Development and evaluation of an integrated electronic data management system in a South African metropolitan critical care service

Allorto, N.L.; Wise, R

doi:10.1080/22201181.2015.1115607

Cited by 9 publications

(12 citation statements)

References 9 publications

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“…We performed a single-centre, retrospective cohort study to evaluate the prognostic validity of the qSOFA score at the time of ICU referral in adult medical v. surgical ICU patients admitted with suspected infection. We utilised the Integrated Critical Care Electronic Database (ICED) [19] at Edendale Hospital in Kwazulu-Natal Province, SA. Edendale Hospital is a regional-level public hospital with 900 beds that operates in a resource-constrained context.…”

Section: Methodsmentioning

confidence: 99%

Prognostic value of the Quick Sepsis-related Organ Failure Assessment (qSOFA) score among critically ill medical and surgical patients with suspected infection in a resourcelimited setting

Bischop

Wilson

Wise

et al. 2021

AJTCCM

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Background. The Quick Sequential Organ Failure Assessment (qSOFA) score is a simple bedside tool validated outside of the intensive care unit (ICU) to identify patients with suspected infection who are at risk for poor outcomes. Objectives. To assess qSOFA at the time of ICU referral as a mortality prognosticator in adult medical v. surgical patients with suspected infection admitted to an ICU in a resource-limited regional hospital in South Africa (SA). Methods. We conducted a retrospective cohort study on adult medical or surgical patients that were admitted to an ICU in a resource-limited hospital in SA. We performed univariate and multivariable logistic regression and compared nested models using likelihood ratio test, and we calculated the area under the receiver operating characteristic curve (AUROC). Results. We recruited a total of 1 162 (medical n=283 and surgical n=875) participants in the study who were admitted to the ICU with suspected infection. qSOFA at the time of ICU referral was highly associated with but poorly discriminant of in-ICU mortality among medical (odds ratio (OR) 2.60, 95% confidence interval (CI) 1.19 - 5.71; p=0.02; AUROC 0.60; 95% CI 0.53 - 0.67; p=0.02) and surgical (OR 2.74; 95% CI 1.73-4.36; p<0.001; AUROC 0.60; 95% CI 0.55 - 0.65; p=0.04) patients. qSOFA model performance was similar between medical and surgical subgroups (p≥0.26). Addition of qSOFA to a baseline risk factor model including age, sex, and HIV status improved the model discrimination in both subgroups (medical AUROC 0.64; 95% CI 0.56 - 0.71; p=0.049; surgical AUROC 0.69; 95% CI 0.64 - 0.74; p<0.0001). Conclusion. qSOFA was highly associated with, but poorly discriminant for, poor outcomes among medical and surgical patients with suspected infection admitted to the ICU in a resource-limited setting. These findings suggest that qSOFA may be useful as a tool to identify patients at increased risk of mortality in these populations and in this context.

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Section: Methodsmentioning

confidence: 99%

Prognostic value of the Quick Sepsis-related Organ Failure Assessment (qSOFA) score among critically ill medical and surgical patients with suspected infection in a resourcelimited setting

Bischop

Wilson

Wise

et al. 2021

AJTCCM

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“…The database was developed as a clinically practical and cost-effective solution to data collection in the Pietermaritzburg metropolitan critical care system. It also meets the requirements of a registry, enabling quality improvement, systems planning and research in a developing country [17] .…”

Section: Methodsmentioning

confidence: 92%

“…861/19). The Integrated Critical Care Electronic Database (iCED) served as the data source [17] . The database was developed as a clinically practical and cost-effective solution to data collection in the Pietermaritzburg metropolitan critical care system.…”

Section: Methodsmentioning

confidence: 99%

Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

Singh

Maharaj

Allorto

et al. 2021

African Journal of Emergency Medicine

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“…15 The Integrated Critical Care Electronic Database (ICED) is the first published multicenter database of its kind in South Africa. 11 It includes all referrals for ICU care at 2 public hospitals within the KwaZulu-Natal Department of Health (Pietermaritzburg, South Africa): Greys Hospital (beginning November 2013), a tertiary hospital with approximately 530 inpatient beds, and Edendale Hospital (beginning July 2014), a regional hospital with approximately 900 inpatient beds. Both hospitals have one mixed medical-surgical ICU that admit adult and pediatric patients and have closed, high-intensity staffing models (see Online Appendix 1 for details).…”

Section: Study Setting and Data Sourcementioning

confidence: 99%

“…Additionally, the burden of critical illness in resource-limited settings is growing and will likely require a different management approach than that developed and used in resource-rich settings. [8][9][10] In a 2-hospital retrospective cohort study, we sought to utilize the first published multicenter electronic critical care database in South Africa 11 to measure the association of ICU capacity strain at various time points along the trajectory of critical illness with patient outcomes and processes of care in a resource-limited setting.…”

Section: Introductionmentioning

confidence: 99%

Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa

Anesi

Gabler

Allorto

et al. 2018

J Intensive Care Med

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Objective: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting. Methods: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country’s first published multicenter electronic critical care database. We assessed the association between multiple ICU capacity strain metrics (ICU occupancy, turnover, census acuity, and referral burden) at different exposure time points (ICU referral, admission, and/or discharge) with clinical and process of care outcomes. The association of ICU capacity strain at the time of ICU admission with ICU length of stay (LOS), the primary outcome, was analyzed with a multivariable Cox proportional hazard model. Secondary outcomes of ICU triage decision (with strain at ICU referral), ICU mortality (with strain at ICU admission), and ICU LOS (with strain at ICU discharge), were analyzed with linear and logistic multivariable regression. Results: No measure of ICU capacity strain at the time of ICU admission was associated with ICU LOS, the primary outcome. The ICU occupancy at the time of ICU admission was associated with increased odds of ICU mortality (odds ratio = 1.07, 95% confidence interval: 1.02-1.11; P = .004), a secondary outcome, such that a 10% increase in ICU occupancy would be associated with a 7% increase in the odds of ICU mortality. Conclusions: In a resource-limited setting in South Africa, ICU capacity strain at the time of ICU admission was not associated with ICU LOS. In secondary analyses, higher ICU occupancy at the time of ICU admission, but not other measures of capacity strain, was associated with increased odds of ICU mortality.

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Development and evaluation of an integrated electronic data management system in a South African metropolitan critical care service

Cited by 9 publications

References 9 publications

Prognostic value of the Quick Sepsis-related Organ Failure Assessment (qSOFA) score among critically ill medical and surgical patients with suspected infection in a resourcelimited setting

Prognostic value of the Quick Sepsis-related Organ Failure Assessment (qSOFA) score among critically ill medical and surgical patients with suspected infection in a resourcelimited setting

Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa

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