Predictors of Mortality in a Critical Care Unit in
South Western Kenya
Ongóndi M, Mwachiro M, Ranketi S
Tenwek Hospital Bomet, Kenya
Correspondence to: Matilda Ongóndi, P.O Box 2437-00202, Nairobi.
Background: Critical care in developing countries has been neglected in the face of high numbers of communicable and infectious diseases like malaria, tuberculosis, HIV and Critical Care Units continue to be limited to large hospitals in urban areas. There is need to know the type of patients admitted to existing units, common diagnoses and outcomes.
Objective: To determine the demographics, diagnosis and mortality of the patient population admitted to Tenwek Hospital critical care units.
Method: Retrospective observational review of all patients admitted to critical care unit in Tenwek Hospital. Results: Six hundred and forty four patients admitted over a 7 month period were studied. The patients were young (32.8yrs), male and majority were from surgical service. The leading reason for admission was trauma. The overall mortality was 26.1%. Factors that significantly influenced mortality on univariate analysis were patients age (p <0.001), hospital stay (p <0.001), hospital service (p=0.002) and priority level (p<0.001). On multivariate analysis age and pediatric service were still significantly associated with increased mortality. Increased monitoring was protective OR 0.1 (95% CI 0.1-0.2, p=0.01). Of those who died 40.4% had full resuscitation, 36.8% had no resuscitation and 8.2% had withdrawal of care. Conclusion: Patients admitted to the critical care units were young, male and mainly from the surgical service with trauma being the commonest diagnosis. Age was an independent predictor of mortality and monitoring was protective.
Keywords: Critical Care, Intensive Care Unit (ICU),
High Dependency Unit (HDU)
Ann Afr Surg. 2016;13(1):3-6
Critical care in developing countries had for a long time been considered a luxury in the face of high number of communicable and infectious diseases like malaria, tuberculosis, HIV and continues to be limited to large hospitals in urban areas (1-3). Most studies done in Africa have shown that the largest group benefiting from ICU care are post-operative surgical patients (2,4). Knowledge of characteristics and outcomes of critically ill patients admitted to ICUs in developing countries may help with identification of priorities and resources allocation for improvement of this type of care (1). The limited number of beds available compared to those in need creates a necessity of optimizing the criteria for admission. There is a paucity of critical care trained staff (critical care nurses and doctors) which may impact the quality of care. Hospitals also face the challenge of getting appropriate equipment and the appropriate technical personnel to support the use of this equipment (5).
The objective of this study was to describe the demographics of the patient population that was admitted to Tenwek Hospital Critical Care Units (ICU and HDU), determine common diagnoses, the admitting services, indication for admission, patient outcomes and factors that were associated with mortality.
This was a retrospective observational chart review of all patients admitted to th