title: Retrospective Descriptive Study of an Intensive Care Unit at a Ugandan Regional Referral Hospital.
abstract: We describe delivery and outcomes of critical care at Mbarara Regional Referral Hospital, a Ugandan secondary referral hospital serving a large, widely dispersed rural population.
  
  
  
  Retrospective observational study of ICU admissions was performed from January 2008 to December 2011.
  
  
  
  Of 431 admissions, 239 (55.4 %) were female, and 142 (33.2 %) were children (<18 years). The median length of stay was 2 (IQR 1-4) days, with 365 patients (85 %) staying less than 8 days. Indications for admission were surgical 49.3 % (n = 213), medical/pediatric 27.4 % (n = 118), or obstetrical/gynecological 22.3 % (n = 96). The overall mortality rate was 37.6 % (162/431) [adults 39.3 % (n = 113/287), children 33.5 % (n = 48/143), unspecified age 100 % (n = 1/1)]. Of the 162 deaths, 76 (46.9 %) occurred on the first, 20 (12.3 %) on the second, 23 (14.2 %) on the third, and 43 (26.5 %) on a subsequent day of admission. Mortality rates for common diagnoses were surgical abdomen 31.9 % (n = 29/91), trauma 45.5 % (n = 30/66), head trauma 59.6 % (n = 28/47), and poisoning 28.6 % (n = 10/35). The rate of mechanical ventilation was 49.7 % (n = 214/431). The mortality rate of ventilated patients was 73.5 % (n = 119/224). The multivariate odd ratio estimates of mortality were significant for ventilation [aOR 6.15 (95 % CI 3.83-9.87), p < 0.0001] and for length of stay beyond seven days [aOR 0.37 (95 % CI 0.19-0.70), p = 0.0021], but not significant for decade of age [aOR 1.06 (95 % CI 0.94-1.20), p = 0.33], gender [aOR 0.61(95 % CI 0.38-0.99), p = 0.07], or diagnosis type [medical vs. surgical aOR 1.08 (95 % CI 0. 63-1.84), medical vs. obstetric/gynecology aOR 0.73 (95 % CI 0.37-1.43), p = 0.49].
  
  
  
  The ICU predominantly functions as an acute care unit for critically ill young patients, with most deaths occurring within the first 48 h of admission. Expansion of critical care capacity in low-income countries should be accompanied by measurement of the nature and impact of this intervention.
authors: Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara, Uganda.
authors: Stephen S
authors: SS
authors: Ttendo
authors: Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA, USA.
authors: Adam
authors: A
authors: Was
authors: Department of Surgery, Brigham and Woman's Hospital, Boston, MA, USA.
authors: Mark A
authors: MA
authors: Preston
authors: Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara, Uganda.
authors: Emmanuel
authors: E
authors: Munyarugero
authors: Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors: Vanessa B
authors: VB
authors: Kerry
authors: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. pfirth@partners.org.
authors: Paul G
authors: PG
authors: Firth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014454:Uganda; D055815:Young Adult