title: The mortality of acutely ill medical patients for up to 60days after admission to a resource poor hospital in sub-Saharan Africa compared with patients of similar illness severity admitted to a Danish Regional Teaching Hospital--an exploratory observational study.
abstract: BACKGROUND
  The outcomes of patients with the same severity of illness in the developed and developing countries have not been compared. Illness severity can now be measured anywhere by the National Early Warning Score (NEWS).
  
  
  METHODS
  An exploratory observational study that compared the 7, 30 and 60 days mortality of 195 Ugandan and 588 Danish acutely ill medical patients that had a NEWS >6 at the time of their admission to the hospital. The association of vital sign changes, alertness and mobility at admission on subsequent outcome was explored.
  
  
  RESULTS
  More Kitovu (34.4%) than Danish patients (22.1%) died within 60 days of admission (OR 1.85, 95% CI 1.27-2.71, p 0.001). However, the survival of non-comatose patients admitted without severely deranged vital signs or who were able to stand without help was identical in both cohorts (Chi square 0.32, p 0.57): these patients made up 50% of all Ugandan and 60% of all Danish patients. In contrast the survival curves of patients admitted in a coma were widely divergent within a week of hospital admission and remained so for a further 60 days (Chi square 10.29, p 0.001).
  
  
  CONCLUSIONS
  This small hypothesis generating observational study with huge selection and treatment bias found no survival difference at 60 days after admission to resource rich and resource poor hospitals for patients without severely deranged vital signs or who were able to stand without help.
authors.affiliation: Medical Wards, St. Joseph's Kitovu Health Care Complex, Masaka, Uganda.
authors.forename: Barbara
authors.initials: B
authors.lastname: Nabayigga
authors.affiliation: Thunder Bay Regional Health Sciences Center, 980 Oliver Road, Thunder Bay ON P78 7A5, ON, Canada. Electronic address: jgkellett@eircom.net.
authors.forename: John
authors.initials: J
authors.lastname: Kellett
authors.affiliation: Department of Medicine, Sydvestjysk Sygehus, Esbjerg, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Brabrand
authors.affiliation: St. Joseph's Kitovu Health Care Complex, Masaka, Uganda.
authors.forename: Martin Otyek
authors.initials: MO
authors.lastname: Opio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001831:Body Temperature; D003718:Denmark / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D006339:Heart Rate; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: Acute medicine; Early warning scores; Outcomes; Post-discharge surveillance