African Journal of Emergency Medicine最新文献

英文中文

Service utilisation and outcomes of transfers by a specialised paediatric and neonatal retrieval service in the Western Cape, South Africa 服务利用和转移的结果由专门的儿科和新生儿检索服务在西开普省，南非

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-11-21 DOI: 10.1016/j.afjem.2025.100925

Shama Patel , Liezl Smit , Grant Felix , Baljit Cheema , Andrew Redfern

Introduction

Development of emergency care systems and provision of quality pre-hospital care have been identified as a priority to reduce childhood morbidity and mortality in low-resource settings. A dedicated paediatric and neonatal retrieval transfer team (SPRINTT) service was established in the Western Cape, South Africa, in 2016. This study describes the utilisation of Emergency Medical Services (EMS) for children and neonates identified as requiring SPRINTT. Additionally, the indications, clinical profile, and outcomes for a sub-group of children transferred to a tertiary paediatric emergency department (PED) are described.

Methods

This retrospective study reviewed cases requiring SPRINTT from November 2019 to November 2020. Data were obtained from EMS Electronic Patient Care Records (ePCR) and Computer Aided Dispatch (CAD) databases. A sub-group of cases transferred to a tertiary PED were reviewed using hospital records.

Results

A total of 2361 inter-facility transfers logged as SPRINTT incident-types occurred during the study period, with 54% being neonates <29 days. The majority (87%) were from urban facilities. Most cases (82%) were high acuity, being triaged as an emergency or very urgent. Of the sub-group of 203 cases transferred to the PED, acute respiratory illnesses (42%) and gastroenteritis (24%) were the most frequent presenting complaints. Eight children (4%) died, and 16% of children were unstable on arrival. Cardiovascular instability and escalation of respiratory support within 60 min of PED arrival were associated with PICU admission and death (p < 0.001).

Conclusion

This study is the first description of the utilisation of the SPRINTT service that includes a description of patient outcomes. The large number of SPRINT-type transfers reflects the considerable burden of acutely ill paediatric and neonatal cases and highlights the need for specialised pre-hospital care services. For the PED sub-group, 84% were stable on arrival suggesting that the retrieval service performs an important role in pre-hospital care and transfer in this setting.

急诊护理系统的发展和提供高质量的院前护理已被确定为在低资源环境中降低儿童发病率和死亡率的优先事项。2016年，在南非西开普省成立了专门的儿科和新生儿检索转移小组（SPRINTT）服务。本研究描述了紧急医疗服务（EMS）对确定需要SPRINTT的儿童和新生儿的利用情况。此外，对转入三级儿科急诊科（PED）的儿童亚组的适应症、临床概况和结果进行了描述。方法回顾性分析2019年11月至2020年11月期间需要sprint治疗的病例。数据来自EMS电子病人护理记录（ePCR）和计算机辅助调度（CAD）数据库。一个亚组的病例转移到三级PED审查使用医院记录。结果在研究期间共发生2361例SPRINTT事件类型的医院间转移，其中54%为29天的新生儿。大多数（87%）来自城市设施。大多数病例（82%）是高视力，被分类为紧急或非常紧急。在转入PED的203例亚组中，急性呼吸道疾病（42%）和肠胃炎（24%）是最常见的主诉。8名儿童（4%）死亡，16%的儿童在抵达时情况不稳定。PED到达后60分钟内心血管不稳定和呼吸支持升级与PICU入院和死亡相关（p < 0.001）。结论：本研究首次描述了SPRINTT服务的使用情况，其中包括对患者结果的描述。大量的sprint型转诊反映了急性儿科和新生儿病例的巨大负担，并突出了对专门院前护理服务的需要。对于PED亚组，84%的患者在到达时病情稳定，这表明检索服务在这种情况下的院前护理和转院中发挥了重要作用。

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引用次数: 0

Clinical profile and outcome of patients with acute kidney injury in the Emergency Department of a teaching hospital in Ethiopia 埃塞俄比亚一家教学医院急诊科急性肾损伤患者的临床概况和预后

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-11-21 DOI: 10.1016/j.afjem.2025.100926

Berihu Assefa Berhe , Benyam Bahta Gebrehiwot , Frehiwot Worku Senbeta , Dirijit Mamo Alemu , Menbeu Sultan Mohammed , Mohammed Kalifa Nuguse , Yemane Gebremedhin Tesfay

Background

Acute Kidney Injury (AKI) affects 13.3 million people annually, with 85% in low resource settings. This study aimed to identify AKI profiles and outcomes in Ethiopia's largest teaching hospital's emergency department, focusing on targeted therapy and preventative measures.

Method and Materials

A cross-sectional study was conducted at an Ethiopian teaching hospital's Emergency Department from June 1, 2021, to June 1, 2022. Descriptive statistics and binary logistic regression were analyzed. A paired samples T-test was used to compare patient findings.

Results

Among the 222 AKI patients included in the study, 110 (49.5 %) were males, and 112 (50.5 %) were females. The mean age of presentation was 48±18 years old. Most patients were from Addis Ababa (41.4 %) and the Oromia region (40.5 %). The most common causes of AKI were infections (26.2 %), acute glomerulonephritis (20.4 %), volume depletion (18.5 %), and obstructive uropathy (16.6 %). Uremic encephalopathy, infection, malignancy, and a low initial Glasgow Coma Scale significantly contributed to unfavorable outcomes. The presence of nephrotoxic antibiotics, infection, and hyponatremia significantly contributed to the admission rate to the wards and intensive care unit.

Conclusion

In conclusion, infection is the dominant cause and mortality predictor of AKI. The majority of patients with infections were sepsis (78.1 %), pyelonephritis (11.4 %), and pneumonia (10.3 %). Early initiation of antibiotics in the Emergency Department contributes to improved outcomes.

背景：急性肾损伤（AKI）每年影响1330万人，其中85%发生在资源匮乏地区。本研究旨在确定埃塞俄比亚最大的教学医院急诊科的AKI概况和结果，重点是靶向治疗和预防措施。方法与材料于2021年6月1日至2022年6月1日在埃塞俄比亚一家教学医院急诊科进行了一项横断面研究。描述性统计和二元逻辑回归分析。配对样本t检验用于比较患者的结果。结果222例AKI患者中，男性110例（49.5%），女性112例（50.5%）。平均发病年龄48±18岁。大多数患者来自亚的斯亚贝巴（41.4%）和奥罗米亚地区（40.5%）。AKI最常见的原因是感染（26.2%），急性肾小球肾炎（20.4%），容量耗竭（18.5%）和梗阻性尿病（16.6%）。尿毒症脑病、感染、恶性肿瘤和较低的初始格拉斯哥昏迷评分显著导致不良结果。肾毒性抗生素、感染和低钠血症的存在显著增加了病房和重症监护病房的入院率。结论感染是AKI的主要病因和死亡预测因子。感染主要为败血症（78.1%）、肾盂肾炎（11.4%）和肺炎（10.3%）。在急诊科早期使用抗生素有助于改善预后。

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引用次数: 0

Global Health research abstracts: July ‘25 全球健康研究摘要：25年7月

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-11-20 DOI: 10.1016/j.afjem.2025.100924

引用次数: 0

Global Health research abstracts: November ‘25 全球健康研究摘要：25年11月

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-11-20 DOI: 10.1016/j.afjem.2025.100921

引用次数: 0

Global Health research abstracts: September ‘25 全球健康研究摘要：25年9月

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-11-20 DOI: 10.1016/j.afjem.2025.100923

引用次数: 0

Global Health research abstracts: October ‘25 全球健康研究摘要：25年10月

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-11-20 DOI: 10.1016/j.afjem.2025.100922

引用次数: 0

Global Health research abstracts: December ‘25 全球健康研究摘要：25年12月

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-11-20 DOI: 10.1016/j.afjem.2025.100920

引用次数: 0

Global Health research abstracts: August ‘25 全球健康研究摘要：25年8月

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-11-20 DOI: 10.1016/j.afjem.2025.100919

引用次数: 0

Incidence of mortality and predictors among patients with shock managed in the emergency room of a tertiary hospital in Ethiopia 埃塞俄比亚一家三级医院急诊室中休克患者的死亡率和预测因素

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-11-15 DOI: 10.1016/j.afjem.2025.100917

Kalsidagn Girma Asfaw , Abel Getachew Adugna , Nahom Mesfin Mekonen , Merahi Kefyalew Merahi , Segni Kejela , Fekadesilassie Henok Moges , Tigist Workneh Leulseged

Introduction

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.

Methods

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.

Result

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.

Conclusion

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.

休克是一种常见的紧急情况，如果不及时诊断和处理，可能导致器官衰竭和死亡。尽管它在全球产生了巨大影响，但在包括埃塞俄比亚在内的资源有限的环境中，数据很少，这阻碍了为改善结果提供高质量的护理。因此，本研究旨在确定埃塞俄比亚圣保罗医院千年医学院急诊科管理的成年休克患者的死亡率和预测因素。方法对该医院于2021年10月1日至2022年5月20日收治的符合条件的患者进行回顾性图表回顾研究。死亡率用观察的人日（PD）随发病率密度估计。为了确定死亡率的预测因子，采用具有稳健标准误差的泊松回归模型拟合了一个广义线性模型，其中使用95% CI的校正相对危险度（ARR）来解释结果。结果研究期间共纳入196例患者，排除记录不完整的18例，纳入178例患者。大多数参与者年龄在40岁或以上（69.7%），女性（51.1%），症状持续时间少于一周（68.5%），至少有一种合并症（70.8%）。死亡发生率为16.5 / 100 PD （95% CI = 13.1 ~ 20.9）。虽然橙色分类与死亡风险降低有关，但高休克指数、脓毒性休克诊断、血管加压药的使用和器官衰竭与死亡风险增加有关。结论休克患者的死亡率相当高。为了优化患者护理和改善预后，重要的是要保持警惕，使用更敏感的工具对休克进行适当的分类和早期诊断，以及时识别高风险病例，并提供及时、优先和有效的干预措施。

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引用次数: 0

Magnitude and associated factors of discharge against medical advice among patients treated in the adult Emergency Department at an Ethiopian University Hospital 埃塞俄比亚大学医院成人急诊科患者不遵医嘱出院的程度及相关因素

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-11-15 DOI: 10.1016/j.afjem.2025.100918

Getachew Worku , Demelash Ataro

Background

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.

Methods

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 < 0.05.

Results

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.

Conclusion

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.

根据医嘱出院（DAMA）是一种全球现象，即患者在医疗团队宣布其适合出院之前自愿终止对医疗护理的同意。这对提供高质量的医疗保健产生不利影响，并对医生个人和医院构成严重的临床、道德和法律挑战。本研究旨在评估DAMA的程度和相关因素。方法在埃塞俄比亚阿瓦萨大学综合专科医院成人急诊科进行一项基于机构的横断面研究。采用系统随机抽样方法抽取322例患者。通过图表审查，使用预先测试的结构化检查表收集数据。描述性统计，包括比例、中位数、表格和图表，用于描述研究参与者的特征。采用二元logistic回归分析确定与DAMA相关的因素。模型的适合度通过Hosmer和Lemeshow检验。p值<； 0.05为显著性水平。结果322例患者中DAMA发生率为7.45%（24例）；95% CI: 4.56 - 10.3%)大多数DAMA患者（41.7%）是由于经济问题，其次是拒绝手术（20.8%）和预后不良（16.7%）。男性[AOR: 4.1；95% CI: 1.17-14.11]和红色和橙色的分类水平[AOR: 2.87；95% CI: 1.02 ~ 8.02]与DAMA相关。结论该研究确定了相当大的DAMA。男性和分诊评分的严重程度被发现是DAMA的独立决定因素。由于财政拮据，大多数病人已经永久离开了医院。因此，加强医疗保险和确保政府保健设施提供必要的资源有助于减少死亡人数。

{"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 , 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 < 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}

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