Inability to Walk Predicts Death among Adult Patients in Hospitals in Malawi

Kayambankadzanja, Raphael Kazidule; Schell, Carl Otto; Nsanjama, Grace; Mbingwani, Isaac; Mndolo, Samson Kwazizira; Rylance, Jamie; Baker, Tim

doi:10.1155/2019/6586891

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…This appears physiologically sound and might not only reflect the degree of frailty [ 15 ] but also the extent to which the patient’s physiologic reserve has been compromised by the acute condition. Similarly, the inability to walk at hospital admission proved to be an accurate predictor of the risk of in-hospital death in three African studies [ 16 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department

Tschoellitsch¹,

Krummenacker

Dünser³

et al. 2023

JCM

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The first clinical impression of emergency patients conveys a myriad of information that has been incompletely elucidated. In this prospective, observational study, the value of the first clinical impression, assessed by 18 observations, to predict the need for timely medical attention, the need for hospital admission, and in-hospital mortality in 1506 adult patients presenting to the triage desk of an emergency department was determined. Machine learning models were used for statistical analysis. The first clinical impression could predict the need for timely medical attention [area under the receiver operating characteristic curve (AUC ROC), 0.73; p = 0.01] and hospital admission (AUC ROC, 0.8; p = 0.004), but not in-hospital mortality (AUC ROC, 0.72; p = 0.13). The five most important features informing the prediction models were age, ability to walk, admission by emergency medical services, lying on a stretcher, breathing pattern, and bringing a suitcase. The inability to walk at triage presentation was highly predictive of both the need for timely medical attention (p < 0.001) and the need for hospital admission (p < 0.001). In conclusion, the first clinical impression of emergency patients presenting to the triage desk can predict the need for timely medical attention and hospital admission. Important components of the first clinical impression were identified.

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Section: Discussionmentioning

confidence: 99%

The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department

Tschoellitsch¹,

Krummenacker

Dünser³

et al. 2023

JCM

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show abstract

“…However, it is notable that even in well-resourced settings, simple clinical assessment has been shown to be as reliable as the Acute Physiology and Chronic Health Evaluation-IV (APACHE-IV) and Simplified Acute Physiology Score-II (SAPS-II)-and superior to the SOFA score-in identifying patients at greatest risk of deterioration (Hiemstra et al, 2019). Indeed, even simpler clinical assessments, including the inability to walk, have been shown to have significant prognostic value in the LMIC setting (Kayambankadzanja et al, 2019). A requirement for ICU support, which contributed to the primary endpoint, was based on clinical assessment rather than strict criteria; however, this emphasised the real-world location of the study and the absence of laboratory support to make these decisions.…”

Section: Discussionmentioning

confidence: 99%

The comparative ability of commonly used disease severity scores to predict death or a requirement for ICU care in patients hospitalised with possible sepsis in Yangon, Myanmar

Minn

Aung

Kyaw

et al. 2021

International Journal of Infectious Diseases

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To determine the comparative prognostic utility of commonly used disease prediction scores in adults with presumed community-acquired sepsis in a resource-limited tropical setting. Methods: This prospective, observational study was performed on the medical ward of a tertiary-referral hospital in Yangon, Myanmar. The ability of the National Early Warning Score 2 (NEWS2), quick NEWS (qNEWS), quick Sequential Organ Failure Assessment (qSOFA) score, Universal Vital Assessment (UVA) and Sequential Organ Failure Assessment (SOFA) scores to predict a complicated inpatient course (death or requirement for intensive care unit (ICU) support) in patients with two or more systemic inflammatory response syndrome criteria was determined. Results: Among the 509 patients, 30 (6%) were HIV-seropositive. The most commonly confirmed diagnoses were tuberculosis (30/509, 5.9%) and measles (26/509, 5.1%). Overall, 75/509 (14.7%) died or required ICU support. All the scores except the qSOFA score, which was inferior, had a similar ability to predict a complicated inpatient course. Conclusions: In this resource-limited tropical setting, disease severity scores calculated at presentation using only vital signs-such as the NEWS2 score-identified high-risk sepsis patient as well as the SOFA score, which is calculated at 24 h and which also requires laboratory data. Use of these simple clinical scores can be used to facilitate recognition of the high-risk patient and to optimise the use of finite resources.

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“…Even when ICU capacity is sufficient, early recognition of critical illness and urgent interventions such as fluid resuscitation and antibiotics on medical wards can improve outcomes and avert the need for ICU admission in a decompensating patient [ 10 , 17 – 29 ]. For inpatients in medical wards, modified triage or medical early warning systems based on physiological and physical parameters [ 18 , 19 , 22 ], oxygen delivery for childhood pneumonia [ 20 ], and modular critical care training programs for non-specialty staff [ 21 , 30 ] have decreased mortality and morbidity.…”

Section: Introductionmentioning

confidence: 99%

Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study

Connolly,

Kasomekera,

Sonenthal

et al. 2023

BMC Health Serv Res

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Introduction As low-income countries (LICs) shoulder a disproportionate share of the world’s burden of critical illnesses, they must continue to build critical care capacity outside conventional intensive care units (ICUs) to address mortality and morbidity, including on general medical wards. A lack of data on the ability to treat critical illness, especially in non-ICU settings in LICs, hinders efforts to improve outcomes. Methods This was a secondary analysis of the cross-sectional Malawi Emergency and Critical Care (MECC) survey, administered from January to February 2020, to a random sample of nine public sector district hospitals and all four central hospitals in Malawi. This analysis describes inputs, systems, and barriers to care in district hospitals compared to central hospital medical wards, including if any medical wards fit the World Federation of Intensive and Critical Care Medicine (WFSICCM) definition of a level 1 ICU. We grouped items into essential care bundles for service readiness compared using Fisher’s exact test. Results From the 13 hospitals, we analysed data from 39 medical ward staff members through staffing, infrastructure, equipment, and systems domains. No medical wards met the WFSICCM definition of level 1 ICU. The most common barriers in district hospital medical wards compared to central hospital wards were stock-outs (29%, Cl: 21% to 44% vs 6%, Cl: 0% to 13%) and personnel shortages (40%, Cl: 24% to 67% vs 29%, Cl: 16% to 52%) but central hospital wards reported a higher proportion of training barriers (68%, Cl: 52% to 73% vs 45%, Cl: 29% to 60%). No differences were statistically significant. Conclusion Despite current gaps in resources to consistently care for critically ill patients in medical wards, this study shows that with modest inputs, the provision of simple life-saving critical care is within reach. Required inputs for care provision can be informed from this study.

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Inability to Walk Predicts Death among Adult Patients in Hospitals in Malawi

Cited by 4 publications

References 17 publications

The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department

The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department

The comparative ability of commonly used disease severity scores to predict death or a requirement for ICU care in patients hospitalised with possible sepsis in Yangon, Myanmar

Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study

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