title: Abnormal Admission Chest X-Ray and MEWS as ICU Outcome Predictors in a Sub-Saharan Tertiary Hospital: A Prospective Observational Study.
abstract: Background. Critical care in Uganda is a neglected speciality and deemed costly with limited funding/prioritization. We studied admission X-ray and MEWS as mortality predictors of ICU patients requiring mechanical ventilation.Materials and Methods. We did a cross-sectional study in Mulago Hospital ICU and 87 patients for mechanical ventilation were recruited with mortality as the outcome of interest. Chest X-ray results were the main independent variable and MEWS was also gotten for all patients.Results. We recruited 87 patients; most were males (60.92%), aged between 16 and 45 years (59.77%), and most admissions for mechanical ventilation were from the Trauma Unit (30.77%). Forty-one (47.13%) of the 87 patients died and of these 34 (53.13%) had an abnormal CXR with an insignificant IRR = 1.75 (0.90-3.38) (p= 0.062). Patients with MEWS ≥ 5 (pvalues = 0.018) and/or having an abnormal superior mediastinum (pvalues = 0.013) showed a positive association with mortality while having a MEWS ≥ 5 had an incidence risk ratio = 3.29 (1.00-12.02) (p= 0.018). MEWS was a good predictor of mortality (predictive value = 0.6739).Conclusion. Trauma (31%) caused most ICU admissions, having an abnormal admission chest X-rays positively associated with mortality and a high MEWS was also a good predictor of mortality.
authors.affiliation: Directorate of Surgery Surgical Services, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: Hannington
authors.initials: H
authors.lastname: Ssemmanda
authors.affiliation: Department of Anaesthesia, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Tonny Stone
authors.identifier: 0000-0002-1638-7321
authors.initials: TS
authors.lastname: Luggya
authors.affiliation: Directorate of Surgery Surgical Services, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: Clare
authors.initials: C
authors.lastname: Lubulwa
authors.affiliation: Department of Radiology, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: Zeridah
authors.initials: Z
authors.lastname: Muyinda
authors.affiliation: Department of Radiology, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: Pascal
authors.initials: P
authors.lastname: Kwitonda
authors.affiliation: Department of Epidemiology, Ministry of Health Uganda, Kampala, Uganda.
authors.forename: Humphrey
authors.initials: H
authors.lastname: Wanzira
authors.affiliation: Directorate of Surgery Surgical Services, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ejoku