title: Frequency of vital signs monitoring and its association with mortality among adults with severe sepsis admitted to a general medical ward in Uganda.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  More research is needed to determine the optimal frequency of vital signs monitoring for severely septic patients in resource-limited settings such as Uganda.
authors.affiliation: Department of Internal Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda ; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Asiimwe
authors.affiliation: Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Samson
authors.initials: S
authors.lastname: Okello
authors.affiliation: Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, United States of America.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Moore
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D056152:Respiratory Rate / Q000502:physiology; D018805:Sepsis / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology*; D014454:Uganda