Kasakula Kaunda1, Kondwelani Mateyo2, Bwalya Mulenga3, Mulenga Chilando2, Musisye Luchembe2, David Nossoro2, Dickson Munkombwe4, Coolwe Namangala2, Julia Mwamba2, Faith Simushi5, Leroy Yankae2, Michael Kinkata2, Gina Perez6, Hari Pradhyuman6, Meron Gebrewold7, Sarah Braun8, Lorraine Chishimba2, Mashina Chomba9, Alexandra Peloso2, Stanley Zimba2, Ngosa Mumba2, Deanna Saylor10, Morgan Prust11
1UTH Internal Medicine Department, 2University Teaching Hospital, 3UNIVERSITY TEACHING HOSPITAL, 4University Teaching Hospital - Adult Hospital, 5Kitwe Teaching Hospital, 6University of Miami School of Medicine, 7Addis Ababa University, 8University Teaching Hospital, Lusaka, Zambia, 9University of Zambia, 10Johns Hopkins Hospital, 11Yale University School of Medicine
Objective:
To define the epidemiology of critical illness and characterize drivers of clinical deterioration among neurology inpatients in a resource-limited hospital in Zambia.
Background:
The global burden of acute neurologic illnesses represents a key driver of morbidity and mortality worldwide and falls disproportionately on patients in low- and middle-income countries where critical care resources are constrained. The University Teaching Hospital (UTH), Zambia’s national referral hospital, has a busy inpatient neurology service.
Design/Methods:
We conducted a prospective, longitudinal, registry-based study of all inpatients admitted to the UTH neurology service. We followed patients throughout their admissions and extracted multiple clinical data points from their medical records including admission diagnosis, diagnostic test results, treatments administered, location of care (ward vs ICU), discharge functional status, cause of death (when applicable), and presence/absence of pre-defined markers of clinical deterioration warranting ICU-level care (mental status decline, recurrent seizures, hemodynamic instability, to name a few). We present a preliminary descriptive analysis of an ongoing study.
Results:
Of 500 admissions enrolled between Jan-Sep 2023, 48% of admissions were for stroke (56% ischemic, 35% hemorrhagic, 9% of unknown type), 18% for seizure (of whom 20% had status epilepticus), and 7% for neurologic infections. The two leading causes of death were sepsis (35% of inpatient deaths) and aspiration pneumonia (22%). The overall inpatient mortality rate was 24%, with only 15% of patients receiving care in an ICU.
Conclusions:
The burden of critical illness among neurology inpatients at UTH is high, with a nearly one in four inpatient mortality rate. Only a small minority receive care in the ICU. The two leading causes of inpatient mortality are both potentially preventable and/or treatable, highlighting the need for protocols that prevent hospital-acquired complications, promote early recognition of clinical deterioration, and guide the rational use of limited critical care resources.