{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T23:17:42Z","timestamp":1784157462323,"version":"3.55.0"},"reference-count":32,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,10,3]]},"abstract":"<jats:p>Not much is known about clinical decision-making in rural, low-resource settings regarding fever, a common reason for presentation to care. In this prospective cohort study of patients presenting with febrile illness to a rural Ugandan health center, we examined demographic and clinical factors predictive of an initial disposition of inpatient admission after clinical evaluation, but before laboratory testing. We then assessed the association of laboratory results and system factors with a change between initial and final disposition plans. Four thousand nine hundred twenty-four patients with suspected febrile illness were included in the primary analysis. The strongest predictors for an initial disposition of admission after clinical examination were impaired consciousness (adjusted risk ratio [aRR], 3.21; 95% confidence interval [CI]: 2.44\u20134.21) and fever on examination (aRR, 2.27; 95% CI: 1.79\u20132.87). Providers initially planned to discharge patients with significant vital sign abnormalities, including tachypnea (3.6%) and hypotension (1.3%). Anemia strongly predicted a final disposition of admission after an initial disposition of discharge (aRR, 48.34; 95% CI: 24.22\u201396.49); other laboratory abnormalities, including hypoglycemia and acidosis, did not change disposition planning. In those with an initial disposition of admission, living farther than the two neighboring villages was associated with a final disposition of discharge (aRR, 2.12; 95% CI: 1.10\u20134.12). A concerning number of patients with abnormal vital signs and laboratory results were not admitted for inpatient care. Geographic factors may influence a patient\u2019s final disposition contrary to a provider\u2019s initial disposition plan. Future work should assess longer term outcomes after discharge and a broader study population.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0338","type":"journal-article","created":{"date-parts":[[2018,7,31]],"date-time":"2018-07-31T07:00:48Z","timestamp":1533020448000},"page":"1080-1088","source":"Crossref","is-referenced-by-count":7,"title":["Who Stays and Who Goes: Predictors of Admission among Patients Presenting with Febrile Illness and a Positive Malaria Rapid Diagnostic Test in a Rural Ugandan Health Center"],"prefix":"10.4269","volume":"99","author":[{"given":"Jonathan L.","family":"Chang","sequence":"first","affiliation":[{"name":"Duke University School of Medicine, Durham, North Carolina;"},{"name":"School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Reyes","sequence":"additional","affiliation":[{"name":"Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Matte","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Ntaro","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar","family":"Mulogo","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew O.","family":"Wiens","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda;"},{"name":"Center for International Child Health, BC Children\u2019s Hospital, Vancouver, British Columbia, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Meshnick","sequence":"additional","affiliation":[{"name":"School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;"},{"name":"Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Siedner","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda;"},{"name":"Massachusetts General Hospital, Boston, Massachusetts;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross M.","family":"Boyce","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda;"},{"name":"Division of Infectious Diseases, University of North Carolina at Chapel Hill, 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