Performance of a new Risk Score in a Patient Monitoring System in Low-Resource Settings in a Hospital in Zomba, Malawi

Sammanfattning

In Low- and Middle-Income countries (LMIC), it is hard to provide adequate healthcareto critically ill children due to limited resources in staff and equipment. Withinthese Low-Resource settings (LRS), pediatric mortality and the occurrence of CriticalIllness Events (CIE) are high. Continuous patient monitoring of vital signscan be particularly helpful in LRS, especially for critically ill children. GOAL 3designed a Continuous Patient Monitoring System (CPMS), service, and training fitfor LRS, IMPALA, and implemented it in the Pediatric High-Dependency Unit ofZomba Central Hospital in Malawi, Africa. To this IMPALA CPMS, a newly developedRisk Score was added. This Risk Score, adjusted from an earlier developedphysiological score, can potentially assign a health risk level with a score between0-100, show the progress of the patient over time, and function as an early warningsystem. In this study, the performance of the Risk Score is assessed, based on itsdistinctive ability to assign a high-risk level to patients who eventually passed awayand to patients who had one or more CIE. The study consisted of 192 participantsunder 5 years of age, whose clinical and score data were analyzed. With a mortalityrate of 12% and 140 CIE in total, there were many critically ill children. Thatgroup showed the highest average Risk Score of 64 in the death subset, and 37 inall patients with one or more CIE, significantly different from an average score of23 in participants who had no CIE and survived. With an AUROC in the rangeof comparable literature, it shows that the Risk Score can distinguish and potentiallypredict patients who pass away moderately to well, especially in the last 6-8hours before discharge. Observations and data analysis revealed challenges with theRisk Score availability, which results in an average score coverage of 82%, mainlydue to problems with the oxygen saturation probe and nurses not implementing thescore system in their routines at the beginning of the study. Optimization and moreresearch have to be done to improve these challenges and validate the Risk Score.