Outcomes of critically ill trauma patients associated with missed ICU admission at Mulago National Referral Hospital

dc.contributor.author Guloba, Umarashid
dc.date.accessioned 2023-12-07T11:30:36Z
dc.date.available 2023-12-07T11:30:36Z
dc.date.issued 2023
dc.description A dissertation submitted to the department of Anesthesia, Critical care and Emergency Medicine in partial fulfilment of the requirements for the award of a Master of Medicine in Emergency Medicine of Makerere University. en_US
dc.description.abstract Trauma is the 6th leading cause of mortality globally with more than 90% is in Africa. It’s a significant cause of admission in Ugandan hospitals and outcomes are largely negative as compared to high income countries. This is due to lack of critical care services for trauma patients of whom missed critical care opportunities are more than 35%. This study informs policy and practice on the status of critical care needs for trauma patients in similar settings. Objective: To determine the outcomes of critically ill trauma patients associated with missing ICU admission at Mulago National Referral Hospital (MNRH). Methods: This was a prospective cohort study of critically ill adult trauma patients admitted to MNRH Accidents and Emergency (A&E) unit. Participants were enrolled consecutively at presentation and followed up for mortality within 24 hours and 30 days. Multinomial logit regression was used to evaluate the association of missed ICU admission with mortality. Generalized Linear Model with a gaussian family and a log link was used to evaluate the association of patients who missed ICU admission with length of stay. Ethical approval was obtained from the School of Medicine Research and Ethics committee. Results: In-hospital mortality within 24 hours was observed in 160 (44.1%) of the patients who missed ICU admission, when compared to 4 (14.8%) of those admitted into ICU. The median survival time for critically ill trauma patients who missed ICU admission was 1.5 days compared to 19 days for those who got admitted into ICU. Patients admitted into ICU had a 90% increase (adjusted exp(β) = 1.90, 95% CI: 1.29-2.82, p-value = 0.001) in the length of stay when compared to those who missed ICU admission. Missing ICU admission multiplied the relative risk of death within 24 hours 8.9 times (adjusted RRR = 8.90, 95% CI: 2.64-29.98, p-value = <0.001) compared to being admitted to ICU. Conclusion: Missing ICU admission is associated with a 3-fold increase in in-hospital mortality. The leading causes of in-hospital mortality were traumatic brain injury, hemorrhagic shock, and hypoxia. Expansion of critical care capacity (including possibilities of establishing a dedicated trauma ICU) is needed to accommodate the increased burden of critical illness from trauma which may reduce mortality and morbidity. en_US
dc.identifier.citation Guloba, U. (2023). Outcomes of critically ill trauma patients associated with missed ICU admission at Mulago National Referral Hospital. (Unpublished master's dissertation). Makerere University, Kampala, Uganda. en_US
dc.identifier.uri http://hdl.handle.net/10570/12762
dc.language.iso en en_US
dc.publisher Makerere University en_US
dc.subject 24 hour mortality en_US
dc.subject Missed ICU admission en_US
dc.subject Trauma patients en_US
dc.subject 30 day mortality trauma en_US
dc.subject Mulago National Referral Hospital en_US
dc.title Outcomes of critically ill trauma patients associated with missed ICU admission at Mulago National Referral Hospital en_US
dc.type Thesis en_US
Files