Background
Methods
Evaluation of study hospitals’ capacities to manage medical emergencies
Characteristics of patients presenting with potentially life-threatening emergencies
Statistical Analysis
Results
n
| 74 |
Number of beds (n) | 10 (5–50) |
Availability of hospital structures (n/%) | |
Emergency/resuscitation room
| 46 (62.2) |
Delivery room
| 72 (97.3) |
Operation room
| 24 (32.4) |
High dependency unit/intensive care unit
| 0 |
Availability of trained staff (n/%) | |
Emergency or critical care physician
| 0 |
Emergency or critical care nurse
| 0 |
Availability of selected diagnostic resources (n/%) | |
Sonography
| 44 (59.5) |
Echocardiography
| 0 |
Possibility to measure full blood count
| 46 (62.2) |
Glucometer
| 69 (93.2) |
Possibility to perform a urine analysis
| 41 (55.5) |
Blood gas analyzer
| 0 |
Possibility to perform selected emergency procedures (n/%) | |
Wound care
| 72 (97.3) |
Burn wound care
| 71 (95.9) |
Foreign body removal
| 64 (86.5) |
Abscess drainage
| 48 (64.9) |
Fracture management
| 57 (77) |
Advanced cardiac life support
| 8 (10.8) |
Oxygen application
| 63 (85.2) |
Airway management
| 10 (13.5) |
Cardioversion
| 1 (1.4) |
Thoracocentesis
| 6 (8.1) |
Paracentesis
| 12 (16.2) |
Pericardiocentesis
| 0 |
Blood transfusion
| 8 (10.8) |
Non-invasive mechanical ventilation
| 0 |
Invasive mechanical ventilation
| 0 |
Central venous catheter insertion
| 2 (2.7) |
Renal replacement therapy
| 0 |
n
| 1267 |
Age (years) | 34 (18–53) |
Male gender (n/%) | 690 (54.4) |
Diagnostic categories (n/%) | |
Trauma
| 325 (25.7) |
Surgical (non-trauma) | 245 (19.3) |
Medical
| 226 (17.8) |
Neurological
| 120 (9.5) |
Infection
| 80 (6.3) |
Obstetrical
| 17 (1.3) |
Other
| 254 (20) |
Modified Early Warning Score (pts) | 3 (2–5) |
South African Trauma Score (pts) | 1 (1–2) |
Need for emergency surgery (n/%) | 132 (10.4) |
Transfer to level II hospital (n/%) | 530 (41.8) |
Reason for not transferring (n/%) | |
Condition manageable at primary level hospital
| 657 (89.1) |
Physician at secondary level hospital discouraged transfer
| 26 (3.5) |
Patient too unstable
| 23 (3.1) |
Transport not possible
| 21 (2.8) |
Family disagreed
| 10 (1.4) |
Length of hospital stay (days) | 5 (1–8) |
Hospital mortality (n/%) | 41 (3.2) |
Cause of death (n/%) | |
Respiratory failure
| 12 (29.3) |
Shock
| 11 (26.8) |
Coma
| 8 (19.5) |
Multiple organ dysfunction
| 8 (19.5) |
Not given
| 2 (4.9) |
Admission diagnosis (n/%) | All patients |
---|---|
n
| 1267 |
Trauma (excl. brain trauma) | 258 (20.4) |
Acute abdomen | 214 (16.9) |
Acute or acute-on-chronic heart failure | 122 (9.6) |
Brain trauma | 67 (5.3) |
Stroke (ischemic or hemorrhagic) | 66 (5.2) |
Community-acquired pneumonia | 64 (5.1) |
Metabolic coma | 54 (4.3) |
Cancer-related condition | 44 (3.5) |
Respiratory failure | 35 (2.8) |
Acute or acute-on-chronic kidney failure | 31 (2.4) |
Surgery-related condition | 22 (1.7) |
Pre-eclampsia/eclampsia | 16 (1.3) |
Decompensated liver cirrhosis | 14 (1.1) |
Infection (excl. community-acquired pneumonia and tuberculosis) | 14 (1.1) |
Miscellaneous | 246 (19.4) |
Patients hospitalized | Patients transferred |
p-value | |
---|---|---|---|
n
| 737 | 530 | |
Age (years) | 38 (20–55) | 32 (17–48) | 0.005a
|
Male gender (n/%) | 365 (49.5) | 325 (61.3) | <0.001a
|
Diagnostic categories (n/%) | |||
Trauma
| 146 (19.8) | 179 (33.8) | <0.001a
|
Surgical (non-trauma) | 101 (13.7) | 144 (27.2) | <0.001a
|
Medical
| 173 (23.5) | 53 (10) | <0.001a
|
Neurological
| 69 (9.4) | 51 (9.6) | 0.7 |
Infection
| 51 (6.9) | 29 (5.5) | 0.41 |
Obstetrical
| 7 (0.9) | 10 (1.9) | 0.13 |
Other
| 190 (25.8) | 64 (12.1) | <0.001a
|
Modified Early Warning Score (pts) | 3 (2–5) | 3 (2–5) | 0.04a
|
South African Trauma Score (pts) | 2 (1–2) | 1 (1–2) | 0.02a
|
Need for emergency surgery (n/%) | 54 (7.3) | 78 (14.7) | <0.001a
|
Length of hospital stay (days) | 5 (1–8) | data not available | |
Hospital mortality (n/%) | 41 (3.2) | data not available |
<28 days | 1–5 years | 5–18 years | >18 years | |
---|---|---|---|---|
N (%) | 36 (2.8) | 86 (6.8) | 174 (13.7) | 971 (76.6) |
Male gender (n/%) | 22 (61.1) | 43 (50) | 115 (66.1) | 510 (52.5) |
Diagnostic categories (n/%) | ||||
Trauma
| 0 | 23 (26.7) | 70 (40.2) | 232 (23.9) |
Surgical (non-trauma) | 4 (11.1) | 16 (18.6) | 54 (31) | 171 (17.6) |
Medical
| 1 (2.8) | 2 (2.3) | 8 (4.6) | 215 (22.1) |
Neurological
| 8 (22.2) | 4 (4.7) | 12 (6.9) | 96 (9.9) |
Infection
| 14 (38.9) | 22 (25.6) | 12 (6.9) | 32 (3.3) |
obstetrical
| 0 | 0 | 0 | 17 (1.8) |
other
| 9 (25) | 19 (22.1) | 18 (10.3) | 208 (21.4) |
Transfer to level II hospital (n/%) | 14 (38.9) | 27 (31.4) | 94 (54) | 395 (40.7) |
Length of hospital stay (days) | 7 (1–10) | 7 (1–7) | 7 (4.25–8) | 7 (1–10) |
Hospital mortality (n/%) | 1 (2.8) | 3 (3.5) | 0 | 37 (3.8) |
Cause of death (n/%) | ||||
Respiratory failure
| 1 (100) | 1 (33.3) | 0 | 10 (27) |
Shock
| 0 | 2 (66.7) | 0 | 9 (24.3) |
coma
| 0 | 0 | 0 | 8 (21.6) |
Multiple organ dysfunction
| 0 | 0 | 0 | 8 (21.6) |
Not given
| 0 | 0 | 0 | 2 (5.4) |