title: The alertness, gait and mortality of severely ill patients at two months after admission to a resource poor sub-Saharan hospital--Why is post-discharge surveillance not routine everywhere?
abstract: BACKGROUND
  Mortality, the first level of the first tier of the Outcomes Measures Hierarchy used to assess the value of health care, is the only hospital outcome usually measured. Gait and alertness after discharge are important to patients; they capture much of the second level of the first tier of the hierarchy, and are required to more fully assess the benefits, value and quality of care.
  
  
  OBJECTIVE
  To assess the alertness, gait and mortality of severely ill patients at two months after admission to a resource poor sub-Saharan hospital.
  
  
  METHODS
  193 severely ill patients admitted to a Ugandan hospital were followed up for up to 60 days.
  
  
  RESULTS
  34% of patients died, 52% were alert and calm with a stable independent gait, 2% had an unstable gait, 6% were bedridden and 7% were lost to follow-up within 60 days of admission: 7.4% of patients discharged alert with a stable gait died within 30 days and 13.9% within 60 days; 26.9% of patients discharged without a stable gait died within 60 days. Sixty day mortality was 5% if patients had a stable independent gait on admission, 25% if they had an unstable gait or needed help to walk, and 50% if they were bedridden. Simple logistic regression models based on cheap easily available data predicted 30 day mortality, alertness and gait (c statistic of both models 0.89 SE 0.03).
  
  
  CONCLUSIONS
  In a resource poor setting gait and alertness assessments are of prognostic value, and practical and informative methods of patient follow-up.
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, Thunder Bay, Ontario, Canada. Electronic address: jgkellett@eircom.net.
authors.forename: John
authors.initials: J
authors.lastname: Kellett
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; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D005684:Gait; D006295:Health Resources; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010351:Patient Discharge; D011379:Prognosis; D012720:Severity of Illness Index; D014454:Uganda; D014851:Wakefulness; D055815:Young Adult
keywords: Acute medicine; Early warning scores; Frailty; Outcomes; Post-discharge surveillance