Are changes in objective observations or the patient's subjective feelings the day after admission the best predictors of in-hospital mortality? An observational study in a low-resource sub-Saharan hospital. (February 2019)

• Record Type: Journal Article
• Authors: Kellett, John; Wasingya-Kasereka, Lucien; Brabrand, Mikkel
• Is Part Of: Resuscitation. Volume 135(2019)
• Page Start: 130
• Page End: 136
• Publication Date: 2019-02
• Subjects: In-hospital mortality -- Early warning scores -- Functional capacity -- Predictors of mortality -- Vital sign trends -- Clinical deterioration; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2018.10.023
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Background: The first clinical re-assessment after admission to hospital probably provides the best opportunity to detect clinical deterioration or failure to improve, and decide if care should be intensified. Aim: Compare changes the day after admission in the patient's subjective feelings and objective findings that included age, gender, the National Early Warning Score (NEWS) on admission, gait stability and mid-upper arm circumference (MUAC) on admission, and changes in NEWS, gait stability and mental alertness. Setting: Acutely ill medical patients admitted to a low-resource sub-Saharan hospital. Methods: Prospective observational study. Results: 1810 patients were reassessed 18 h after hospital admission. Logistic regression identified NEWS and gait stability on admission, a subjective feeling of improvement, the change in NEWS, and MUAC as clinically significant predictors of in-hospital mortality. Stratifying patients according to their NEWS on admission altered the predictive value of the four other predictors: for patients with an admission NEWS < 3 a subjective feeling of improvement is the most powerful predictor of a good outcome. For patients with an admission NEWS > = 3 the change in NEWS, gait stability on admission and MUAC provide additional prognostic information. Conclusion: NEWS and gait stability on admission, MUAC, a subjective feeling of improvement, and change in NEWS the day after admission are all clinically significant predictors of in-hospital mortality.