Frequency of Vital Signs Monitoring and its Association with Mortality among Adults with Severe Sepsis Admitted to a General Medical Ward in Uganda

Abstract

IntroductionOptimal vital signs monitoring of patients with severe sepsis in resource-limited settings may improve outcomes. The objective of this study was to determine the frequency of vital signs monitoring of patients with severe sepsis and its association with mortality in a regional referral hospital in Uganda.MethodsWe reviewed medical records of patients admitted to Mbarara Regional Referral Hospital in Southwestern Uganda with severe sepsis defined by the presence of infection plus ≥2 of the systemic inflammatory response syndrome criteria, and ≥1 organ dysfunction (altered mental state, hypotension, jaundice, or thrombocytopenia). We recorded frequency of vital signs monitoring in addition to socio-demographic, clinical, and outcome data. We analyzed the data using logistic regression.ResultsWe identified 202 patients with severe sepsis. The median age was 35 years (IQR, 25–47) and 98 (48%) were female. HIV infection and anemia was present in 115 (57%) and 83 (41%) patients respectively. There were 67 (33%) in-hospital deaths. The median monitoring frequency per day was 1.1 (IQR 0.9–1.5) for blood pressure, 1.0 (IQR, 0.8–1.3) for temperature and pulse, and 0.5 (IQR, 0.3–1.0) for respiratory rate. The frequency of vital signs monitoring decreased during the course of hospitalization. Patients who died had a higher frequency of vital signs monitoring (p<0.05). The admission respiratory rate was associated with both frequency of monitoring (coefficient of linear regression 0.6, 95% CI 0.5–0.8, p<0.001) and mortality (AOR 2.5, 95% CI 1.3–5.3, p = 0.01). Other predictors of mortality included severity of illness, HIV infection, and anemia (p<0.05).ConclusionsMore research is needed to determine the optimal frequency of vital signs monitoring for severely septic patients in resource-limited settings such as Uganda.

Derivation and validation of a universal vital assessment (UVA) score: a tool for predicting mortality in adult hospitalised patients in sub-Saharan Africa

“…This level of monitoring is generally not possible in resource-limited environments where patients are likely to have vital signs assessed only once per day. 33 However, even a single deranged vital sign value signalled clinical deterioration in an ICU in Tanzania and increasing numbers of deranged values increased the odds of mortality. 30 A subsequent treatment algorithm based on abnormal vital signs improved targeted clinical responses and mortality outcomes for hypotensive patients.…”

The Early Recognition and Management of Sepsis in Sub-Saharan African Adults: A Systematic Review and Meta-Analysis

“…However, implementation would likely be challenging due to critical shortages of both health care workers and material resources in sub-Saharan African healthcare settings [ 36 ] and this tool has not yet been used to direct patient care in clinical trials. For example, a retrospective cohort study in Uganda demonstrated that the median monitoring frequency was 1.1/day for blood pressure and 0.5/day for respiratory rate in patients admitted to medical wards [ 37 ]. For an effective rapid response system, the afferent recognition limb must trigger an efferent ‘action’ limb to manage the at-risk patients [ 38 ].…”

Remote patient monitoring for improving outpatient care of patients at risk for sepsis

“…However, no consistent guideline exists for how often to measure vitals. For patients in a hospital environment, the World Health Organization (WHO) recommends temperature measurements every six hours after admission for sepsis, and one to three times daily after the first 24 hours [20]. Since a fever can take up to 60 minutes to develop, failing to probe this often could lead to a delayed detection of sepsis [21].…”