Background Early warning scores (EWS) generated in a developed healthcare setting may not perform as well in low-resource settings in sub-Saharan Africa. Method The performance of EWS used in developed world was compared with those generated in low-resource settings in sub-Saharan Africa. Results When tested on 1,266 acutely ill patients consecutively admitted to a low-resource Ugandan hospital there was no statistical difference in the performance of any of the EWS tested. The performance of all the scores appeared to be improved by the addition of mobility assessment. Although statistically insignificant, the National Early Warning Score with extra points added for impaired mobility had the highest discrimination and sensitivity. Conclusion There were only marginal and no statistical differences in the performance of EWS generated in low-and high-resource healthcare settings in a cohort of unselected acutely ill medical patients admitted to a low-resource hospital in sub-Saharan Africa.
Summary
Background
The relationship between symptoms, signs and discharge diagnoses with in-hospital mortality is poorly defined in low-resource settings.
Aim
To explore the prevalence of presenting symptoms, signs and discharge diagnoses of medical patients admitted to a low-resource sub-Saharan hospital and their association with in-hospital mortality.
Methods
In this prospective observational study, the presenting symptoms and signs of all medical patients admitted to a low-resource hospital in sub-Saharan Africa, their discharge diagnoses and in-hospital mortality were recorded.
Results
Pain, gastro-intestinal complaints and feverishness were the commonest presenting symptoms, but none were associated with in-hospital mortality. Only headache was associated with decreased mortality, and no symptom was associated with increased in-hospital mortality. Malaria was the commonest diagnosis. Vital signs, mobility, mental alertness and mid-upper arm circumference (MUAC) had the strongest association with in-hospital mortality. Tuberculosis and cancer were the only diagnoses associated with in-hospital mortality after adjustment for these signs.
Conclusion
Vital signs, mobility, mental alertness and MUAC had the strongest association with in-hospital mortality. All these signs can easily be determined at the bedside at no additional cost and, after adjustment for them by logistic regression the only diagnoses that remain statistically associated with in-hospital mortality are tuberculosis and cancer.
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