Increasing Evidence-Based Interventions in Patients with Acute Infections in a Resource-Limited Setting: A Before-and-After Feasibility Trial in Gitwe, Rwanda

Urayeneza, Olivier; Mujyarugamba, Pierre; Rukemba, Zacharie; Nyiringabo, Vincent; Ntihinyurwa, Polyphile; Baelani, John I; Kwizera, Arthur; Bagenda, Danstan; Mer, Mervyn; Musa, Ndidiamaka; Hoffman, Julia T; Mudgapalli, Ashok; Porter, Austin M.; Kissoon, Niranjan; Ulmer, Hanno; Harmon, Lori; Farmer, Joseph C.; Dünser, Martin W.; Patterson, Andrew J.

doi:10.1097/ccm.0000000000003227

Cited by 10 publications

(3 citation statements)

References 23 publications

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“…In this study, we externally validated the ability of the UVA score to predict in-hospital mortality in a cohort of patients with acute infection admitted to a hospital in Rwanda who were not part of the UVA score derivation cohort [ 7 ]. In doing so, despite a 10% difference in case fatality rates between the derivation and validation cohorts (17% vs 7%), we found that the AUC for the prediction of in-hospital mortality was identical between derivation and validation cohorts at 0.77 [ 7 , 9 ]. Increasing UVA scores were associated with increased case fatality rates and odds ratio of death.…”

Section: Discussionmentioning

confidence: 93%

“…We performed a secondary analysis of data collected from adults ≥18 years admitted with an acute infectious disease to Gitwe District Hospital from the adult and pediatric Emergency Department of Gitwe District Hospital as well as eight referring health centers in the Ruhango District, Southern Province, Rwanda from March 2016 until March 2017 [ 9 ]. In the original study, using a data collection tool ( S1 Fig ), acute infection was defined as a suspected or confirmed infection, which was based on a clinical assessment and present for less than two weeks.…”

Section: Methodsmentioning

confidence: 99%

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Performance of the Universal Vital Assessment (UVA) mortality risk score in hospitalized adults with infection in Rwanda: A retrospective external validation study

et al. 2022

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Background We previously derived a Universal Vital Assessment (UVA) score to better risk-stratify hospitalized patients in sub-Saharan Africa, including those with infection. Here, we aimed to externally validate the performance of the UVA score using previously collected data from patients hospitalized with acute infection in Rwanda. Methods We performed a secondary analysis of data collected from adults ≥18 years with acute infection admitted to Gitwe District Hospital in Rwanda from 2016 until 2017. We calculated the UVA score from the time of admission and at 72 hours after admission. We also calculated quick sepsis-related organ failure assessment (qSOFA) and modified early warning scores (MEWS). We calculated amalgamated qSOFA scores by inserting UVA cut-offs into the qSOFA score, and modified UVA scores by removing the HIV criterion. The performance of each score determined by the area under the receiver operator characteristic curve (AUC) was the primary outcome measure. Results We included 573 hospitalized adult patients with acute infection of whom 40 (7%) died in-hospital. The admission AUCs (95% confidence interval [CI]) for the prediction of mortality by the scores were: UVA, 0.77 (0.68–0.85); modified UVA, 0.77 (0.68–0.85); qSOFA, 0.66 (0.56–0.75), amalgamated qSOFA, 0.71 (0.61–0.80); and MEWS, 0.74 (0.64, 0.83). The positive predictive values (95% CI) of the scores at commonly used cut-offs were: UVA >4, 0.35 (0.15–0.59); modified UVA >4, 0.35 (0.15–0.59); qSOFA >1, 0.14 (0.07–0.24); amalgamated qSOFA >1, 0.44 (0.20–0.70); and MEWS >5, 0.14 (0.08–0.22). The 72 hour (N = 236) AUC (95% CI) for the prediction of mortality by UVA was 0.59 (0.43–0.74). The Chi-Square test for linear trend did not identify an association between mortality and delta UVA score at 72 hours (p = 0.82). Conclusions The admission UVA score and amalgamated qSOFA score had good predictive ability for mortality in adult patients admitted to hospital with acute infection in Rwanda. The UVA score could be used to assist with triage decisions and clinical interventions, for baseline risk stratification in clinical studies, and in a clinical definition of sepsis in Africa.

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Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Performance of the Universal Vital Assessment (UVA) mortality risk score in hospitalized adults with infection in Rwanda: A retrospective external validation study

et al. 2022

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“…Given that improved critical care outcomes are possible outside of the ICU [19; 27, 28] and given the dearth of ICU physician presence in Haiti and other LMICs, ramping up critical care education and training for non-ICU clinicians and nurses is crucial. Structured critical care training can reduce adult [29] and pediatric ICU mortality in LMICs [30–32].…”

Section: Discussionmentioning

confidence: 99%

Critical care capacity in Haiti: A nationwide cross-sectional survey

et al. 2019

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Objective Critical illness affects health systems globally, but low- and middle-income countries (LMICs) bear a disproportionate burden. Due to a paucity of data, the capacity to care for critically ill patients in LMICs is largely unknown. Haiti has the lowest health indices in the Western Hemisphere. In this study, we report results of the first known nationwide survey of critical care capacity in Haiti. Design Nationwide, cross-sectional survey of Haitian hospitals in 2017–2018. Setting Haiti. Subjects All Haitian health facilities with at least six hospital beds. Interventions Electronic- and paper-based survey. Results Of 51 health facilities identified, 39 (76.5%) from all ten Haitian administrative departments completed the survey, reporting 124 reported ICU beds nationally. Of facilities without an ICU, 20 (83.3%) care for critically ill patients in the emergency department. There is capacity to ventilate 62 patients nationally within ICUs and six patients outside of the ICU. One-third of facilities with ICUs report formal critical care training for their physicians. Only five facilities met criteria for a Level 1 ICU as defined by the World Federation of Societies of Intensive and Critical Care Medicine. Self-identified barriers to providing more effective critical care services include lack of physical space for critically ill patients, lack of equipment, and few formally trained physicians and nurses. Conclusions Despite a high demand for critical care services in Haiti, current capacity remains insufficient to meet need. A significant amount of critical care in Haiti is provided outside of the ICU, highlighting the important overlap between emergency and critical care medicine in LMICs. Many ICUs in Haiti lack basic components for critical care delivery. Streamlining critical care services through protocol development, education, and training may improve important clinical outcomes.

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Antibiotics, Antivirals, and Antifungals in Critical Care

Shamshirsaz,

Vaught

2024

Critical Care Obstetrics

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Increasing Evidence-Based Interventions in Patients with Acute Infections in a Resource-Limited Setting: A Before-and-After Feasibility Trial in Gitwe, Rwanda

Cited by 10 publications

References 23 publications

Performance of the Universal Vital Assessment (UVA) mortality risk score in hospitalized adults with infection in Rwanda: A retrospective external validation study

Performance of the Universal Vital Assessment (UVA) mortality risk score in hospitalized adults with infection in Rwanda: A retrospective external validation study

Critical care capacity in Haiti: A nationwide cross-sectional survey

Antibiotics, Antivirals, and Antifungals in Critical Care

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