = 2 mg/dL, Glasgow Coma Score less than 6, prothrombin time greater than 15 seconds, blood urea nitrogen (BUN) greater than 50 mg/dL, intubation, performance status before hospitalization, and cardiopulmonary resuscitation (CPR). The P values for the fit of the preliminary and validation models are .939 and .314, respectively, and the areas under the ROC curves are .812 and .802. CONCLUSION We report a disease-specific multivariable logistic regression model to estimate the probability of hospital mortality in a cohort of critically ill cancer patients admitted to the ICU. The model consists of 16 unambiguous and readily available variables. This model should move the discussion regarding appropriate use of ICU resources forward. Additional validation in a community hospital setting is warranted.

scholarly journals SAPS 3—From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission

2005 ◽  
Vol 31 (10) ◽  
pp. 1345-1355 ◽  
Author(s):  
Rui P. Moreno ◽  
Philipp G. H. Metnitz ◽  
Eduardo Almeida ◽  
Barbara Jordan ◽  
Peter Bauer ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Prognostic Model ◽  
Saps 3 ◽  
Icu Admission

Intensive care unit mortality in sub-Saharan Africa: The modified sequential organ function assessment score

2015 ◽  
Vol 30 (4) ◽  
pp. 835
Author(s):  
Cornelius Sendagire ◽  
Michael Lipnick ◽  
Daniel Obua ◽  
Jane Nakibuuka ◽  
Joseph Ejoku
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Mortality ◽  
Sub Saharan Africa ◽  
Organ Function ◽  
Assessment Score ◽  
Sub Saharan ◽  
Function Assessment

scholarly journals Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian’s model

2019 ◽  
Author(s):  
Charles Ssemugabo ◽  
Sarah Nalinya MPH ◽  
Abdullah Ali Halage ◽  
Ruth Mubeezi Neebye ◽  
David Musoke ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Sub Saharan Africa ◽  
Major Public Health Problem ◽  
Pesticide Poisoning ◽  
Process And Outcome ◽  
Sub Saharan

Abstract Background Pesticide poisoning is a major public health problem in many Low-and-Middle Income Countries (LMICs). Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Majority of the pesticide related deaths can be averted if poisoning patients are managed well. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. Therefore, this study was aimed at exploring doctors’ experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda. Methods Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent ensuring quality care. Results Presence of hospital units such as medical wards including Intensive Care Unit (ICU), pediatrics and internal medicine; availability of equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors’ knowledge and experiences improved the quality of care given to pesticide poisoning patients. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients. Conclusion Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance to improving management of pesticide poisoning cases in hospitals in Kampala, Uganda.

scholarly journals Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian’s model

2020 ◽  
Author(s):  
Charles Ssemugabo ◽  
Sarah Nalinya MPH ◽  
Abdullah Ali Halage ◽  
Ruth Mubeezi Neebye ◽  
David Musoke ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Health Workers ◽  
Sub Saharan Africa ◽  
Pesticide Poisoning ◽  
Process And Outcome ◽  
Sub Saharan

Abstract Background Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. This study was aimed at exploring doctors’ experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda.Methods Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent ensuring quality care.Results Doctors reported structural, process and outcome facets that support diagnosis and treatment of pesticide poisoning cases improved the quality of care provided by doctors. Among the structures includes hospital units such as Intensive Care Unit (ICU), pediatrics and internal medicine; equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors’ knowledge and experiences. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases whether or not relevant to treat the actual pesticide poisoning. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients.Conclusion Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance to improve management of pesticide poisoning cases in hospitals in Kampala, Uganda.

scholarly journals Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian’s model

2019 ◽  
Author(s):  
Charles Ssemugabo ◽  
Sarah Nalinya MPH ◽  
Abdullah Ali Halage ◽  
Ruth Mubeezi Neebye ◽  
David Musoke ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Health Workers ◽  
Sub Saharan Africa ◽  
Pesticide Poisoning ◽  
Process And Outcome ◽  
Sub Saharan

Abstract Background: Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. This study was aimed at exploring doctors’ experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda. Methods: Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent ensuring quality care. Results: Doctors reported structural, process and outcome facets that support diagnosis and treatment of pesticide poisoning cases improved the quality of care provided by doctors. Among the structures includes hospital units such as Intensive Care Unit (ICU), pediatrics and internal medicine; equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors’ knowledge and experiences. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases whether or not relevant to treat the actual pesticide poisoning. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients. Conclusion: Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance to improve management of pesticide poisoning cases in hospitals in Kampala, Uganda.

scholarly journals Disparities in Intensive Care Unit Admission and Mortality Among Patients With Schizophrenia and COVID-19: A National Cohort Study

2020 ◽  
Author(s):  
Guillaume Fond ◽  
Vanessa Pauly ◽  
Marc Leone ◽  
Pierre-Michel Llorca ◽  
Veronica Orleans ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Mental Illness ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Severe Mental Illness ◽  
Vulnerable Population ◽  
Icu Admission ◽  
Risk Of Death

Abstract Patients with schizophrenia (SCZ) represent a vulnerable population who have been understudied in COVID-19 research. We aimed to establish whether health outcomes and care differed between patients with SCZ and patients without a diagnosis of severe mental illness. We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. Cases were patients who had a diagnosis of SCZ. Controls were patients who did not have a diagnosis of severe mental illness. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. A total of 50 750 patients were included, of whom 823 were SCZ patients (1.6%). The SCZ patients had an increased in-hospital mortality (25.6% vs 21.7%; adjusted OR 1.30 [95% CI, 1.08–1.56], P = .0093) and a decreased ICU admission rate (23.7% vs 28.4%; adjusted OR, 0.75 [95% CI, 0.62–0.91], P = .0062) compared with controls. Significant interactions between SCZ and age for mortality and ICU admission were observed (P = .0006 and P &lt; .0001). SCZ patients between 65 and 80 years had a significantly higher risk of death than controls of the same age (+7.89%). SCZ patients younger than 55 years had more ICU admissions (+13.93%) and SCZ patients between 65 and 80 years and older than 80 years had less ICU admissions than controls of the same age (−15.44% and −5.93%, respectively). Our findings report the existence of disparities in health and health care between SCZ patients and patients without a diagnosis of severe mental illness. These disparities differed according to the age and clinical profile of SCZ patients, suggesting the importance of personalized COVID-19 clinical management and health care strategies before, during, and after hospitalization for reducing health disparities in this vulnerable population.

Sign in / Sign up

Export Citation Format

Share Document