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Abstract Details

Burden of Critical Illness Among Neurology Inpatients in Zambia
General Neurology
P1 - Poster Session 1 (8:00 AM-9:00 AM)
15-002
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.

To define the epidemiology of critical illness and characterize drivers of clinical deterioration among neurology inpatients in a resource-limited hospital in Zambia.

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.

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.

 

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.
Authors/Disclosures
Morgan Prust, MD (Yale University School of Medicine)
PRESENTER
Dr. Prust has nothing to disclose.
Kasakula Kaunda (UTH Internal Medicine Department) No disclosure on file
John Mateyo (University Teaching Hospital) No disclosure on file
Bwalya Mulenga No disclosure on file
Mulenga Chilando (University Teaching Hospital) No disclosure on file
Musisye Luchembe No disclosure on file
DAVID NASSORO (Ministry of Health) No disclosure on file
Dickson Munkombwe, MD (University Teaching Hospital - Adult Hospital) Dr. Munkombwe has nothing to disclose.
Coolwe Namangala No disclosure on file
Julia Mwamba (University Teaching Hopsital) No disclosure on file
Faith Simushi, MD (University Teaching Hospital) Dr. Simushi has received research support from American Neurological Association - ANA.
Leroy Yankae No disclosure on file
Michael Kinkata No disclosure on file
Gina Perez No disclosure on file
Hari Pradhyumnan No disclosure on file
Meron Gebrewold, MD (Addis Ababa University) Dr. Gebrewold has nothing to disclose.
Sarah Braun (University Teaching Hospital, Lusaka, Zambia) No disclosure on file
Lorraine Chishimba, MBChB (University Teaching Hospital) Dr. Chishimba has nothing to disclose.
Mashina Chomba, MBChB (University of Zambia) Dr. Chomba has nothing to disclose.
Alexandra Peloso, MD Dr. Peloso has nothing to disclose.
Stanley Zimba, MBBS (University Teaching Hospital) Dr. Zimba has nothing to disclose.
Ngosa Mumba No disclosure on file
Deanna Saylor, MD, MHS (Johns Hopkins Hospital) The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from National Multiple Sclerosis Society. The institution of Dr. Saylor has received research support from American Academy of Neurology. The institution of Dr. Saylor has received research support from United States Department of State. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and Educational Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.