Are changes in objective observations or the patient's subjective feelings the day after admission the best predictors of in-hospital mortality? An observational study in a low-resource sub-Saharan hospital

摘要

Background: The first clinical re-assessment after admission to hospital probably provides the best opportunity to detect clinical deterioration or failure to improve, and decide if care should be intensified. Aim: Compare changes the day after admission in the patient's subjective feelings and objective fin dings that included age, gender, the National Early Warning Score (NEWS) on admission, gait stability and mid-upper arm circumference (MUAC) on admission, and changes in NEWS, gait stability and mental alertness. Setting: Acutely ill medical patients admitted to a low-resource sub-Saharan hospital. Methods: Prospective observational study. Results: 1810 patients were reassessed 18 h after hospital admission. Logistic regression identified NEWS and gait stability on admission, a subjective feeling of improvement, the change in N EWS, and MUAC as clinically significant predictors of in-hospital mortality. Stratifying patients according to their NEWS on admission altered the predictive value of the four other predictors: for patients with an admission NEWS <3 a subjective feeling of improvement is the most powerful predictor of a good outcome. For patients with an admission NEWS > = 3 the change in NEWS, gait stability on admission and MUAC provide additional prognostic information. Conclusion: NEWS and gait stability on admission, MUAC, a subjective feeling of improvement, and change in NEWS the day after admission are all clinically significant predictors of in-hospital mortality.