Feasibility of the modified sequential organ function assessment score in a resource-constrained setting: a prospective observational study

Abstract

BackgroundSub-Saharan Africa has a great burden of critical illness with limited health care resources. We evaluated the feasibility and utility of the modified Sequential Organ Function Assessment (mSOFA) score in assessing morbidity and mortality in the National Referral Hospital’s intensive care unit (ICU) for one year.MethodsWe conducted a prospective, observational cohort study on patients above 12 years of age admitted to the ICU at Mulago Hospital (Kampala, Uganda). All SOFA scores were determined at admission and at 48 h. We modified the SOFA score by replacing the PaO2/FiO2 ratio with SPO2/FiO2. The primary outcome was ICU mortality.ResultsThis ICU cohort of 118 patients had a mean age of 37 years and an ICU mortality rate of 46.6%. Non-survivors had higher initial (7.7 SD 3.8 vs. 5.5 SD 3.3; p = 0.007), mean (8.1 SD 3.9 vs 4.7 SD 2.6; p < 0.001) and highest mSOFA scores (9.4 SD 4.2 vs. 5.8 SD 3.2; p < 0.001), with an increase of 1.0 (SD 3.1) mSOFA on average after 48 h when compared to survivors (p < 0.001). The area under the receiver operating characteristic curves for each mSOFA category was: initial-0.68, mean-0.76, highest-0.76 and delta mSOFA-0.74. Multivariate logistic regression analysis showed no significant association between mSOFA scores and mortality.ConclusionOur results confirm that calculation of the mSOFA score is feasible for an ICU population in a resource-limited country. More data are needed to test for an association between mSOFA and mortality.

Development a reverse triage system based on modified sequential organ failure assessment for increasing the critical care surge capacity

“…[ 14 21 ] However, Sendagire et al reported a decreasing trend. [ 19 ] The reason for the increase in the mean MSOFA scores in the current study and some other studies is that over time, some patients who were better and had lower MSOFA scores were discharged from the critical care unit. Moreover, the death of patients with high MSOFA scores in the first few days of admission was one of the reasons for the increase in the mean scores.…”

“…In this context, several studies have demonstrated that MSOFA has good power in predicting morbidity and mortality of patients. [ 14 19 20 21 ]…”

“…Sendagire et al and Halim et al reported the average MSOFA scores on the 1 st day of admission to be 6.3 ± 5.7 and 3.1 ± 98.95, respectively. [ 19 20 ] This finding suggests that different approaches were used when deciding on patients' admission in the critical care unit. It appears that factors such as the level of development of medical knowledge, the availability of advanced medical equipment, and the per capita number of critical care unit beds of a country are effective in determining patients' hospitalization in the critical care units.…”

“…A higher score indicates a greater deterioration in the patient's condition [ Table 1 ]. The MSOFA system is a valid and reliable tool that has been used in several studies,[ 14 18 19 ] as its reliability coefficient for hospitalized patients in the critical care units has been found to be 0.94. [ 18 ]…”

The inability to walk unassisted at hospital admission as a valuable triage tool to predict hospital mortality in Rwandese patients with suspected infection

“…In order to reduce the death toll from infectious diseases in this setting, future research efforts should focus primarily on patients with an acute infection who are at risk of in-hospital death. While some modified illness scores have shown promise [5,6], no triage tool exists which could early and reliably differentiate between patients with a minimal risk of death and patients who are at risk of dying from their infectious process.…”