Outcomes 30 days after ICU admission: the 30DOS study

  • Robyn Marais Medpharm Publications
  • Robert Wise
  • Kim de Vasconcellos
  • David Skinner
  • Reitze Rodseth
  • Dean Gopalan
  • David Muckart
  • Zohra Banoo
  • Tashmin Bisseru
  • Steve Blakemore
  • Jenine De Meyer
  • Michael Faurie University of KwaZulu-Natal
  • Kom Govender University of KwaZulu-Natal
  • Timothy Hardcastle University of KwaZulu-Natal
  • Prakash Jeena
  • Nicky Kalafatis University of KwaZulu-Natal
  • Kroshlan Kistan University of KwaZulu-Natal
  • Theroshnie Kisten
  • Carolyn Lee University of KwaZulu-Natal
  • Colin Mitchell University of KwaZulu-Natal
  • Magesvaran Moodley University of KwaZulu-Natal
  • Mary Morgan University of KwaZulu-Natal
  • Arisha Ramkilliwana
  • Rajesh Ramjee
  • Darshan Reddy University of KwaZulu-Natal
  • Afke Robroch
  • Shivani Singh University of KwaZulu-Natal
  • Richard von Rahden University of KwaZulu-Natal
  • Bruce Biccard University of Cape Town
Keywords: critical care; 30-day mortality; Outcome; South Africa

Abstract

Background: The spectrum of illness and long-term outcome of critically ill patients admitted to intensive care units (ICUs) in South Africa remains largely unknown. Objectives: This study was designed to provide data on ICU outcomes and disease burden in public sector ICUs in KwaZulu-Natal. The primary objective was to describe 30-day mortality of all patients admitted to participating sites. Secondary objectives included clinical demographics and spectrum of illness amongst these patients, and testing a template to demonstrate feasibility of such data collection. Methods: 30DOS was a multicentre, prospective, observational cohort study conducted over 30 days. An a priori decision was made to report study results separately for adults and paediatric patients. This article reports the results for adult patients. The complete 30-DOS study included 11 ICUs in six hospitals. All adult patients admitted to study ICUs were included. Patients were followed up telephonically by a research assistant. Data on patient demographics, preadmission functional scoring, injury severity scoring, co-morbidities, admission diagnosis/es, organ support, and outcome were collected. Results: A total of 228 adults were included. The majority of admissions (73.7%) occurred on an emergency basis, with 68.4% occurring in the postoperative period. Approximately half were for non-communicable disease (49.6%), followed by trauma (29.0%) and infectious disease (21.5%). There were a total of 59 (25.9%) deaths within the first 30 days after admission. In-ICU mortality was 19.7%. There were 12 (5.3%) in-hospital deaths following discharge and two (0.9%) out-of-hospital deaths. Thirty-day survival was known for 174 (76.3%) admissions with a 33.9% mortality rate. Conclusion: Overall in-ICU mortality was 19.7% with a large trauma burden in a young population. Thirty-day mortality was 33.9%. Information pertaining to patient demographics and spectrum of illness provided novel information to further the understanding of the demand placed on critical care resources within South Africa. (Full text available online at www.medpharm.tandfonline.com/ojaa) South Afr J Anaesth Analg 2017; DOI: 10.1080/10.1080/22201181.2017.1402553

Author Biographies

Robert Wise
Pietermaritzburg Metropolitan Department of Anaesthetics Critical Care and Pain Management Pietermaritzburg; and Clinical Unit Critical Care Edendale Hospital Pietermaritzburg; and Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal
Kim de Vasconcellos
Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban; and Department of Critical Care King Edward VIII Hospital Durban
David Skinner
Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban
Reitze Rodseth
Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban
Dean Gopalan
Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban
David Muckart
Discipline of Surgery University of KwaZulu-Natal Durban
Zohra Banoo
KwaZulu-Natal Department of Health District Ethekweni Paediatric Care Inkosi Albert Luthuli Central Hospital Durban; and Discipline of Paediatrics University of KwaZulu-Natal Durban
Tashmin Bisseru
Paediatrics Life Hilton Hospital Pietermaritzburg
Steve Blakemore
Anaesthesiology St Augustine’s Hospital Durban
Jenine De Meyer
Inkosi Albert Luthuli Central Hospital National Health Laboratory Services Durban; and Clinical Unit Inkosi Albert Luthuli Central Hospital Durban
Michael Faurie, University of KwaZulu-Natal
Discipline of Surgery\ University of KwaZulu-Natal Durban
Kom Govender, University of KwaZulu-Natal
Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban
Timothy Hardcastle, University of KwaZulu-Natal
Clinical Unit Inkosi Albert Luthuli Central Hospital Durban; and Trauma Service Inkosi Albert Luthuli Central Hospital Durban; and Trauma Training Unit University of KwaZulu-Natal Durban
Prakash Jeena
Paediatric Intensive Care Unit Inkosi Albert Luthuli Central Hospital Durban
Nicky Kalafatis, University of KwaZulu-Natal
Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban; and Critical Care Inkosi Albert Luthuli Central Hospital Durban
Kroshlan Kistan, University of KwaZulu-Natal
Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban
Theroshnie Kisten
Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban; and Critical Care Inkosi Albert Luthuli Central Hospital Durban
Carolyn Lee, University of KwaZulu-Natal
Head of Clinical Department: Internal Medicine Pietermaritzburg; and School of Clinical Medicine College of Health Sciences University of KwaZulu-Natal Durban
Colin Mitchell, University of KwaZulu-Natal
Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management Pietermaritzburg; and Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban
Magesvaran Moodley, University of KwaZulu-Natal
Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban
Mary Morgan, University of KwaZulu-Natal
Discipline of Paediatrics University of KwaZulu-Natal Durban; and Paediatrics Pietermaritzburg Metropolitan Hospitals Complex Pietermaritzburg
Arisha Ramkilliwana
Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management Pietermaritzburg; and Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban
Rajesh Ramjee
Anaesthesiology Prince Mshiyeni Memorial Hospital Durban
Darshan Reddy, University of KwaZulu-Natal
Department of Cardiothoracic Surgery Nelson R Mandela School of Medicine University of KwaZulu-Natal Durban
Afke Robroch
Wilhemina’s Childrens Hospital UMC Utrecht The Netherlands
Shivani Singh, University of KwaZulu-Natal
Discipline of Paediatrics University of KwaZulu-Natal Durban; and Paediatric Critical Care Inkosi Albert Luthuli Central Hospital Durban
Richard von Rahden, University of KwaZulu-Natal
Discipline of Anaesthesiology and Critical Care School of Clinical Medicine University of KwaZulu-Natal Durban; and Intensive Care Unit Grey’s Hospital Pietermaritzburg
Bruce Biccard, University of Cape Town
Department of Anaesthesia and Perioperative Medicine University of Cape Town and Groote Schuur Hospital Cape Town
Published
2018-03-19
Section
Research Articles