AJTMH: Predictors of admission among patients presenting with febrile illness

31 July, 2018

Dear HIFA colleagues,

This is potentially of interest, but unfortunately the full text is restricted-access and the authors do not appear to have placed the paper in an OA repository. (The publisher ASTMH is, however, a partner of Hinari)

CITATION: Who Stays and Who Goes: Predictors of Admission among Patients Presenting with Febrile Illness and a Positive Malaria Rapid Diagnostic Test in a Rural Ugandan Health Center

Authors: Jonathan L. Chang, Raquel Reyes, Michael Matte, Moses Ntaro, Edgar Mulogo, Matthew O. Wiens, Steven R. Meshnick, Mark J. Siedner and Ross Boyce

American Journal of Tropical Medicine and Hygiene 2018

DOI: https://doi.org/10.4269/ajtmh.18-0338

ABSTRACT

Not much is known about clinical decision-making in rural, low-resource settings regarding fever, a common reason for presentation to care. In this prospective cohort study of patients presenting with febrile illness to a rural Ugandan health center, we examined demographic and clinical factors predictive of an initial disposition of inpatient admission after clinical evaluation, but before laboratory testing. We then assessed the association of laboratory results and system factors with a change between initial and final disposition plans. Four thousand nine hundred twenty-four patients with suspected febrile illness were included in the primary analysis. The strongest predictors for an initial disposition of admission after clinical examination were impaired consciousness (adjusted risk ratio [aRR], 3.21; 95% confidence interval [CI]: 2.44–4.21) and fever on examination (aRR, 2.27; 95% CI: 1.79–2.87). Providers initially planned to discharge patients with significant vital sign abnormalities, including tachypnea (3.6%) and hypotension (1.3%). Anemia strongly predicted a final disposition of admission after an initial disposition of discharge (aRR, 48.34; 95% CI: 24.22–96.49); other laboratory abnormalities, including hypoglycemia and acidosis, did not change disposition planning. In those with an initial disposition of admission, living farther than the two neighboring villages was associated with a final disposition of discharge (aRR, 2.12; 95% CI: 1.10–4.12). A concerning number of patients with abnormal vital signs and laboratory results were not admitted for inpatient care. Geographic factors may influence a patient’s final disposition contrary to a provider’s initial disposition plan. Future work should assess longer term outcomes after discharge and a broader study population.

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Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 18,000 members in 177 countries, interacting on five global forums in three languages. He also currently chairs the Dgroups Foundation (www.dgroups.info), which supports 800 communities of practice on international development, health and social justice. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org