Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward.
Global neurology
Head trauma
Neurological illness
Neurological infections
Stroke
Uganda
Journal
BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555
Informations de publication
Date de publication:
31 Jan 2020
31 Jan 2020
Historique:
received:
15
08
2019
accepted:
23
01
2020
entrez:
2
2
2020
pubmed:
2
2
2020
medline:
4
6
2020
Statut:
epublish
Résumé
While the burden of neurologic illness in developing countries is increasing, less is known about mortality among patients admitted to sub-Saharan African hospitals with neurologic disease. We sought to characterize the rate and patient-level predictors of in-hospital mortality in a Ugandan Neurology ward.cc. Data was prospectively collected on 335 patients admitted to the Neurology ward of Mulago Hospital, Kampala, Uganda. Kaplan-Meier survival curves and multivariate COX proportional hazard modeling were used to assess survival. Within our sample (n = 307), 35.8% received no diagnosis at time of hospital admission. Stroke (27.3%), head trauma (19.6%), and malaria (16.0%) were the most common diagnoses. Among the 56 (18.5%) patients who died during the index hospitalization, the most common diagnosis at admission and at death was stroke. Adjusted regression analysis showed that patients without a diagnosis at time of death (HR = 7.01 [2.42-20.35], p < .001) and those with diagnoses of infections (HR = 5.21 [2.16-12.58], p = <.001), stroke (HR = 2.69 [1.20-6.04], p = .017), or head trauma (HR = 3.39, [1.27-9.07], p = 0.15) had worse survival. In-hospital mortality affected nearly 20% of the cohort, with worse survival among those without a diagnosis and with infections, stroke, head trauma. Future work should identify reasons for increased mortality among these high-risk groups and implement targeted interventions.
Sections du résumé
BACKGROUND
BACKGROUND
While the burden of neurologic illness in developing countries is increasing, less is known about mortality among patients admitted to sub-Saharan African hospitals with neurologic disease. We sought to characterize the rate and patient-level predictors of in-hospital mortality in a Ugandan Neurology ward.cc.
METHODS
METHODS
Data was prospectively collected on 335 patients admitted to the Neurology ward of Mulago Hospital, Kampala, Uganda. Kaplan-Meier survival curves and multivariate COX proportional hazard modeling were used to assess survival.
RESULTS
RESULTS
Within our sample (n = 307), 35.8% received no diagnosis at time of hospital admission. Stroke (27.3%), head trauma (19.6%), and malaria (16.0%) were the most common diagnoses. Among the 56 (18.5%) patients who died during the index hospitalization, the most common diagnosis at admission and at death was stroke. Adjusted regression analysis showed that patients without a diagnosis at time of death (HR = 7.01 [2.42-20.35], p < .001) and those with diagnoses of infections (HR = 5.21 [2.16-12.58], p = <.001), stroke (HR = 2.69 [1.20-6.04], p = .017), or head trauma (HR = 3.39, [1.27-9.07], p = 0.15) had worse survival.
CONCLUSIONS
CONCLUSIONS
In-hospital mortality affected nearly 20% of the cohort, with worse survival among those without a diagnosis and with infections, stroke, head trauma. Future work should identify reasons for increased mortality among these high-risk groups and implement targeted interventions.
Identifiants
pubmed: 32005185
doi: 10.1186/s12883-020-1627-5
pii: 10.1186/s12883-020-1627-5
pmc: PMC6995141
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
42Subventions
Organisme : NIA NIH HHS
ID : P30 AG059299
Pays : United States
Organisme : UCB US
ID : None
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIMH NIH HHS
ID : R25 MH081482
Pays : United States
Organisme : FIC NIH HHS
ID : D43 TW009343
Pays : United States
Organisme : Office of Academic Affiliations, Department of Veterans Affairs
ID : HSRD CDA 1 IK2 HX001388-01A1
Références
PLoS One. 2014 Jun 24;9(6):e100420
pubmed: 24959714
Cardiovasc J Afr. 2015 Mar-Apr;26(2 Suppl 1):S27-38
pubmed: 25962945
Dakar Med. 1999;44(2):162-5
pubmed: 11957278
Acta Neurol Scand. 2013 Mar;127(3):198-207
pubmed: 22845781
Neurology. 2007 Jan 30;68(5):338-42
pubmed: 17261679
Am J Trop Med Hyg. 2017 Nov;97(5):1454-1460
pubmed: 28820708
J Neurol Sci. 2016 Apr 15;363:217-24
pubmed: 27000253
Niger J Clin Pract. 2014 Mar-Apr;17(2):237-40
pubmed: 24553038
Stroke. 2006 Mar;37(3):754-5
pubmed: 16484605
S Afr Med J. 1999 Jan;89(1):63-5
pubmed: 10070416
World Neurosurg. 2017 Oct;106:462-469
pubmed: 28698086
Epilepsy Behav. 2015 Oct;51:28-32
pubmed: 26253598
Popul Health Metr. 2012 Mar 05;10(1):4
pubmed: 22390221
Lancet Neurol. 2007 Mar;6(3):269-78
pubmed: 17303533
Prog Cardiovasc Dis. 2013 Nov-Dec;56(3):234-9
pubmed: 24267430
Neurology. 2007 Oct 23;69(17):1715-8
pubmed: 17954787
J Neurol Sci. 2017 Oct 15;381:165-168
pubmed: 28991673
Can J Neurol Sci. 2013 Jul;40(4):576-9
pubmed: 23786743
PLoS One. 2016 Jul 21;11(7):e0159579
pubmed: 27442529
Circulation. 2015 Oct 27;132(17):1667-78
pubmed: 26503749
Afr Health Sci. 2015 Sep;15(3):1016-22
pubmed: 26957995
Lancet. 2016 Aug 20;388(10046):761-75
pubmed: 27431356
Stroke. 2001 Jan;32(1):63-9
pubmed: 11136916
BMC Neurol. 2016 Nov 17;16(1):227
pubmed: 27855635
Pediatr Hematol Oncol. 2015 Mar;32(2):164-71
pubmed: 25251071
Ann Afr Med. 2011 Oct-Dec;10(4):278-83; discussion 283-4
pubmed: 22064253
Lancet Neurol. 2017 Nov;16(11):877-897
pubmed: 28931491
Popul Health Metr. 2011 Aug 04;9:38
pubmed: 21816103
Lancet Glob Health. 2017 Sep;5(9):e924-e935
pubmed: 28807190
Int J Epidemiol. 2007 Jun;36(3):642-51
pubmed: 17329316
Neurology. 2014 Jul 22;83(4):349-51
pubmed: 25049303
Neurology. 2005 Feb 8;64(3):412-5
pubmed: 15699367
J Clin Epidemiol. 2012 Mar;65(3):309-16
pubmed: 22169084