Presenting symptoms, diagnoses and in-hospital mortality in a low resource hospital environment.

Abstract

The relationship between symptoms, signs and discharge diagnoses with in-hospital mortality is poorly defined in low-resource settings. To explore the prevalence of presenting symptoms, signs and discharge diagnoses of medical patients admitted to a low-resource sub-Saharan hospital and their association with in-hospital mortality. In this prospective observational study, the presenting symptoms and signs of all medical patients admitted to a low-resource hospital in sub-Saharan Africa, their discharge diagnoses and in-hospital mortality were recorded. Pain, gastro-intestinal complaints and feverishness were the commonest presenting symptoms, but none were associated with in-hospital mortality. Only headache was associated with decreased mortality, and no symptom was associated with increased in-hospital mortality. Malaria was the commonest diagnosis. Vital signs, mobility, mental alertness and mid-upper arm circumference (MUAC) had the strongest association with in-hospital mortality. Tuberculosis and cancer were the only diagnoses associated with in-hospital mortality after adjustment for these signs. Vital signs, mobility, mental alertness and MUAC had the strongest association with in-hospital mortality. All these signs can easily be determined at the bedside at no additional cost and, after adjustment for them by logistic regression the only diagnoses that remain statistically associated with in-hospital mortality are tuberculosis and cancer.