Importance of early transfer to higher levels of in-patient care - an experience from a lower-middle-income country.

IF 0.8 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL Journal of the Pakistan Medical Association Pub Date : 2025-02-01 DOI:10.47391/JPMA.10971
Huzefa Jibril, Syed Ahsan Ali, Safia Awan, Muhammad Tariq
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Abstract

Objective: To ascertain the frequency of hospitalised internal medicine patients requiring escalation to a higher level of care, and in-hospital mortality in such cases.

Methods: The prospective, observational study was conducted from September 1 to October 15, 2021 at a tertiary care hospital in Karachi, and comprised adult patients of either gender admitted to the internal medicine general wards and high dependency units. Data was collected prospectively using a proforma. Data was analysed using SPSS 23.

Results: Of the 837 patients admitted, 617(73.7%) were included. There were 310(50.2%) females and 307(49.8%) males with mean age 52.2±18.8 years. The most common comorbidity was hypertension 288(46.7%). Of the 617 patients, 51(8.3%) required escalation to a higher level of care. Escalation to the intensive care unit and high dependency unit occurred in 19(37.3%) and 32(62.7%) patients, respectively. In-hospital mortality among patients who required escalation to the intensive care unit was 52.6%. In instances where the escalation was required within 48 hours of admission, in-hospital mortality was 8.3% (2/24), whereas, it was 40.7% (11/27) in cases when it was initiated beyond 48 hours of admission (p=0.010). The median length of hospital stay was also significantly lower when the escalation was initiated within 48 hours of admission 5 days (interquartile range: 4-7 days) compared to when it was delayed 13 days (interquartile range: 6-19 days) (p<0.001). The principal discharge diagnosis of sepsis was significantly associated with escalation to a higher level of care (p<0.001) and in-hospital mortality (p<0.001).

Conclusions: Initiation of escalation to higher levels of care within 48 hours of admission was found to be associated with reduced in-hospital mortality and length of hospital stay.

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来源期刊
CiteScore
1.10
自引率
11.10%
发文量
983
审稿时长
3-6 weeks
期刊介绍: Primarily being a medical journal, JPMA publishes scholarly research focusing on the various fields in the areas of health and medical education. It publishes original research describing recent advances in health particularly clinical studies, clinical trials, assessments of pathogens of diagnostic importance, medical genetics and epidemiological studies. Review articles highlighting importance of various issues in the domain of public health, drug research and medical education are also accepted. As a leading journal of South Asia, JPMA remains cognizant of the recent advances in the rapidly growing fields of biomedical sciences, it invites and encourages scholars to write short reviews and invited editorials on the emerging issues. We particularly aim to promote health standards of developing countries by encouraging manuscript submissions on issues affecting the public health and health delivery services.
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