Clinical outcomes and their associated factors for post-ICU patients admitted ai n the wards at Muhimbili national hospital and Muhimbili Orthopadeic Institute, Dar es salaam Tanzania

Abstract

Background: Mortality in the ward after ICU discharge is considered a quality parameter, and is commonly defined as a source of unexpected or avoidable mortality. A worse outcome is associated with the physiological reserve before ICU admission. Unfortunately locally no studies have been done to establish the extent of mortality in the ward post-ICU and their associated factors and measures designed to address them. Objective: This study was designed to determine the clinical outcomes and their associated factors for post-ICU patients admitted in the wards from the two intensive care units of Muhimbili National Hospital and Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania. Methods: A descriptive cross sectional study was conducted over a ten-month period from June 2009 to march 2010. All patients admitted at the two ICUs who consented and later discharged from ICU to the general wards during the study period were enrolled. Demographic information, reason for admission, nature of admission, Clinical Sickness Score (CSS) at admission to ICU, Length of stay in ICU, Mortality in the ward, Cause of death in the ward were documented and were critically evaluated. Results: In this study 582 patients were enrolled, 183(31.4%) died in ICU, further 39(9.8%) died in the general wards. Sepsis was the most common cause of death post-ICU accounting for 16(41.03%), Higher CSS score at admission, length of ICU stay were associated with mortality. Independent predictor of post-ICU mortality was severity of illness at admission to ICU as predicted by CSS at admission to ICU. Conclusions: This study shows that post-ICU mortality in the wards in this centre is less than that found in other countries of the developing world. The common cause of death in the ward post-ICU was sepsis. This provides knowledge that to update either our antibiotic use protocols or infection control protocols. The data collected also indicates that the determinants of post-ICU mortality in the ward was Clinical Sickness Score at admission to ICU and was that the independent predictor of post-ICU ward mortality and the overall ICU and post-ICU death in hospital.