Critical Care at the University Teaching Hospital,Zambia: Mortality and Quality of Life Outcomes: Cross Sectional Study

Abstract

Background: The Traditional goal of intensive care has been to reduce short-term mortality. While worthwhile in terms of “saving lives”, this goal fails to address the issue of what it means to survive intensive care (ICU). Key questions include whether ICU survivors have optimal long-term outcomes. This study provides updated mortality rates of ICU patients at UTH and compares this to historical data. Also, for the first time it will provide an insight into the mortality and functional recovery of patients discharged alive from ICU. This extremely important outcome data is essential if the ICU is to apply its limited resources in the most effective manner and plan its admission, treatment and discharge protocols accordingly in the future. Outcome from critical care is related to patient selection. Criteria for admission for maximum utility and most beneficial outcomes include severity of admission illness (i.e. severity and number of organ/system failure), age and physiological reserve. Admission GCS is a particularly powerful indicator of outcome potential in brain injury. The underlying diagnosis must also be of a recoverable illness. Admission GCS and diagnosis or clinical category was recorded to try to identify areas of best and worst outcome to guide further admission policy development. Method: This is an observational cross sectional study conducted at the University Teaching Hospital Lusaka Zambia. 559 Patients were sampled comprising both male and female. Five patients had missing data hence were omitted from analysis and one patients was lost to follow up. The age range was between 16 and 80years old. Patients were recruited on admission to ICU over a period of 3 months and were seen at discharge and interviewed two weeks post discharge from ICU using a structured questionnaire. Hospital records were looked at to get information on the 2015 ICU admissions. The data was analyzed using SPSS version 22 for Mac and logistical analysis done for the qualitative variables Results: Findings of the study showed that patients who had GCS less than 6 had a mortality rate of 81.1%. Traumatic brain injury was the leading cause of admission, with patients admitted for postoperative stabilization having the most benefit with 6% mortality. Of patients discharged alive from ICU, 25% were fully functional at 2 weeks post discharge from intensive care, 45% could undertake ADLs but were not back to function in full capacity, 20% of the patients required assistance with ADLs and the remaining 10% had died by 2 weeks post discharge from ICU. ICU mortality was found to be at 37%. Conclusion: There is a high overall mortality rate of patients admitted to ICU with a particularly high mortality and residual disability in those with admission GCS less than 8 compared to those admitted with a higher GCS. Mortality of particular groups warrant further investigation such as the HIV positive, pregnancy related and TBI admitted with GCS less than 6. Functional outcomes in the small sample studies achieved good return to function in a short period.