Prognosis of the Patients in Resuscitation Field in Mali

Introduction: The patients whose vital prognosis is immediately threatened by one or several serious organs failures and consecutive to various pathologies are admitted in resuscitations (IUC). The rates of morbi-mortality are raised in Africa. Objective: To study the prognostic factors. Patient and Methods: It was about a transverse survey from January 2015 to April 2016 in the unit of polyvalent resuscitation of the service of anesthesia resuscitation of the academic hospital center of Gabriel Toure. It included all patient admitted for medico-surgical pathologies of more than three hours of hospitalization. It was about a consecutive recruitment of case. The Chi2 and Fisher tests were used for the comparison of our results with a p value = 0.05 considered as meaningful. The consent of the patients or parents was gotten. The survey didn’t include a potentially dangerous act. Results: During the period, 624 patients have been collected of which: 50.4% were medical pathologies, 19.4% surgical pathologies and 30.2% of gyneco-obstetric pathologies. At least a complication had occurred in 11.2%. Mortality was of 27%. The sex-ratio was of 0.51. The middle age was of 31.88 ± 17, 2 years with extremes of 2 years and 80 years. The met complications were: the scab, the syndrome of acute respiratory distress (ARD), the urinary infection, the pneumopathie, the shock, thrust hypertensive, stops cardio circulatory with respectively 35.1%, 26.6%, 22.3%, 6.4% and 3.2%. The middle length of stays was of 4.83 ± 5.32 days with extremes of 1 day to 29 days. Conclusion: The complications under hospitalization in unit (IUC) of resuscitation in Mali are a major challenge in term of prevention and management. The potentially non serious pathologies complicate themselves and compromise the vital prognosis.


Introduction
The patients whose vital prognosis is immediately threatened by one or several serious organ failure and consecutive to various pathologies are admitted in resuscitations. This state makes that it is necessary to assure an increased surveillance of the patients and to have some prérequis to know the use of techniques and specific materials, the continuous surveillance and a qualified staff. The modes of admission are variable; they can be direct or by transfer. In Europe, the direct admission of the patients in resuscitation is spilled enough due to the regulation of the emergencies with a frequency of 30% [1] [2]. To the United States, the importance of the traumatic mortality justified a regional organization of the management of the injured based on the traumas center. The modes of admission of the patients in resuscitation influence on the prognosis of these. The system of the polyvalent resuscitation in the countries of limited resources demand more efficiency. In France the death rate of the patients admitted in resuscitation reaches 20% -50% [3] [4]. In Africa in Burkina the global death rate was of 63.6% [5].
The death rates observed in Niger, Gabon and Morocco were respectively 28.34%, 27.8% and 30% [6]. A previous survey achieved in the service recovered a death rate of 42.5% [7]. The evaluation of the foreseeable evolution of the patients or even the degree of gravity is a practice in the sense of the quality of the care. So to improve the prognosis of our patients, we initiated this survey with as objective to determine the prognostic factors of the patients in resuscitation.

Patient and Methods
It was about a prospective and transverse survey from January 2015 to April 2016 in the unit of polyvalent resuscitation of the service of anesthesia resuscitation of the academic hospitable center of Gabriel Toure. The population of survey was constituted of the set of the patients admitted in polyvalent resuscitation unit. Was included all patient admitted for médico-surgical pathologies of more than three hours of hospitalization. It was about a consecutive recruitment of case. The data were collected from the register of hospitalization of the service, from the files of the hospitalized, patients from the daily cards of prescription and surveillance and finally from the results of the para clinics exams achieved. A questionnaire has been assigned to all patients which permitted to collect the sociodemographic, clinical and para clinical data. All patients were examined systematically with a compilation of the different clinical parameters (general state conjunctive, the conscience, score of wakening of Albrètte, the tempera-ture, the arterial pressure, the cardiac frequency and the respiratory frequency). The retained diagnoses were regrouped by organ. The Chi 2 and Fisher tests were used for the comparison of our results with the value of p = 0.05 considéred as meaningful. The consent of the patients or parents was gotten. The survey didn't include a potentially dangerous act.

Results
During the period, 624 patients have been collected of which: 50.4% of medical pathologies, 19.4% of surgical pathologies and 30.2% of gynéco-obstetric pathologies. At least a complication had occurred in 11.2%. Mortality was of 27%. The sex-ratio was of 0.51. The middle age was of 31.88 ± 17.2 years with extremes of 2 years and 80 years. The intrahospitol admissions dominated (91% of the cases). The three main motives of admission were the post-operative survey, the conscience alteration, and the eclampsia with respectively 25.6%, 13.3% and 10.7%. The patients didn't have any antecedent in 42.9% of the cases. The met complications were: the scabs, the syndrome of acute respiratory distress (SDRA), the urinary infection, the pneumopathie, the shock, thrust hypertensive, stop cardio circulatory with respectively 35.1%, 26.6%, 22.3%, 6.4% and 3.2%. The three fashions of exit were: the intra hospital transfert (71.8%), death (26.8%) and the exéat (1.4%). The middle length of stays was of 4.83 ± 5.32 days with extremes of 1 day to 29 days.
Patients of 50 years and more died more that the other age groups with 56.5% of death rate (P = 0.0001). Patients of masculine sex died more that women (41.9% against 19.3% P = 0.0001). Mortality was more important among the patients who had medical antecedents with (P = 0.001). Patients admit with a score of Glasgow? = 7 died more either 56.8% (P = 0.0001). Complications were noted more frequently in men (18.1% against 7.7% P = 0.0001). The complications were observed to all age groups: less than 20 years (6.9%), 20 to 40 years (14.7%), 40 to 60 years (6.5%), 60 years and more (17.4%) (P = 0.0001). The intervening of the complications varied with the length of stay with 5.3% to 4 days of stay length, 9.5% for a length between 4 and 7 days and 35.7% to more of 7 days of stay length. The complications had occurred in 50% of the cases of direct admission, 6.4% in case of transfer and 11.2% in case of mutation (P = 0.024). The exits by mutation according to the age group were from 87.9% to less of 20 years, 74.8% between 20 and 40 years, 58.2% between 40 and 60 years and 43.5% to more of 60 years (P = 0.0001). None of the patients of GLASGOW score of lower to 7 didn't leave by transfer against 3.1% of the patients of GLASGOW score superior to 8 (P = 0.0001). Femal patients stayed less than 4 days (60.1% of the cases against 41.9%) (P = 0.0001). The fashions of exit according to the motive of admission, of the diagnosis are mentioned in the Table 1 and Table 2, and the length of stay according to the motive of admission Table 3.

Discussion
The environment in which we exercise is characterized by a weak medicalization Open Journal of Anesthesiology    days. It is comparable to those noted in the literature with middle lengths of variable stay between 4 and 10 days [8] [9] [10] [11]. This relatively short length is due to the predominance of the admission motives as the post-operative surveillances and the eclampsia. In these two cases the stays are relatively short and a less important mortality. This is as much true as some studies found that the patients who have an elevated initial gravity have a longer stay length [12]. The length of the stay is often used like alternative to measure the morbidity, but it is always tributary of the policies concerning exit, therapeutic habits and management of the beds [13]. The urinary infections and the pneumopathies occur to 100% at the men and the scabs are observed majoritary at the men. The anatomical particularities make that the men are exposed to the urinary infections more. Also considering the short stay length at the women in reason often of the motives of amission, they are less exposed. The shock occurred besides to 100% among the subjects of 60 years. It could be explained by the existence of the factors of comorbidity to these ages that are not often identified before because of the under medicaliza- where the death rate is more high, in all others cases the patients go out majoritary by mutation. According to the diagnosis the modes of exit are different with P < 0.05.

Conclusion
The intervening of the complications under hospitalization in unit of resuscita-