African Journal of Emergency Medicine最新文献

{"title":"Global Health research abstracts: October ‘25","authors":"","doi":"10.1016/j.afjem.2025.100922","DOIUrl":"10.1016/j.afjem.2025.100922","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100922"},"PeriodicalIF":1.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health research abstracts: December ‘25","authors":"","doi":"10.1016/j.afjem.2025.100920","DOIUrl":"10.1016/j.afjem.2025.100920","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100920"},"PeriodicalIF":1.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health research abstracts: August ‘25","authors":"","doi":"10.1016/j.afjem.2025.100919","DOIUrl":"10.1016/j.afjem.2025.100919","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100919"},"PeriodicalIF":1.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of mortality and predictors among patients with shock managed in the emergency room of a tertiary hospital in Ethiopia","authors":"Kalsidagn Girma Asfaw ,&nbsp;Abel Getachew Adugna ,&nbsp;Nahom Mesfin Mekonen ,&nbsp;Merahi Kefyalew Merahi ,&nbsp;Segni Kejela ,&nbsp;Fekadesilassie Henok Moges ,&nbsp;Tigist Workneh Leulseged","doi":"10.1016/j.afjem.2025.100917","DOIUrl":"10.1016/j.afjem.2025.100917","url":null,"abstract":"<div><h3>Introduction</h3><div>Shock is a common emergency condition which can lead to organ failure and death if not diagnosed and managed timely. Despite its huge global impact, data is scarce in resource-limited settings, including Ethiopia, which hinders the provision of quality care for improved outcomes. Hence, this study aimed to determine the incidence of death and predictors among adult patients with shock managed at the Emergency Department of St. Paul’s Hospital Millennium Medical College in Ethiopia.</div></div><div><h3>Methods</h3><div>A retrospective chart review study was conducted among eligible patients managed at the hospital between October 1, 2021 and May 20, 2022. Mortality was estimated with incidence density using person day (PD) of observation. To identify predictors of mortality, a generalized linear model using poisson regression model with robust standard errors fitted, where adjusted relative risk (ARR) with 95 % CI was used to interpret results.</div></div><div><h3>Result</h3><div>During the study period, a total of 196 patients were identified for assessment, of which 18 with incomplete records were excluded, resulting in 178 eligible patients for inclusion. The majority of participants were 40 or older (69.7 %) and female (51.1 %), presenting with symptoms lasting less than one week (68.5 %) and had at least one comorbid illness (70.8 %). The incidence of death was 16.5 deaths per 100 PD (95 % CI = 13.1 to 20.9). While triage to orange was associated with a decreased risk of death, high shock index, septic shock diagnosis, vasopressor use, and organ failure were associated with increased risk of death.</div></div><div><h3>Conclusion</h3><div>The incidence of mortality among shock patients was found to be considerable. To optimize patient care and improve outcomes, it is important to remain vigilant in the proper triage and early diagnosis of shock using more sensitive tools for prompt identification of high-risk cases, as well as to provide timely, prioritized and effective interventions.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100917"},"PeriodicalIF":1.2,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnitude and associated factors of discharge against medical advice among patients treated in the adult Emergency Department at an Ethiopian University Hospital","authors":"Getachew Worku ,&nbsp;Demelash Ataro","doi":"10.1016/j.afjem.2025.100918","DOIUrl":"10.1016/j.afjem.2025.100918","url":null,"abstract":"<div><h3>Background</h3><div>Discharge against medical advice (DAMA) is a global phenomenon in which patients voluntarily terminate their consent to medical care before the medical team declares them fit for discharge. This adversely affects the delivery of quality health care and poses serious clinical, ethical, and legal challenges to the individual physician and the hospital. This study aims to assess the magnitude and factors associated with DAMA.</div></div><div><h3>Methods</h3><div>An institution-based cross-sectional study was conducted at the adult emergency department of Hawassa University Comprehensive Specialized Hospital, Ethiopia. A systematic random sampling technique was used to select 322 patients. The data were collected using a pretested, structured checklist through chart review. Descriptive statistics, including proportions, medians, tables, and charts, were used to describe the characteristics of the study participants. Binary logistic regression analysis was used to identify factors associated with DAMA. The model's fitness was checked by the Hosmer and Lemeshow tests. The significance level was declared at a p-value &lt; 0.05.</div></div><div><h3>Results</h3><div>This study found that the magnitude of DAMA was 7.45 % (24 out of 322); 95 % CI: 4.56–10.3 %) The majority of patients with DAMA 1041.7 %) were due to a financial issue, followed by the refusal of procedure 5, 20.8 %) and poor prognosis 4, 16.7 %). Being male [AOR: 4.1; 95 % CI: 1.17–14.11] and triage levels of Red and Orange [AOR: 2.87; 95 % CI: 1.02- 8.02] were associated with DAMA.</div></div><div><h3>Conclusion</h3><div>The study identified a considerable magnitude of DAMA. Being male and the severity of the triage score were found to be independent determinants of DAMA. The majority of patients had permanently left the hospital due to financial constraints. Therefore, strengthening health insurance and ensuring the availability of the necessary resources at government health facilities could help reduce DAMA.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100918"},"PeriodicalIF":1.2,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An assessment of emergency care capacity at three hospitals in the Harare metropol, Zimbabwe: A descriptive cross-sectional study using the WHO Hospital Emergency Assessment Tool (HEAT)","authors":"Prince Deka,&nbsp;Peter Hodkinson","doi":"10.1016/j.afjem.2025.100915","DOIUrl":"10.1016/j.afjem.2025.100915","url":null,"abstract":"<div><h3>Introduction</h3><div>Zimbabwe has experienced significant population growth, as well as a rise in noncommunicable diseases, impacting the demand for emergency care services. However, there is limited data on the state of Zimbabwe's emergency care systems to meet this growing need. This pilot study aimed to assess the capacity of Emergency Departments at three major referral hospitals in Harare, Zimbabwe.</div></div><div><h3>Methodology</h3><div>A cross-sectional descriptive study was conducted using the World Health Organization’s Hospital Emergency Assessment Tool (HEAT). Key participants from each hospital were interviewed in 2023 to gather data on facility characteristics, human resources, diagnostic services, and signal functions.</div></div><div><h3>Results</h3><div>Three large hospitals offering round-the-clock emergency care services were included. A core of dedicated doctors and nurses manned the Emergency Department in all three facilities, yet none had specific training in emergency medicine. There were various significant challenges to the operation of emergency departments, including access to water for one, and two with limited capacity to perform emergency diagnostic tests as they lacked the necessary equipment and consumables. One hospital reported a sufficient set of emergency protocols and guidelines, while the other two hospitals exhibited varying levels of availability in these areas. Two facilities reported adequate capacity in performing &gt;85 % of signal functions. Common challenges included the absence of emergency-trained staff, lack of a formal triage system, and equipment deficiencies, all of which constrained their ability to deliver certain signal functions.</div></div><div><h3>Conclusion</h3><div>This assessment revealed a spectrum of service availabilities across the three hospitals, with common barriers identified. To strengthen the country's emergency care system, efforts should be focused on improving consumable supplies, prioritising training initiatives in emergency medicine to build a skilled workforce and implementing standardised protocols and triage systems across facilities. Continuous monitoring and evaluation of implemented interventions are necessary to ensure sustainable improvements in emergency care delivery.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100915"},"PeriodicalIF":1.2,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital emergency response and management of pregnancy-associated haemorrhage in KwaZulu-Natal Province, South Africa: A Retrospective Cross-Sectional Study","authors":"S Govender ,&nbsp;OP Khaliq ,&nbsp;T Abel ,&nbsp;J Moodley","doi":"10.1016/j.afjem.2025.100912","DOIUrl":"10.1016/j.afjem.2025.100912","url":null,"abstract":"<div><h3>Background</h3><div>Pregnancy-associated haemorrhage (PAH) is a leading contributor to maternal mortality in KwaZulu-Natal (KZN) and the fourth most common cause in South Africa. Delays in treating PAH increase maternal mortality; prompt prehospital response is therefore critical to improve outcomes. The aim of this study was to analyse response times and clinical management of PAH by public sector Emergency Care Providers in KZN, looking specifically at postpartum haemorrhage (PPH).</div></div><div><h3>Methods</h3><div>A retrospective cross-sectional study was conducted in two phases. Phase 1 involved analysis of emergency call centre records (n = 4779) assessing response time patterns. Phase 2 analysed randomly selected PPH cases (n = 61) to assess clinical management practices. Descriptive statistics summarised demographics, response patterns, and clinical practice, Pearson correlation examined the relationships between time variables, and chi-square tests assessed associations between clinical variables (p &lt; 0.05).</div></div><div><h3>Results</h3><div>More than half (51.5 %) of PAH cases had ambulance response times &gt;60 min. Median pre-response time was 30 min; overall response time was 63.5 min but both were positively skewed by extreme delays, with higher trimmed means(50.9 min and 85.7 min respectively). Most cases (81.6 %, n = 3899) were transported from primary healthcare facilities to hospitals, with Intermediate Life Support Providers managing 75.7 % of the cases. In the sampled PPH patients, compliance with vital signs monitoring was initially high (91.8 %) but declined in transit (42.6 %). Providers were largely non-compliant in documenting blood loss and patient history. Despite almost all patients showing clinical signs of shock 44.3 % of PPH cases received no intravenous fluids.</div></div><div><h3>Conclusion</h3><div>Significant time delays in EMS response and inconsistencies in PAH clinical management by EMS providers were identified. Improved resource allocation, focused training and adherence to clinical and departmental guidelines are vital to strengthening maternal emergency care in KZN.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100912"},"PeriodicalIF":1.2,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma beyond the limbs: Epidemiology and outcomes of non-extremity penetrating trauma in a tertiary hospital Emergency Department, Eastern Cape, South Africa","authors":"Laetitia Lüttich,&nbsp;Sian Geraty,&nbsp;Roshen Maharaj","doi":"10.1016/j.afjem.2025.100916","DOIUrl":"10.1016/j.afjem.2025.100916","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma is a major health burden in low- to middle-income countries, with penetrating injuries being a leading cause of death. South Africa’s trauma rates are estimated to be 5–9 times higher than the global average. Penetrating injuries, compared to blunt trauma, carry higher morbidity and mortality. This study describes the epidemiology and resource burden of penetrating non-extremity injuries presenting to a teriary hospital Emergency Department (ED) in Gqeberha, South Africa.</div></div><div><h3>Methods</h3><div>This descriptive retrospective study was conducted at Livingstone Tertiary Hospital (LTH) ED in Gqeberha, Eastern Cape, and included all patients with non-extremity penetrating trauma from 1 June 2020 to 31 January 2021.</div></div><div><h3>Results</h3><div>During the study period, there were 6020 consecutive trauma presentations to the ED, of which 1107 cases met inclusion criteria and were included in the study. The study revealed a male predominance, with a male-to-female ratio of 5.6:1 (<em>p</em> &lt; 0.001). The median age was 29 years (range: 1–80 years). Most patients presented over the weekend (Saturday and Sunday) [<em>N</em> = 488, 44%, <em>p</em> &lt; 0.001] and after hours on weekdays (<em>N</em> = 444, 40%). Resource utilisation in the ED increased during these periods, including increased diagnostic imaging, procedural interventions, and blood product requests. Of the study participants, 828 (75%) were brought to the ED using private transport. There were a total of 30 deaths (3%), of which 17 (57%) were deceased on arrival in the ED; the remaining 13 deaths (43%) occurred while in the ED or after disposition to a specialist.</div></div><div><h3>Conclusion</h3><div>This study offers insight into the epidemiology and outcomes of non-extremity penetrating trauma, including prolonged hospital stays and ICU admissions. It underscores the need for multidisciplinary prevention strategies, structured trauma systems, and comparative research to guide best practices, improve resource allocation, and reduce the broader economic impact of trauma on individuals and communities.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100916"},"PeriodicalIF":1.2,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating call prioritisation discrepancies and Emergency Medical Services resource allocation in the North West province of South Africa","authors":"Bongumusa N. Mbatha ,&nbsp;Simpiwe Sobuwa ,&nbsp;Ntuthuko G. Chule","doi":"10.1016/j.afjem.2025.100913","DOIUrl":"10.1016/j.afjem.2025.100913","url":null,"abstract":"<div><div>The overwhelming flow of non-emergent cases burdens Emergency Medical Services (EMS), reducing their capacity to respond to life-threatening emergencies and compromising care for patients with emergent clinical needs. This study evaluated the appropriateness of the EMS deployment in a district of the North West Province in South Africa.</div></div><div><h3>Methods</h3><div>A retrospective quantitative descriptive analysis was conducted on cases completed by the district EMS service between 1 and 12 January 2022. Patient report forms and control room assessment forms, containing demographic and clinical data, were analysed to assess the EMS deployment accuracy. Descriptive statistics were used to analyse the continuous and categorical variables, while Pearson’s chi-square test and ANOVA tests examined associations between call prioritisation decisions, on-scene resource allocation, and the qualifications of call takers and dispatchers.</div></div><div><h3>Results</h3><div>Of the 535 records meeting the inclusion criteria, 71.1% revealed mismatches between call prioritisation and on-scene triage. The over-prioritisation rate was 90.9%, while the under-prioritisation rate was 17.1%. Additionally, 35.0% of patients were transported to a medical facility without receiving any medical interventions.</div></div><div><h3>Conclusion</h3><div>Significant disparities exist between call prioritisation and actual patient clinical needs, exacerbating the strain on an already resource-constrained EMS system. Standardised call prioritisation protocols and improved training for call takers and dispatchers are necessary to enhance EMS efficiency.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100913"},"PeriodicalIF":1.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of shock index, lactate and physician’s gestalt in predicting adverse events among critically ill adult patients at an Emergency Department in Tanzania","authors":"Humphrey G. Medarakini ,&nbsp;Alphonce N. Simbila ,&nbsp;Ellen Weber ,&nbsp;Zeinab B. Hassan ,&nbsp;Florian Vedasto ,&nbsp;Jennifer Tesha ,&nbsp;Rebecca N. Tugara ,&nbsp;Peter P. Kunambi ,&nbsp;Elizabeth Bernard ,&nbsp;Said S. Kilindimo","doi":"10.1016/j.afjem.2025.100914","DOIUrl":"10.1016/j.afjem.2025.100914","url":null,"abstract":"<div><h3>Introduction</h3><div>Physicians working in Emergency Departments (ED) must be able to identify critically ill patients likely to deteriorate and prioritize their care. While shock index, point of lactate and physician gestalt are commonly used in high-income countries to predict adverse events their applicability has not been widely tested in low-middle income countries.</div></div><div><h3>Methods</h3><div>A prospective cohort study of all adult patients (≥18 years) triaged to the resuscitation area of Muhimbili ED in Tanzania from 1^st September - 31^st December 2022. Shock index (SI) on arrival, initial point of care lactate and the physician’s estimates of the probability of an adverse event were recorded. The discriminatory ability of these index tests was compared for prediction of an adverse event in the ED, using DeLong’s test. Sensitivity, specificity, positive and negative predictive values were calculated. For SI, a standard cut off ≥ 1 was used and for lactate a standard cut off &gt; 2 mmol/L was used. For physician gestalt, the optimum cut off of a 70 % probability of adverse event was determined based on Youdens’ index.</div></div><div><h3>Results</h3><div>A total of 320 critically ill patients were enrolled. SI (AUC = 0.734, 95 % CI 0.658 to 0.810) achieved a sensitivity of 59.3 % and a specificity of 83.1 %. Elevated lactate (AUC = 0.819, 95 % CI 0.76 to 0.88) achieved a sensitivity of 89.8 % and a specificity of 58.2 %. Physician gestalt had an AUC = 0.877, (95 % CI 0.833 to 0.922) using the optimal probability of ≥70 % and achieved a sensitivity of 88.1 % and a specificity of 76.2 %. The AUC of physician’s gestalt was significantly higher than that of SI (<em>p</em> = 0.0008), but was not significantly different from lactate (<em>p</em> = 0.067). The difference in AUC for lactate and SI was also not statistically significant (<em>p</em> = 0.10).</div></div><div><h3>Discussion</h3><div>Physicians gestalt in our setting demonstrated superior predictive performance compared to shock index and a comparable performance to lactate. This supports the use of gestalt as a low-resource risk stratification tool in emergency settings. However, accuracy of gestalt may depend on physician experience.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100914"},"PeriodicalIF":1.2,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}