African Journal of Emergency Medicine最新文献_第4页

Performance of shock index, lactate and physician’s gestalt in predicting adverse events among critically ill adult patients at an Emergency Department in Tanzania 休克指数、乳酸和医生格式塔在预测坦桑尼亚急诊科危重成人患者不良事件中的表现

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-10-23 DOI: 10.1016/j.afjem.2025.100914

Humphrey G. Medarakini , Alphonce N. Simbila , Ellen Weber , Zeinab B. Hassan , Florian Vedasto , Jennifer Tesha , Rebecca N. Tugara , Peter P. Kunambi , Elizabeth Bernard , Said S. Kilindimo

Introduction

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.

Methods

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 > 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.

Results

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 (p = 0.0008), but was not significantly different from lactate (p = 0.067). The difference in AUC for lactate and SI was also not statistically significant (p = 0.10).

Discussion

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.

在急诊科（ED）工作的医生必须能够识别可能恶化的危重病人，并优先考虑他们的护理。虽然休克指数、乳酸点和医师格式塔在高收入国家常用来预测不良事件，但它们在中低收入国家的适用性尚未得到广泛测试。方法对2022年9月1日至12月31日在坦桑尼亚Muhimbili ED复苏区分类的所有成年患者（≥18岁）进行前瞻性队列研究。记录到达时的休克指数（SI）、初始护理点乳酸和医生对不良事件概率的估计。采用DeLong试验比较这些指标试验预测ED不良事件的区分能力。计算敏感性、特异性、阳性预测值和阴性预测值。SI采用标准截止值≥1，乳酸采用标准截止值2 mmol/L。对于完形医生来说，不良事件概率为70%的最佳临界值是根据Youdens指数确定的。结果共纳入320例危重患者。SI （AUC = 0.734, 95% CI 0.658 ~ 0.810）的敏感性为59.3%，特异性为83.1%。乳酸浓度升高（AUC = 0.819, 95% CI 0.76 ~ 0.88）的敏感性为89.8%，特异性为58.2%。医师格式塔的AUC = 0.877 (95% CI 0.833 ~ 0.922)，最佳概率≥70%，灵敏度为88.1%，特异性为76.2%。医师格式塔的AUC显著高于SI (p = 0.0008)，但与乳酸无显著差异（p = 0.067）。乳酸和SI的AUC差异也无统计学意义（p = 0.10）。讨论：在我们的研究中，医师格式塔比休克指数和乳酸盐表现出更优越的预测性能。这支持在紧急情况下使用格式塔作为低资源风险分层工具。然而，格式塔的准确性可能取决于医生的经验。

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引用次数: 0

Knowledge, attitude and practice of emergency care providers on obstetric haemorrhage in KwaZulu-Natal, South Africa: A cross-sectional study 南非夸祖鲁-纳塔尔省紧急护理提供者对产科出血的知识、态度和做法：一项横断面研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-09-27 DOI: 10.1016/j.afjem.2025.100909

S Govender , OP Khaliq , T Abel , J Moodley

Background

Obstetric haemorrhage (OH) is a leading cause of maternal deaths worldwide. The South African Department of Health recommends that all childbirths be managed by skilled personnel who can identify and manage complications to reduce adverse maternal, perinatal and neonatal outcomes. Emergency Care (EC) providers are prehospital personnel mandated to fulfil this role; however, little is known about their knowledge, attitudes and practices (KAP) for OH emergencies. This study assesses EC providers’ knowledge (specifically pathophysiology, diagnosis and treatment), attitude and practices regarding OH management in KwaZulu-Natal (KZN), South Africa.

Methods

A cross-sectional KAP survey was administered to public-sector EC providers at designated central locations in each of the 11 KZN districts, with participants representing multiple ambulance stations in their respective districts. Data were collected through a structured questionnaire completed by 417 participants enrolled between July 2022 and August 2023. Modified Bloom’s cut-off points were used to develop KAP scores, enabling categorical assessment. Data analysis included descriptive and inferential statistics.

Results

Participants (n = 417) were predominantly male (75.3 %, n = 314). The majority were aged ≥40 years (66.4 %, n = 277), ranging from 18 to 60 years. Regarding OH, 95.7 % demonstrated poor knowledge, 65.5 % a positive attitude and 96.6 % poor practices. The Kruskal-Wallis test (p < 0.001) showed knowledge scores varied substantially by qualification level. Logistic regression indicated higher qualifications were associated with better knowledge, attitude and practices.

Conclusion

Targeted up-skilling and mandatory obstetric simulation for EC providers in KZN are needed to close knowledge-practice gaps. Despite a positive attitude, EC providers demonstrated poor knowledge and practices in OH management. These shortcomings appear influenced by systemic and contextual barriers and require further investigation. Nevertheless, our findings highlight the importance of sustained, targeted training and EMS support to address critical gaps and improve obstetric outcomes in emergency settings.

背景产科出血（OH）是全世界孕产妇死亡的主要原因。南非卫生部建议，所有分娩应由能够识别和处理并发症的熟练人员进行管理，以减少孕产妇、围产期和新生儿的不良后果。急诊服务提供者是受命履行这一职责的院前工作人员；然而，对他们的知识，态度和实践（KAP）对OH紧急情况知之甚少。本研究评估了南非夸祖鲁-纳塔尔省（KZN） EC提供者关于OH管理的知识（特别是病理生理学、诊断和治疗）、态度和做法。方法在KZN 11个区的指定中心地点对公共部门EC提供者进行了横断面KAP调查，参与者代表各自地区的多个救护站。数据通过结构化问卷收集，417名参与者在2022年7月至2023年8月期间注册。采用改良的Bloom分界点编制KAP分数，进行分类评估。数据分析包括描述性统计和推断性统计。结果417例患者以男性为主（75.3 %,n = 314）。年龄≥40岁（66.4%,n = 277）居多，年龄在18 ~ 60岁之间。对于健康护理，95.7%的人表现为知识贫乏，65.5%的人表现为积极态度，96.6%的人表现为行为不良。Kruskal-Wallis检验（p < 0.001）显示知识得分因资格水平的不同而有很大差异。逻辑回归显示，学历越高，知识、态度和行为越好。结论有针对性的技能提升和强制性产科模拟需要在KZN的EC提供者缩小知识和实践差距。尽管态度积极，但电子商务提供者在OH管理方面表现出较差的知识和实践。这些缺点似乎受到系统和背景障碍的影响，需要进一步调查。然而，我们的研究结果强调了持续的、有针对性的培训和EMS支持对于解决紧急情况下的关键差距和改善产科结果的重要性。

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引用次数: 0

Assessing the relationship between armed conflict and infectious disease incidence in Six Sub-Saharan Countries: Implications for Emergency Departments in conflict areas 评估撒哈拉以南六个国家武装冲突与传染病发病率之间的关系：对冲突地区急诊科的影响

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-09-26 DOI: 10.1016/j.afjem.2025.100911

Andrew Holzman , Daniel Olinga , Jacob Busingye , Douglas Rappaport

Introduction

This study aimed to update and expand on prior ecological analyses by examining within-country and cross-national correlations between conflict deaths and infectious disease incidence in six neighboring sub-Saharan African countries.

Methods

We analyzed six countries including Uganda, Rwanda, the Democratic Republic of the Congo, Central African Republic, South Sudan, and Burundi using conflict death data from the Uppsala Conflict Data Program and disease incidence data from the World Health Organization databases. Data were analyzed for the maximum period covered in the UCDP for each country, in general from 1990 to the present. Seven diseases were examined: malaria, tuberculosis, human immunodeficiency virus, tetanus, pertussis, measles, and yellow fever. We assembled matrices of regressions between conflict deaths and disease incidence within and across countries. The approach of this study was hypothesis-generating, with the intent to flag associations worthy of further consideration.

Results

Within-country analyses identified strong positive associations in Burundi (e.g., tuberculosis: R² = 0.81, p<0.001; tetanus: R² = 0.59, p<0.001) and Uganda (e.g., tuberculosis: R² = 0.56, p<0.001; malaria: R² = 0.42, p<0.001). Weaker but statistically significant correlations were also observed with measles in Uganda (R² = 0.13, p = 0.04) and Burundi (R² = 0.29, p = 0.001). Cross-nationally, we observed strong correlations between conflict deaths in Burundi and tuberculosis incidence in Uganda (R² = 0.86, p<0.001) and conflict deaths in South Sudan and malaria in the Democratic Republic of the Congo (R² = 0.64, p<0.001).

Conclusion

We confirm prior reports of malaria incidence association with armed conflict while introducing potential new associations involving tetanus and measles. Our hypothesis-generating approach supports further research. Emergency physicians and health systems in conflict-affected and adjacent regions should anticipate shifts in disease burden and consider preparedness strategies.

本研究旨在通过检查六个邻近的撒哈拉以南非洲国家冲突死亡与传染病发病率之间的国内和跨国相关性，更新和扩展先前的生态分析。方法采用乌普萨拉冲突数据计划中的冲突死亡数据和世界卫生组织数据库中的疾病发病率数据，对乌干达、卢旺达、刚果民主共和国、中非共和国、南苏丹和布隆迪等6个国家进行了分析。对每个国家统一发展方案所涵盖的最长时期的数据进行了分析，总的来说是从1990年到现在。检查了七种疾病：疟疾、肺结核、人类免疫缺陷病毒、破伤风、百日咳、麻疹和黄热病。我们收集了国家内部和国家间冲突死亡与疾病发病率之间的回归矩阵。本研究的方法是假设生成，目的是标记值得进一步考虑的关联。结果国内分析确定了布隆迪（例如，结核病：R²= 0.81,p<0.001；破伤风：R²= 0.59,p<0.001）和乌干达（例如，结核病：R²= 0.56,p<0.001；疟疾：R²= 0.42,p<0.001）的强正相关。乌干达（R²= 0.13,p = 0.04）和布隆迪（R²= 0.29,p = 0.001）与麻疹的相关性也较弱，但有统计学意义。在跨国研究中，我们观察到布隆迪的冲突死亡人数与乌干达的结核病发病率（R²= 0.86,p<0.001）以及南苏丹的冲突死亡人数与刚果民主共和国的疟疾发病率（R²= 0.64,p<0.001）之间存在很强的相关性。结论：我们证实了先前关于疟疾发病率与武装冲突相关的报道，同时引入了破伤风和麻疹的潜在新关联。我们的假设生成方法支持进一步的研究。受冲突影响地区和邻近地区的急诊医生和卫生系统应预测疾病负担的变化，并考虑防范战略。

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引用次数: 0

Workplace violence against nurses in the Emergency Department in a Ghanaian Tertiary Hospital 加纳一家三级医院急诊部对护士的工作场所暴力

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-09-23 DOI: 10.1016/j.afjem.2025.100905

Florence Nana Amoah , Cecilia Eliason , William Wilberforce Amoah , Philemon Adoliwine Amooba

Introduction

Workplace Violence (WPV) is a shared problem in healthcare settings as well as a complex and perilous universal concern, specifically for the nursing profession. Violence in various Emergency Departments (ED) has increased in recent years, with accumulative data of nursing staff exposed to violent behaviors in the health sector that negatively affect the quality of care provided. However, limited research conducted in the Ghanaian context has subdued the understanding of workplace violence and its impact on emergency nurses.

Methods

A qualitative approach, using an explorative-descriptive design to delve into the experiences of nurses who have had WPV at the ED. A purposive sampling technique was used to select 20 participants. Data was collected using a semi-structured interview guide until saturation was attained. Thematic analysis approach was used to analyze the data.

Results

Four themes identified were understanding of WPV, coping strategies, effects on work performance, and experiences and responses to WPV. Participants reported encountering incidences of violence at the workplace. Abuse was perceived as predictable and increasing in intensity and frequency which victims acknowledged significantly affected both their level of devotion to their jobs and capacity to care for patients. The normalization of WPV has led to significant under-reporting of incidents.

Conclusion

The study identified verbal abuse as the leading cause of WPV, which greatly affects the service rendered to patients. Safe working environments, occupational health measures, and effective prevention policies and interventions are needed in emergency department settings.

工作场所暴力（WPV）是医疗保健环境中的一个共同问题，也是一个复杂而危险的普遍问题，特别是对护理专业而言。近年来，各急诊科的暴力事件有所增加，积累的数据表明，护理人员在卫生部门遭受暴力行为，对所提供的护理质量产生了负面影响。然而，在加纳背景下进行的有限研究削弱了对工作场所暴力及其对急诊护士影响的理解。方法采用定性方法，采用探索性描述设计，深入研究在急诊科接受过WPV的护士的经历。采用有目的抽样技术，选择20名参与者。使用半结构化访谈指南收集数据，直到达到饱和。采用主题分析法对数据进行分析。结果确定了四个主题，分别是对工作消极情绪的理解、应对策略、对工作绩效的影响以及对工作消极情绪的经历和反应。参与者报告了在工作场所遇到的暴力事件。虐待被认为是可预见的，而且强度和频率都在增加，受害者承认这大大影响了他们对工作的投入程度和照顾病人的能力。WPV的正常化导致严重漏报事件。结论言语虐待是WPV发生的主要原因，严重影响了对患者的服务。急诊科需要安全的工作环境、职业卫生措施以及有效的预防政策和干预措施。

{"title":"Workplace violence against nurses in the Emergency Department in a Ghanaian Tertiary Hospital","authors":"Florence Nana Amoah , Cecilia Eliason , William Wilberforce Amoah , Philemon Adoliwine Amooba","doi":"10.1016/j.afjem.2025.100905","DOIUrl":"10.1016/j.afjem.2025.100905","url":null,"abstract":"<div><h3>Introduction</h3><div>Workplace Violence (WPV) is a shared problem in healthcare settings as well as a complex and perilous universal concern, specifically for the nursing profession. Violence in various Emergency Departments (ED) has increased in recent years, with accumulative data of nursing staff exposed to violent behaviors in the health sector that negatively affect the quality of care provided. However, limited research conducted in the Ghanaian context has subdued the understanding of workplace violence and its impact on emergency nurses.</div></div><div><h3>Methods</h3><div>A qualitative approach, using an explorative-descriptive design to delve into the experiences of nurses who have had WPV at the ED. A purposive sampling technique was used to select 20 participants. Data was collected using a semi-structured interview guide until saturation was attained. Thematic analysis approach was used to analyze the data.</div></div><div><h3>Results</h3><div>Four themes identified were understanding of WPV, coping strategies, effects on work performance, and experiences and responses to WPV. Participants reported encountering incidences of violence at the workplace. Abuse was perceived as predictable and increasing in intensity and frequency which victims acknowledged significantly affected both their level of devotion to their jobs and capacity to care for patients. The normalization of WPV has led to significant under-reporting of incidents.</div></div><div><h3>Conclusion</h3><div>The study identified verbal abuse as the leading cause of WPV, which greatly affects the service rendered to patients. Safe working environments, occupational health measures, and effective prevention policies and interventions are needed in emergency department settings.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100905"},"PeriodicalIF":1.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118426","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}

引用次数: 0

Predictors of immediate survival in Emergency Department cardiac arrest in Ethiopia: Insights from a resource-limited setting 埃塞俄比亚急诊科心脏骤停患者即刻存活的预测因素：来自资源有限环境的见解

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-09-19 DOI: 10.1016/j.afjem.2025.100906

Zigale Tilaye Ayalew , Alemayehu Beharu Tekle , Molla Asnake Kebede , Melaku T. Berhanu , Ashenafi Jemal , Etsegent akloge

Background

In-hospital cardiac arrest (IHCA) in Emergency Departments (EDs) remains a leading cause of mortality, particularly in low-resource countries. This study aims to identify the clinical characteristics and predictors of immediate survival among ED cardiac arrest patients in Ethiopian hospitals.

Methods

A retrospective cross-sectional study was conducted among 215 adult patients who experienced IHCA in the EDs of Saint Paul’s Hospital Millennium Medical College and Addis Ababa Burn, Emergency, and Trauma Hospital between January 2022 and December 2023. Logistic regression was used to identify predictors of immediate survival, defined as returns of spontaneous circulation sustained for at least one hour.

Results

Among 215 patients, the mean age was 50.7 years, and 58.6 % were male. The overall immediate survival rate was 46.5 % (n = 100). Independent predictors of survival included male sex (AOR 2.20; 95 % CI 1.06–2.89), respiratory failure as the cause of arrest (AOR 15.04; 95 % CI 2.34–95.13), continuous cardiac monitoring (AOR 4.94; 95 % CI 1.59–15.39), and initial shockable rhythms—ventricular fibrillation (AOR 37.93; 95 % CI 2.20–655.58) or pulseless ventricular tachycardia (AOR 25.64; 95 % CI 5.08–129.47). Admission for sepsis was associated with lower survival (AOR 0.05; 95 % CI 0.01–0.68).

Conclusion

Nearly half of patients with ED cardiac arrest in Ethiopia achieved immediate survival. Continuous monitoring, rapid recognition of shockable rhythms, and prompt management of reversible causes such as respiratory failure improve outcomes, while sepsis remains a predictor of poor survival. Strengthening ED monitoring and resuscitation capacity could improve cardiac arrest outcomes in similar African settings.

背景：医院内急诊科的心脏骤停（IHCA）仍然是导致死亡的主要原因，特别是在资源匮乏的国家。本研究旨在确定埃塞俄比亚医院ED心脏骤停患者的临床特征和即时生存预测因素。方法对2022年1月至2023年12月在圣保罗医院千禧医学院和亚的斯亚贝巴烧伤、急诊和创伤医院急诊科经历IHCA的215例成年患者进行回顾性横断面研究。使用逻辑回归来确定即时生存的预测因子，定义为持续至少一小时的自发循环恢复。结果215例患者平均年龄50.7岁，男性占58.6%。总即刻生存率为46.5% （n = 100）。生存的独立预测因素包括男性（AOR 2.20; 95% CI 1.06-2.89），呼吸衰竭作为骤停原因（AOR 15.04; 95% CI 2.34-95.13），持续心脏监测（AOR 4.94; 95% CI 2.59 - 15.39），以及初始休克性心律-室颤（AOR 37.93; 95% CI 2.20 - 655.58）或无脉性室性心动过速（AOR 25.64; 95% CI 5.08-129.47）。因脓毒症入院与较低的生存率相关（AOR 0.05; 95% CI 0.01-0.68）。结论埃塞俄比亚近一半的ED心脏骤停患者立即存活。持续监测，快速识别休克节律，及时处理可逆性原因，如呼吸衰竭，可改善预后，而脓毒症仍然是生存不良的预测指标。加强ED监测和复苏能力可以改善类似非洲环境下的心脏骤停结果。

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引用次数: 0

Examining the burden of unintentional injuries in Ghana: A systematic review and meta-analysis 检查加纳意外伤害的负担：系统回顾和荟萃分析

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-09-18 DOI: 10.1016/j.afjem.2025.100907

Daniel Gyaase , Deepti Beri , Stacie Powell , Nipuna Cooray , Margie Peden , Julie Brown , Jagnoor Jagnoor

Background

In Ghana, there is a lack of comprehensive and empirical data on injuries. In the absence of robust national datasets, systematic reviews serve as a critical tool for understanding existing evidence. Our study synthesises the available literature to estimate the pooled prevalence and mortality associated with unintentional injuries in Ghana.

Method

We searched and identified studies that reported on the burden (prevalence, mortality, economic and disabilities) of commonly reported unintentional injuries (road traffic injuries, falls, burns, drowning and poisoning) in Ghana. Studies were identified from PubMed, EMBASE, Global Health, and Scopus from 2000 to 2023.

Result

A total of 46 studies were included in the review. The prevalence and mortality of unintentional injuries were high, with a pooled estimate of 18 % (95 % CI: 11 % – 26 %) and 15 % (9 % CI: 10 % – 21 %), respectively. Road traffic injury (RTI) was found to be a major contributor to the high prevalence and mortality. Our review found limited data on the economic burden and disabilities from unintentional injuries. Despite the lack of complete data, the cost of treating unintentional injuries appears to be significantly high. The annual cost of treating RTIs was US$6730,862.89, falls were US$1645,736.50, and burns were US$464,937.11.

Conclusion

Our review found a high prevalence, mortality, and likely economic burden of unintentional injuries in Ghana. Prioritising road safety could significantly reduce the burden of unintentional injuries in Ghana. Due to the limited studies on the economic burden and disability from unintentional injuries, more research is needed to drive insurance policies and rehabilitation practices.

在加纳，缺乏关于伤害的全面和经验数据。在缺乏健全的国家数据集的情况下，系统评价是理解现有证据的关键工具。我们的研究综合了现有文献，以估计加纳与意外伤害相关的总患病率和死亡率。方法我们检索并确定了报告加纳常见意外伤害（道路交通伤害、跌倒、烧伤、溺水和中毒）负担（患病率、死亡率、经济和残疾）的研究。从2000年至2023年的PubMed、EMBASE、Global Health和Scopus中确定了研究。结果共纳入46项研究。意外伤害的患病率和死亡率很高，合并估计分别为18% （95% CI: 11% - 26%）和15% （9% CI: 10% - 21%）。道路交通伤害是造成高发病率和高死亡率的一个主要因素。我们的研究发现，关于意外伤害造成的经济负担和残疾的数据有限。尽管缺乏完整的数据，但治疗意外伤害的费用似乎非常高。治疗rti的年费用为6730,862.89美元，跌倒为1645,736.50美元，烧伤为464,937.11美元。结论：我们的综述发现加纳意外伤害的患病率、死亡率和可能的经济负担都很高。优先考虑道路安全可以大大减轻加纳意外伤害的负担。由于对意外伤害的经济负担和残疾的研究有限，需要更多的研究来推动保险政策和康复实践。

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引用次数: 0

Critical care transfers of ventilator-dependent patients from operating theatres to Critical Care Units in a South African Metropole 南非大都市呼吸机依赖患者从手术室到重症监护病房的重症监护转移

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-09-18 DOI: 10.1016/j.afjem.2025.100908

Esther Cloete , Jacobus J Badenhorst , Anthony R Reed

Background

Ventilated patients in the operating theatre who need transfer to other facilities, can contribute to delays and inefficencies in surgical and theatre resources. In 2018, an interhospital retrieval service was established to provide transfers between state hospitals in the Cape Town Metropole exclusively for intubated, post-operative patients. This study aims to describe the utilisation of the retrieval system and gain insights into retrieval patterns.

Methods

This retrospective observational study analysed all post-operative patients using the retrieval system between state hospitals in the Cape Town Metropole from July 2018 – December 2021, as recorded in an existing SPRINTT-OR registry.

Results

A total of 291 patients were included. Most patients retrieved were male (n = 186, 63.9 %), with a mean age of 34.95 (S ± 13.59). The median time interval from request to ambulance arrival was 61 min. Most patients (n = 184, 63.2 %) were transferred from a single Large Metro District Hospital (LMDH). Trauma surgery was the most common diagnostic category (n = 123, 42.3 %), followed by infective causes (n = 79, 27.1 %) and Obstetrics & Gynaecology (n = 52, 17.9 %).

Conclusion

This study provides insight into the retrieval needs of ventilated, post-operative patients across different healthcare facilities in an African metropolitan area who are transferred with a dedicated, specialised transfer service. It describes the system's use and provides insight into patient demographics, diagnoses, and transfer timing, as well as the role of Emergency Medical Services (EMS) in optimising the functioning of a healthcare system.

背景手术室内需要通风的患者需要转移到其他设施，可能会导致手术和手术室资源的延误和效率低下。2018年，建立了一项医院间检索服务，专门为开普敦大都会的公立医院之间的插管术后患者提供转诊服务。本研究旨在描述检索系统的使用，并深入了解检索模式。方法本回顾性观察性研究分析了2018年7月至2021年12月在开普敦大都会州立医院使用检索系统的所有术后患者，这些患者记录在现有的sprint - or登记处。结果共纳入291例患者。大多数患者为男性（n = 186, 63.9%），平均年龄34.95 （S±13.59）岁。从请求到救护车到达的中位时间间隔为61分钟。大多数患者（n = 184, 63.2%）来自单一的大型都会区医院（LMDH）。创伤外科是最常见的诊断类别（n = 123, 42.3%），其次是感染原因（n = 79, 27.1%）和妇产科（n = 52, 17.9%）。结论：本研究提供了对非洲大都市地区不同医疗机构的通气术后患者的检索需求的见解，这些患者通过专门的专业转移服务转移。它描述了系统的使用，并提供了对患者人口统计，诊断和转移时间的见解，以及紧急医疗服务（EMS）在优化医疗保健系统功能中的作用。

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引用次数: 0

Nurses’ knowledge and self-reported adherence to advanced life support guidelines during in-hospital cardiac arrest in a referral hospital in Ghana 加纳一家转诊医院的护士在院内心脏骤停期间的知识和自我报告对高级生命支持指南的遵守情况

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-09-17 DOI: 10.1016/j.afjem.2025.100903

Gyimaa Nti –Darkwah , Susana Erica Somuah , Amos Prince Otuah , Mary Agongo

Introduction

Adherence to Advanced Life Support guidelines is vital for improving patient survival during a cardiac arrest. Nurses are often the first responders during inhospital cardiac arrests. This study assessed nurses’ knowledge of advanced life support guidelines and their self-reported adherence to recommended practices during in-hospital cardiac arrest.

Methods

A descriptive cross-sectional design was employed. Using simple random sampling, 138 registered nurses were recruited from the New Tafo Government Hospital in Ghana. A structured questionnaire was used to collect relevant data on the participants’ sociodemographic characteristics, knowledge on and self-reported adherence to advanced life support guidelines. Descriptive and inferential statistics were used for analysis.

Results

Less than half (39.9%) of nurses demonstrated good knowledge of advanced life support guidelines, with a similar proportion (34.8%) showing high self-reported adherence to advanced life support guidelines in simulated scenarios, and confidence level (39.8%) in responding to a cardiac arrest. Most respondents (65.2%) had never performed CPR in a clinical setting, and only 22.5% had participated in a simulation exercise. Recent advanced life support training (within the past 12 months) and greater years of clinical experience were significantly associated with higher knowledge levels.

Discussion

Nurses’ knowledge of and self-reported adherence to advanced life support guidelines, as well as confidence level in responding to a cardiac arrest situation were low. Regular, structured advanced life support refresher training incorporating simulation and practical drills is essential to enhance nurses’ readiness and performance during cardiac emergencies

在心脏骤停期间，坚持高级生命支持指南对于提高患者生存率至关重要。护士通常是院内心脏骤停的第一反应者。本研究评估了护士对高级生命支持指南的知识，以及他们在院内心脏骤停期间对推荐做法的自我报告依从性。方法采用描述性横断面设计。采用简单随机抽样的方法，从加纳新塔福政府医院招募了138名注册护士。使用结构化问卷收集参与者的社会人口学特征、对高级生命支持指南的知识和自我报告的依从性的相关数据。采用描述性统计和推理统计进行分析。结果不到一半（39.9%）的护士表现出对高级生命支持指南的良好了解，相似比例（34.8%）的护士在模拟情景中表现出高度的自我报告对高级生命支持指南的遵守，对心脏骤停的反应有信心（39.8%）。大多数受访者（65.2%）从未在临床环境中实施过心肺复苏术，只有22.5%参加过模拟演习。最近的高级生命支持培训（过去12个月内）和更多年的临床经验与更高的知识水平显着相关。讨论护士对高级生命支持指南的知识和自我报告的依从性，以及应对心脏骤停情况的信心水平较低。定期的、结构化的高级生命支持复习培训，包括模拟和实际演练，对于提高护士在心脏紧急情况下的准备和表现至关重要

{"title":"Nurses’ knowledge and self-reported adherence to advanced life support guidelines during in-hospital cardiac arrest in a referral hospital in Ghana","authors":"Gyimaa Nti –Darkwah , Susana Erica Somuah , Amos Prince Otuah , Mary Agongo","doi":"10.1016/j.afjem.2025.100903","DOIUrl":"10.1016/j.afjem.2025.100903","url":null,"abstract":"<div><h3>Introduction</h3><div>Adherence to Advanced Life Support guidelines is vital for improving patient survival during a cardiac arrest. Nurses are often the first responders during inhospital cardiac arrests. This study assessed nurses’ knowledge of advanced life support guidelines and their self-reported adherence to recommended practices during in-hospital cardiac arrest.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional design was employed. Using simple random sampling, 138 registered nurses were recruited from the New Tafo Government Hospital in Ghana. A structured questionnaire was used to collect relevant data on the participants’ sociodemographic characteristics, knowledge on and self-reported adherence to advanced life support guidelines. Descriptive and inferential statistics were used for analysis.</div></div><div><h3>Results</h3><div>Less than half (39.9%) of nurses demonstrated good knowledge of advanced life support guidelines, with a similar proportion (34.8%) showing high self-reported adherence to advanced life support guidelines in simulated scenarios, and confidence level (39.8%) in responding to a cardiac arrest. Most respondents (65.2%) had never performed CPR in a clinical setting, and only 22.5% had participated in a simulation exercise. Recent advanced life support training (within the past 12 months) and greater years of clinical experience were significantly associated with higher knowledge levels.</div></div><div><h3>Discussion</h3><div>Nurses’ knowledge of and self-reported adherence to advanced life support guidelines, as well as confidence level in responding to a cardiac arrest situation were low. Regular, structured advanced life support refresher training incorporating simulation and practical drills is essential to enhance nurses’ readiness and performance during cardiac emergencies</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100903"},"PeriodicalIF":1.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096470","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}

引用次数: 0

Demographics of paediatric trauma at a zonal referral hospital for northwestern Tanzania: A cross-sectional study 坦桑尼亚西北部地区转诊医院儿科创伤的人口统计：一项横断面研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-09-17 DOI: 10.1016/j.afjem.2025.100902

Arthi Kozhumam , Shazmah Suleman , Vihar Kotecha , Doug Lorenz , Charles Uttoh , Rebecca Yalimo , Colleen Fant

Introduction

Despite a high burden of paediatric injury (25 % of all presenting injuries) in Tanzanian studies, literature remains limited, especially in recent years, regarding detail of care provided for the injured child across different healthcare settings in the country. This study aims to understand and map the pediatric trauma burden and factors descriptively associated with pediatric injury at the zonal referral hospital, Bugando Medical Center (BMC), for northwestern Tanzania.

Methods

This study was a subgroup cross-sectional analysis of paediatric (ages 0 through 17) data collected from trauma patients who received care at BMC from March - August 2023, focused on paediatric-specific injury occurrence, injury characteristics, and location. Descriptive analyses of paediatric patient demographics, past medical history, prehospital characteristics, and injury characteristics across body system were conducted to understand the burden of serious injury in this setting. Geospatial analyses across region were conducted to understand patient density, triage level, prehospital care, and Euclidean distance from injury region to BMC.

Results

146 children were included in analysis. Almost all children were injured at home (42.5 %) or in a traffic crash (33.6 %), with more than half (56.8 %) in the highest (red) triage category. Nearly 70 % had received prehospital care from a healthcare professional. Head and maxillo-facial injuries were most the most common. Distance from Bugando Medical Center was associated with higher triage level but not with prehospital care.

Discussion

Paediatric injury in this referral hospital in northwestern Tanzania has distinct variations in referral patterns, injury locations and injury types. Efforts are particularly needed for head and maxillo-facial emergency support due to the predominance of injuries to these body systems. Regional variations in paediatric trauma incidence may represent a future target for outreach from this referral institution.

尽管在坦桑尼亚的研究中，儿科伤害的负担很高（占所有出现的伤害的25%），但关于该国不同医疗机构对受伤儿童的护理细节的文献仍然有限，特别是近年来。本研究旨在了解和绘制坦桑尼亚西北部地区转诊医院Bugando医疗中心（BMC）的儿童创伤负担和与儿童损伤描述性相关的因素。方法：本研究对从2023年3月至8月在BMC接受治疗的创伤患者收集的儿科（0至17岁）数据进行亚组横断面分析，重点关注儿科特异性损伤发生、损伤特征和部位。对儿科患者人口统计学、既往病史、院前特征和全身系统损伤特征进行描述性分析，以了解这种情况下严重损伤的负担。通过跨区域的地理空间分析，了解患者密度、分诊水平、院前护理以及损伤区域到BMC的欧几里得距离。结果146例儿童纳入分析。几乎所有的儿童都是在家中受伤（42.5%）或在交通事故中受伤（33.6%），其中超过一半（56.8%）属于最高（红色）分类。近70%的人接受了医疗保健专业人员的院前护理。头部和上颌面部损伤最为常见。距离Bugando医疗中心的距离与较高的分诊水平相关，但与院前护理无关。讨论坦桑尼亚西北部这家转诊医院的儿科损伤在转诊模式、损伤部位和损伤类型方面存在明显差异。由于这些身体系统的损伤占主导地位，特别需要努力为头部和颌面提供紧急支持。儿科创伤发生率的地区差异可能代表该转诊机构今后的推广目标。

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引用次数: 0

Embracing 3D printing in emergency medicine training in Africa 在非洲急诊医学培训中采用3D打印技术

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-09-13 DOI: 10.1016/j.afjem.2025.100904

Marvin Jansen, Fahmi Adams

Africa's emergency medicine training faces challenges of limited resources, inadequate simulation tools, and few locally relevant training models. This article explores how three-dimensional (3D) printing can help address these gaps by enabling the creation of affordable, customizable models for procedural skills and simulation-based education. We discuss the context of emergency medicine training in Africa, where limited access to high-fidelity manikins and other teaching aids hampers skills acquisition. The model printing format may be of limited applicability in the context of dynamic simulations, where the model is required to interact and perform a function, versus static simulation, with the emphasis on identification and directed procedures. We highlight illustrative use cases, including a 3D-printed airway management manikin and a basic suturing practice pad, to demonstrate the technology’s potential for hands-on learning. Key benefits of integrating 3D printing into training programs are examined, such as improved access to simulation, better local adaptability, and increased opportunity for producing affordable task trainers that are suited for hands-on emergency procedures. We also acknowledge challenges, from startup costs and infrastructure needs to the learning curve of 3D printers and suggest practical steps for implementation. This commentary encourages educators and institutions in Africa to explore 3D printing for education, and we envision it becoming integral to emergency medicine training across the continent; fostering skill development, self-sufficiency, and ultimately improving patient care.

非洲的急诊医学培训面临着资源有限、模拟工具不足以及缺乏与当地相关的培训模式等挑战。本文探讨了三维（3D）打印如何通过为程序技能和基于模拟的教育创建负担得起的、可定制的模型来帮助解决这些差距。我们讨论了非洲急诊医学培训的背景，在那里，高保真人体模型和其他教学辅助工具的有限获取阻碍了技能的获得。模型打印格式在动态仿真环境中可能适用性有限，在动态仿真环境中，需要模型进行交互并执行功能，而静态仿真环境则强调识别和指导过程。我们重点介绍了说导性用例，包括3d打印气道管理假人和基本缝合练习垫，以展示该技术在实践学习方面的潜力。研究了将3D打印集成到培训计划中的主要好处，例如改进模拟访问，更好的本地适应性，以及增加生产适合动手紧急程序的负担得起的任务培训器的机会。我们也承认挑战，从启动成本和基础设施需要3D打印机的学习曲线，并建议实施的实际步骤。这篇评论鼓励非洲的教育工作者和机构探索3D打印教育，我们设想它将成为整个非洲大陆急诊医学培训的一部分；促进技能发展，自给自足，并最终改善病人护理。

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引用次数: 0