Assessment of the burden of critical illness in a rural Botswana hospital with the use of an early warning score.

Background: There is little data on prevalence of critical illness in Sub Saharan Africa, especially in rural areas, but it is needed to develop critical care services in district hospitals.

Methods: We sought to determine the prevalence of patients 'at risk of' critical illness using an Early Warning Score (EWS) in a district hospital in Botswana. During two-month period patients daily vital signs were recorded and EWSs calculated on adult medical or surgical wards to identify patients who scored ≥3.

Results: EWS on 826 patients were obtained. There were 180 patients with ≥3 [8 refused to give consent and were excluded] with mortality 63(37%) and 646 patients scored below 3, mortality of 3 (0.6%). Patients with scores ≥3 were medical (63%), surgical (27%) and orthopaedic (9%). Of patients that were transferred to a referral centre [6 (3%)], none were admitted to ICU. Patients who died lived for 6.5 (SD 7.0) days after first score of ≥3. HIV prevalence among patients that died was 37%. Other co-morbidities were rare, except hypertension (21%). Cause of death was not clear in 60% of patients. When cause of death could be inferred from clinical records, it was illness related in 75% of cases.

Conclusions: Using the EWS we have identified the burden of critical illness in a rural district hospital in Botswana and the 'critical care gap' where patients do not get the intensive care they need.