Predicting Mortality for Adolescent and Adult Patients with Fever in Resource-Limited Settings
Year: 2018
Type: article
Study design: Observational Study
Abstract: Febrile illnesses are a major cause of mortality in sub-Saharan Africa. Early identification of patients at increased risk of death may avert adverse outcomes. We aimed to independently evaluate the performance of the Modified Early Warning Score, quick Sequential Organ Failure Assessment (qSOFA) score, and Integrated Management of Adolescent and Adult Illness (IMAI) emergency signs and severity criteria to predict in-hospital mortality among a prospective cohort of febrile patients in Tanzania. We evaluated 419 patients aged ≥ 10 years in the period 2007-2008. Of the 44 patients who died, 31 (70.5%) were human immunodeficiency virus (HIV) infected. On univariate analysis, in-hospital mortality was associated with HIV infection, oxygen saturation < 90%, respiratory distress, Glasgow Coma Scale < 15, neck stiffness, unconsciousness, convulsions, hemoglobin < 9 g/dL, absence of a systemic syndrome, and neurologic syndrome. A qSOFA score ≥ 2, the presence of at least one, two, or three IMAI emergency signs, and IMAI severe respiratory distress syndrome without shock were significantly associated with in-hospital mortality. The criterion "presence of at least one IMAI emergency sign" showed a good diagnostic accuracy, as highlighted by the high sensitivity, low negative likelihood ratio, and wide area under the receiver operating characteristics curve. The remaining scores showed a poor performance in predicting fatal outcomes in our study population. Further studies are needed to validate our findings and to derive early warning scores that have good clinical performance in settings throughout sub-Saharan Africa.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: National Science Foundation, Bill and Melinda Gates Foundation, University of Otago, Research Councils UK, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, National Institutes of Health, Directorate for Biological Sciences, Duke Global Health Institute, Duke University, Biotechnology and Biological Sciences Research Council, National Institute of Allergy and Infectious Diseases, Fogarty International Center
Awards: Viral Zoonoses and Severe Febrile Illness in Northern Tanzania, Social, Economic and Environmental Drivers of Zoonoses in Tanzania (SEEDZ), G1886633764, University of California Global Health Institute Program for Fellows and Scholars, G3028693477, G3168060087, G3204045353, The impact and social ecology of bacterial zoonoses in northern Tanzania, G3435376506, G396838351, G4518260094, International Clinical Trials Unit, The Impact and Society Ecology of Bacterial Zoonoses in Northern Tanzania: Under, G5443035086, G5499729572, International Vaccine Institute - to build additional evidence to understand where typhoid vaccine is needed in Africa and accelerate its delivery where needed, G8532363547, Investigating Febrile Deaths in Tanzania (INDITe), G9000261046
OpenAlex ID: W2890052587