The sixth vital sign: HIV status assessment and severe illness triage in Uganda

Mj, Cummings; Goldberg, Elijah; Mwaka, Savio; Kabajaasi, Olive; Vittinghoff, Eric; Katamba, Achilles; Cattamanchi, Adithya; Kenya-Mugisha, Nathan; Davis, J. Lucian; St, Jacob

doi:10.5588/pha.17.0045

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…The World Health Organization in 2011 recommended that HIV status be assessed in all patients in HIV prevalent regions (191). Cummings et al proposed that HIV assessment and triage of severely ill should be adopted as the sixth vital sign citing that 395 of 2451 Ugandan patients who were HIV positive were more likely to develop shock or die during hospitalization (192).…”

Section: Diagnosis Diagnosismentioning

confidence: 99%

A Comprehensive Assessment of The Eight Vital Signs

Draves

Tekiner

Yale

et al. 2022

The EuroBiotech Journal

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The term “vital sign” has been assigned to various phenomena with the presumptive intent to emphasize their importance in health care resulting in the emergence of eight vital signs with multiple designations and overlapping terms. This review developed a case definition for vital signs and identified and described the fifth through eighth vital signs. PubMed/Medline, Google and biographical databases were searched using the individual Medical Subject Headings (MeSH) terms, vital sign and fifth, vital sign and sixth, vital sign and seventh, and vital sign eighth. The search was limited to human clinical studies written in English literature from 1957 up until November 30, 2021. Excluded were articles containing the term vital sign if used alone without the qualifier fifth, sixth, seventh, or eighth or about temperature, blood pressure, pulse, and respiratory rate. One hundred ninety-six articles (122 for the fifth vital sign, 71 for the sixth vital sign, two for the seventh vital sign, and one for the eighth vital sign) constituted the final dataset. The vital signs consisted of 35 terms, classified into 17 categories compromising 186 unique papers for each primary authored article with redundant numbered vital signs for glucose, weight, body mass index, and medication compliance. Eleven terms have been named the fifth vital sign, 25 the sixth vital sign, three the seventh, and one as the eighth vital sign. There are four time-honored vital signs based on the case definition, and they represent an objective bedside measurement obtained noninvasively that is essential for life. Based on this case definition, pulse oximetry qualifies as the fifth while end-tidal CO2 and cardiac output as the sixth. Thus, these terms have been misappropriated 31 times. Although important to emphasize in patient care, the remainder are not vital signs and should not be construed in this manner.

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Section: Diagnosis Diagnosismentioning

confidence: 99%

A Comprehensive Assessment of The Eight Vital Signs

Draves

Tekiner

Yale

et al. 2022

The EuroBiotech Journal

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“…According to the World Health Organization (WHO), the African region experiences both the greatest burden of disease and the lowest density of health workers at 2.2 healthcare professionals per 1000 population (3). This health care worker shortage results in overburdened medical staff, overcrowded facilities and limitations in the inpatient monitoring (4)(5)(6), with worsening illness often under-recognized and associated with substantial mortality (7) (8).…”

Section: Introductionmentioning

confidence: 99%

Family-Assisted Severity of Illness Monitoring for Hospitalized Children in Low-resource settings – a two-arm interventional pilot study

Arnim

Kumar

Clark

et al. 2021

Preprint

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IntroductionPediatric mortality remains unacceptably high in many low-resource settings, with inpatient deaths often associated with delayed recognition of clinical deterioration. The Family-Assisted Severe Febrile Illness ThERapy (FASTER) tool has been developed for caregivers to assist in monitoring their hospitalized children and alert clinicians. While utilization of the tool is feasible, the impact on outcomes in low-resource settings has not been studied.MethodsRandomized controlled pilot study at Kenyatta National Hospital, Kenya. Children hospitalized with acute febrile illness with a caregiver at the bedside for 24 hours were enrolled. Caregivers were trained using the FASTER tool (monitors work of breathing, mental status, perfusion, producing color-coded flags to signal illness severity). The primary outcome was the frequency of clinician reassessments between intervention (FASTER) and control (standard care) arms. Secondary outcomes included survey assessments of clinician and caregiver experiences with the tool. The study was registered with ClinicalTrials.govNCT03513861.Results150 patient/caregiver pairs were enrolled, 139 included in the analysis, 74 in the intervention, 65 in the control arm. Patients’ median age was 0.9 (range 0.2-10) and 1.1 years (range 0.2-12) in intervention versus control arms. The most common diagnoses were pneumonia (80[58%]), meningitis (58[38%]) and malaria (34[24%]). 134(96%) caregivers were patients’ mothers. Clinician visits/hour increased with patients’ illness severity in both arms, but without difference in frequency between arms (point estimate for the difference -0.2%, p=0.99). Of the 16 deaths, 8 (four/arm) occurred within 2 days of enrollment. Forty clinicians were surveyed, 33(82%) reporting that FASTER could improve outcomes of very sick children in low-resource settings; 26(65%) rating caregivers as able to adequately capture patients’ severity of illness. Of 70 caregivers surveyed, 63(90%) reported that FASTER training was easy to understand; all(100%) agreed that the intervention would improve care of hospitalized children and help identify sick children in their community.DiscussionAlthough we observed no difference in recorded frequency of clinician visits with FASTER monitoring, the tool was rated positively by caregivers and clinicians. Further research to refine implementation with additional input from all stakeholders might increase the effectiveness of FASTER in detecting and responding to clinical deterioration in low-resource settings.

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“…3,4 In this issue of Public Health Action, Cummings and colleagues have assessed the effectiveness of a multimodal quality improvement programme on HIV status assessment in western Uganda. 5 The quality improvement (QI) programme included a one-week instructional course on the early recognition of severe illness and HIV status assessment as an important part of management of sick individuals, followed by site-specific QI interventions: audits, performance assessments and mentoring. HIV status in adults and adolescents admitted to medical wards was assessed before and after the intervention.…”

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confidence: 99%