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

Kitovu Hospital Study Group

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.

OriginalsprogEngelsk
TidsskriftResuscitation
Vol/bind135
Sider (fra-til)130-136
ISSN0300-9572
DOI
StatusUdgivet - 1. feb. 2019

Fingeraftryk

Hospital Mortality
Patient Admission
Logistic Models
Prospective Studies

Citer dette

@article{f4ee9b6f54664a2dbe7502616ed4f2f1,
title = "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",
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.",
keywords = "Clinical deterioration, Early warning scores, Functional capacity, In-hospital mortality, Predictors of mortality, Vital sign trends",
author = "John Kellett and Lucien Wasingya-Kasereka and Mikkel Brabrand and {Kitovu Hospital Study Group}",
note = "Copyright {\circledC} 2018 Elsevier B.V. All rights reserved.",
year = "2019",
month = "2",
day = "1",
doi = "10.1016/j.resuscitation.2018.10.023",
language = "English",
volume = "135",
pages = "130--136",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier",

}

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. / Kitovu Hospital Study Group.

I: Resuscitation, Bind 135, 01.02.2019, s. 130-136.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Are changes in objective observations or the patient's subjective feelings the day after admission the best predictors of in-hospital mortality?

T2 - An observational study in a low-resource sub-Saharan hospital

AU - Kellett, John

AU - Wasingya-Kasereka, Lucien

AU - Brabrand, Mikkel

AU - Kitovu Hospital Study Group

N1 - Copyright © 2018 Elsevier B.V. All rights reserved.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - 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.

AB - 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.

KW - Clinical deterioration

KW - Early warning scores

KW - Functional capacity

KW - In-hospital mortality

KW - Predictors of mortality

KW - Vital sign trends

U2 - 10.1016/j.resuscitation.2018.10.023

DO - 10.1016/j.resuscitation.2018.10.023

M3 - Journal article

VL - 135

SP - 130

EP - 136

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

ER -