Hospital burden of critical illness across global settings: a point prevalence and cohort study in Malawi, Sri Lanka and Sweden.

Summary

Among 3,652 adult inpatients across eight hospitals in Malawi, Sri Lanka, and Sweden, the point prevalence of critical illness was 12.0% with 18.7% hospital mortality. Critically ill patients had a 7.5-fold higher crude odds of death versus non-critically ill, and 96.1% were cared for in general wards outside ICUs.

Key Findings

• Point prevalence of critical illness among adult inpatients was 12.0% (95% CI 11.0–13.1).
• Hospital mortality among critically ill patients was 18.7% (95% CI 15.3–22.6); crude OR of death vs non-critically ill was 7.5 (95% CI 5.4–10.2).
• 96.1% (95% CI 93.9–97.6) of critically ill patients were treated in general wards rather than ICUs.

Clinical Implications

Hospitals should implement essential, low-cost critical care in general wards (e.g., early identification using vital signs, oxygen therapy, fluid resuscitation, monitoring) and strengthen escalation pathways to ICU.

Limitations

• Single-day point-prevalence snapshots per site may miss temporal variation in caseload.
• Vital sign-based definition may misclassify some patients; generalizability limited to eight hospitals.

Future Directions

Test ward-based, essential critical care bundles and early warning systems at scale and evaluate effects on mortality and ICU utilization across health systems.