The alertness, gait and mortality of severely ill patients at two months after admission to a resource poor sub-Saharan hospital--Why is post-discharge surveillance not routine everywhere?

Abstract

BACKGROUND: Mortality, the first level of the first tier of the Outcomes Measures Hierarchy used to assess the value of health care, is the only hospital outcome usually measured. Gait and alertness after discharge are important to patients; they capture much of the second level of the first tier of the hierarchy, and are required to more fully assess the benefits, value and quality of care. AIM: To assess the alertness, gait and mortality of severely ill patients at two months after admission to a resource poor sub-Saharan hospital. METHODS: 193 severely ill patients admitted to a Ugandan hospital were followed up for up to 60 days. RESULTS: 34% of patients died, 52% were alert and calm with a stable independent gait, 2% had an unstable gait, 6% were bedridden and 7% were lost to follow-up within 60 days of admission: 7.4% of patients discharged alert with a stable gait died within 30 days and 13.9% within 60 days; 26.9% of patients discharged without a stable gait died within 60 days. Sixty day mortality was 5% if patients had a stable independent gait on admission, 25% if they had an unstable gait or needed help to walk, and 50% if they were bedridden. Simple logistic regression models based on cheap easily available data predicted 30 day mortality, alertness and gait (c statistic of both models 0.89 SE 0.03). CONCLUSION: In a resource poor setting gait and alertness assessments are of prognostic value, and practical and informative methods of patient follow-up.