Are changes in objective observations or the patient's subjective feelings the day after admission the best predictors of in-hospital mortality? An observational study in a low-resource sub-Saharan hospital.

Background: The first clinical re-assessment after admission to hospital probably provides the best opportunity to detect clinical deterioration or failure to improve, and decide if care should be intensified.
Aim: Compare changes the day after admission in the patient's subjective feelings and objective findings that included age, gender, the National Early Warning Score (NEWS) on admission, gait stability and mid-upper arm circumference (MUAC) on admission, and changes in NEWS, gait stability and mental alertness.
Setting: Acutely ill medical patients admitted to a low-resource sub-Saharan hospital.
Methods: Prospective observational study.
Results: 1810 patients were reassessed 18 h after hospital admission. Logistic regression identified NEWS and gait stability on admission, a subjective feeling of improvement, the change in NEWS, and MUAC as clinically significant predictors of in-hospital mortality. Stratifying patients according to their NEWS on admission altered the predictive value of the four other predictors: for patients with an admission NEWS < 3 a subjective feeling of improvement is the most powerful predictor of a good outcome. For patients with an admission NEWS > = 3 the change in NEWS, gait stability on admission and MUAC provide additional prognostic information.
Conclusion: NEWS and gait stability on admission, MUAC, a subjective feeling of improvement, and change in NEWS the day after admission are all clinically significant predictors of in-hospital mortality.
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