Journal Article

Frequency of Vital Signs Monitoring and its Association with Mortality among Adults with Severe Sepsis Admitted to a General Medical Ward in Uganda

Okello, Samson, Moore, Christopher C., Asiimwe, Stephen B.

2014

Overview

Optimal vital signs monitoring of patients with severe sepsis in resource-limited settings may improve outcomes. The objective of this study was to determine the frequency of vital signs monitoring of patients with severe sepsis and its association with mortality in a regional referral hospital in Uganda. We reviewed medical records of patients admitted to Mbarara Regional Referral Hospital in Southwestern Uganda with severe sepsis defined by the presence of infection plus ≥ 2 of the systemic inflammatory response syndrome criteria, and ≥ 1 organ dysfunction (altered mental state, hypotension, jaundice, or thrombocytopenia). We recorded frequency of vital signs monitoring in addition to socio-demographic, clinical, and outcome data. We analyzed the data using logistic regression. We identified 202 patients with severe sepsis. The median age was 35 years (IQR, 25-47) and 98 (48%) were female. HIV infection and anemia was present in 115 (57%) and 83 (41%) patients respectively. There were 67 (33%) in-hospital deaths. The median monitoring frequency per day was 1.1 (IQR 0.9-1.5) for blood pressure, 1.0 (IQR, 0.8-1.3) for temperature and pulse, and 0.5 (IQR, 0.3-1.0) for respiratory rate. The frequency of vital signs monitoring decreased during the course of hospitalization. Patients who died had a higher frequency of vital signs monitoring (p<0.05). The admission respiratory rate was associated with both frequency of monitoring (coefficient of linear regression 0.6, 95% CI 0.5-0.8, p<0.001) and mortality (AOR 2.5, 95% CI 1.3-5.3, p = 0.01). Other predictors of mortality included severity of illness, HIV infection, and anemia (p<0.05). More research is needed to determine the optimal frequency of vital signs monitoring for severely septic patients in resource-limited settings such as Uganda.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Adults / Analysis / Anemia / Antibiotics / Blood pressure / Blood Pressure - physiology / Data processing / Demographics / Emergency medical care / Female / Health aspects / Heart Rate - physiology / HIV / HIV infections / Hospital Mortality / Hospitalization / Hospitals / Human immunodeficiency virus / Humans / Hypotension / Illnesses / Infection / Infections / Inflammation / Inflammatory response / Intensive care / Internal medicine / Jaundice / Laboratories / Male / Medical records / Medical research / Medicine / Middle Aged / Monitoring / Mortality / Patients / Physiology / Regression analysis / Respiration / Respiratory rate / Respiratory Rate - physiology / Sepsis / Sepsis - mortality / Sepsis - pathology / Sepsis - physiopathology / Systemic inflammatory response syndrome / Telemedicine / Thrombocytopenia / Uganda / Vital signs