African Journal of Emergency Medicine最新文献_第7页

Alphachloralose intoxication: A retrospective study on epidemiology, clinical presentation, and management in an adult emergency department in Morocco 氯氯醛中毒：摩洛哥成人急诊科流行病学、临床表现和管理的回顾性研究

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-06-25 DOI: 10.1016/j.afjem.2025.100887

El Mehdi Samali , Abdelghafour El Koundi , Amine Meskine , Hicham Balkhi , Mohammed Moussaoui

Background

Alphachloralose, initially used as a hypnotic and anesthetic, is now restricted to rodenticides. Despite limited medical use, it remains accessible in North Africa, contributing to intentional poisonings. Poisoning primarily presents with neurological and respiratory symptoms, posing a significant public health concern. This study describes the epidemiological, clinical, and therapeutic characteristics of alphachloralose poisoning cases admitted to the adult emergency department of a university hospital in Casablanca, Morocco.

Methods

A retrospective study analyzed emergency department records for alphachloralose poisoning cases from October 2022 to June 2023. Poisoning was confirmed based on clinical presentation, witness accounts, and/or biological toxicological evidence. Data on demographics, exposure circumstances, clinical features, interventions, and outcomes were extracted. Severity was evaluated using the Poisoning Severity Score (PSS), grading the severity into five levels from 0 (no symptoms) to 4 (fatal). Hospital stay duration and complications were also assessed.

Results

Some 53 cases were included, with mean age of patients 27 years, and a male-to-female ratio of 0.83. Suicidal ingestion accounted for the vast majority of cases (98 %). Alphachloralose was exclusively ingested in powdered form, as no other formulations are available in Morocco. Neurological and respiratory disturbances were the most common clinical manifestations, with 28 % of cases classified as severe according to the PSS. Gastric lavage was performed in 52.8 % of cases, benzodiazepines were administered in 54 %, and 39.6 % of patients required intubation. The median time to admission to intensive care was 5 h. The average duration of hospitalization was 2.4 ± 1.2 days. Although one fatality occurred, 98 % of cases recovered fully without complications, emphasizing the importance of early and appropriate management.

Conclusion

Alphachloralose poisoning is a significant toxicological concern in North Africa due to its availability and misuse. Severe symptoms are frequent, but early intervention leads to favorable outcomes. Public health measures focusing on regulation and education are essential.

phachlorose最初用作催眠和麻醉剂，现在仅限于灭鼠剂。尽管医疗用途有限，但在北非仍然可以获得，助长了故意中毒。中毒主要表现为神经系统和呼吸系统症状，引起严重的公共卫生问题。本研究描述了摩洛哥卡萨布兰卡一所大学医院成人急诊科收治的甲氯氯蔗糖中毒病例的流行病学、临床和治疗特点。方法回顾性分析2022年10月至2023年6月急诊收治的甲氯氯蔗糖中毒病例。中毒是根据临床表现、证人陈述和/或生物毒理学证据确定的。提取了人口统计学、暴露环境、临床特征、干预措施和结果的数据。使用中毒严重程度评分（PSS）评估严重程度，将严重程度分为5个级别，从0（无症状）到4（致命）。住院时间和并发症也进行了评估。结果共纳入53例，平均年龄27岁，男女比0.83。自杀性摄入占绝大多数病例（98%）。由于摩洛哥没有其他配方，因此只以粉末形式摄入氯醛。神经系统和呼吸障碍是最常见的临床表现，根据PSS， 28%的病例被分类为严重。52.8%的患者使用洗胃，54%的患者使用苯二氮卓类药物，39.6%的患者需要插管。至重症监护的中位时间为5小时，平均住院时间为2.4±1.2天。虽然发生了一例死亡，但98%的病例完全恢复，无并发症，强调了早期和适当治疗的重要性。结论甲氯氯蔗糖的可获得性和滥用是北非地区严重的毒理学问题。严重的症状是常见的，但早期干预导致良好的结果。注重监管和教育的公共卫生措施至关重要。

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引用次数: 0

Global Health research abstracts: June ‘25 全球健康研究摘要：25年6月

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-06-23 DOI: 10.1016/j.afjem.2025.100886

Jonathan Kajjimu

The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.

《非洲急诊医学杂志》与其他几个区域急诊医学期刊合作，发表各自期刊的摘要。摘要不一定链接到开放获取论文，但是，所有摘要都可以在没有订阅的情况下访问。

引用次数: 0

Characteristics and outcomes of children initiated on high flow nasal cannula and continuous positive airway pressure at the emergency centre of a district hospital in South Africa 南非一家地区医院急诊中心开始使用高流量鼻插管和持续气道正压治疗的儿童的特点和结果

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-06-16 DOI: 10.1016/j.afjem.2025.100884

Jessica Head , Andrew Redfern , Jana Hoole , Liezl Ulbrich , Refilwe More , Daniël J. van Hoving , Eric D. McCollum , Shubhada Hooli

Introduction

High-flow nasal cannula (HFNC) and continuous positive airway pressure delivered via a nasal interface (nCPAP) are increasingly used for paediatric emergency care in South Africa. In Cape Town, initiation of HFNC/nCPAP at a district hospital, in most instances, necessitates transfer to a paediatric high-care facility. We sought to describe the population of children initiated on HFNC/nCPAP and their short-term hospital outcomes post interfacility transfer.

Methods

The authors conducted a one-year retrospective observational study between August 1st 2021, to July 31st^, 2022 of children initiated on HFNC or nCPAP in the emergency centre (EC) of Khayelitsha district Hospital and transferred by ambulance to Tygerberg Hospital paediatric emergency centre. Children were excluded from the study if they were <10 days or >13 years of age, if they had an advanced care plan that restricted the escalation of respiratory support or if their medical records were incomplete.

Results

At Khayelitsha Hospital, 117 patients were initiated on HFNC (n = 58) or nCPAP (n = 59). Participants had a median age of 6.8 months. There were no major adverse events reported during inter-facility transfer. Respiratory support was weaned to low flow oxygen or room air within 24 h of transfer in 23.9 % and escalated in 9.4 %. During hospital stay 14.5 % were admitted to intensive care, 6.0 % ultimately required mechanical ventilation, and the in-hospital mortality rate was 1.7 %.

Conclusion

Roughly a quarter of patients were weaned from respiratory support within 24 h of transfer. Short term outcomes were good overall, demonstrating safe interfacility transfer and low mortality. Further research is needed to inform practice on best use of HFNC and nCPAP in the emergency care of children presenting with acute respiratory illness in South Africa.

在南非，高流量鼻插管（HFNC）和通过鼻接口持续气道正压通气（nCPAP）越来越多地用于儿科急诊护理。在开普敦，在地区医院开始实施手足口病治疗/儿童预防感染方案，在大多数情况下，需要转到儿科高级护理机构。我们试图描述开始接受HFNC/nCPAP治疗的儿童人群，以及他们在医院转院后的短期住院结果。方法对2021年8月1日至2022年7月31日在卡耶利沙区医院急诊中心（EC）开始接受HFNC或nCPAP治疗并被救护车转至Tygerberg医院儿科急诊中心的儿童进行为期一年的回顾性观察研究。如果儿童的年龄为10天或13岁，如果他们有一个限制呼吸支持升级的高级护理计划，或者如果他们的医疗记录不完整，则排除在研究之外。结果卡耶利沙医院有117例患者（58例）开始HFNC或nCPAP治疗（59例）。参与者的平均年龄为6.8个月。在设施间转移期间未报告重大不良事件。23.9%的人在转移后24小时内停止呼吸支持，转而使用低流量氧气或室内空气，9.4%的人增加呼吸支持。在住院期间，14.5%被送进重症监护室，6.0%最终需要机械通气，住院死亡率为1.7%。结论约四分之一的患者在转移后24 h内脱离呼吸支持。短期结果总体良好，显示出安全的设施间转移和低死亡率。需要进一步研究，以便为在南非急性呼吸道疾病患儿急诊护理中最佳使用HFNC和nCPAP的实践提供信息。

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引用次数: 0

Implementing the Safe Airway Checklist (SAC) at the emergency department of a major teaching hospital in Rwanda: A pre- and post-intervention study 在卢旺达一家大型教学医院急诊科实施安全气道检查表（SAC）：一项干预前和干预后研究

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-06-11 DOI: 10.1016/j.afjem.2025.03.002

Joseph Biramahire , Matthew Pereira , Appolinaire Manirafasha , Doris Lorette Uwamahoro , Jean Paul Mvukiyehe , Paulin Banguti , Eugene Tuyishime

Background

Airway management is a critical aspect of emergency care, and adherence to standardized protocols can improve patient outcomes. However, in resource-limited settings such as Rwanda, the implementation of airway management protocols in the emergency department (ED) may face challenges. This study aims to evaluate the impact of implementing the Safe Airway Checklist (SAC) on airway management practices and post-intubation complications in a major teaching hospital in Rwanda.

Methods

A pre- and post-intervention study design was used to assess the impact of the SAC on intubation practices and post-intubation checklist in the ED at the University Teaching Hospital of Kigali. The study included a baseline assessment of residents’ intubation practices, followed by implementation of the SAC, and post-implementation data collection to evaluate changes in adherence to airway management practices and post-intubation complications.

Results

Among 77 intubation (40 pre-intervention and 37 post-intervention), the implementation of the SAC led to improvement in 4 key airway management practices (airway cart and glidescope setup, premedication use, restraining patients, and checking ABG within 10–15 min) in the ED. However, the reduction in rates of post-intubation complications was not statistically significant.

Conclusion

The implementation of the Safe Airway Checklist in the ED of a major teaching hospital in Rwanda significantly improved several critical aspects of airway management. While no statistically significant reduction in post-intubation complications were observed, the decreasing trend of complication rates suggests promising benefits that merit further exploration. These findings highlight the value of standardized checklists in enhancing clinical practices and underscore the need for ongoing research to fully understand their impact on patient outcomes especially in low resources settings.

背景：气道管理是急诊护理的一个关键方面，遵守标准化的方案可以改善患者的预后。然而，在资源有限的情况下，如卢旺达，气道管理协议的实施在急诊科（ED）可能面临挑战。本研究旨在评估卢旺达一家大型教学医院实施安全气道检查表（SAC）对气道管理实践和插管后并发症的影响。方法采用干预前和干预后的研究设计，评估SAC对基加利大学教学医院急诊科插管操作和插管后检查表的影响。该研究包括对居民插管实践的基线评估，随后是SAC的实施，以及实施后的数据收集，以评估对气道管理实践的依从性和插管后并发症的变化。结果77例插管（干预前40例，干预后37例）中，SAC的实施改善了急诊科4项关键气道管理措施（气道手推车和滑梯设置、用药前使用、约束患者、10-15分钟内检查血气测定），但插管后并发症发生率的降低无统计学意义。结论在卢旺达一家大型教学医院的急诊科实施安全气道检查表，显著改善了气道管理的几个关键方面。虽然没有观察到插管后并发症的统计学显著减少，但并发症发生率的下降趋势表明有希望的益处值得进一步探索。这些发现强调了标准化检查清单在加强临床实践中的价值，并强调了正在进行的研究的必要性，以充分了解它们对患者预后的影响，特别是在资源匮乏的情况下。

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引用次数: 0

Nurses’ knowledge on trauma and emergency care and associated factors in Ghanaian district hospitals 加纳地区医院护士对创伤和急救护理及相关因素的了解

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-06-10 DOI: 10.1016/j.afjem.2025.04.004

Akua K Karikari , Adam Gyedu , Isaac Yankson , Dorcas Doefe Amedzake , Peter Agyei-Baffour , Anthony K Edusei , Peter Donkor , Charles Mock

Introduction

Nurses’ knowledge of emergency care is a vital component of emergency capabilities. We sought to evaluate the factors that influence the knowledge on trauma and emergency care of nurses in district hospitals in Ghana.

Methods

In this cross-sectional study, we administered a questionnaire on emergency care to 406 nurses working in 11 (out of 37) randomly-selected district hospitals in the Ashanti Region. This included 10 multiple-choice questions on trauma care and 10 on general medical/surgical emergency care to objectively assess knowledge on emergency care. Analysis involved descriptive statistics, inferential tests comparing tests scores with Student’s t-tests and ANOVA, and multivariable linear regression.

Results

Mean overall test score for knowledge was 60.1 % correct (SD 13.7 %). Results were tightly clustered with an inter-quartile range of 50 % to 70 %. Factors influencing the test scores on multivariable linear regression included: (a) gender (male nurses scored an adjusted 3.8 % higher than female nurses, p = 0.015; beta=3.8; 95 %CI 0.7–6.8); and (b) refresher training (nurses who had received refresher training on emergency care scored an adjusted 3.3 % higher than those who had not received such training, p = 0.018; beta=3.3; CI 0.6–6.0). The higher overall scores for male nurses were due solely to higher scores on trauma-related questions. Male nurses scored an average of an adjusted 5.1 % higher on the trauma questions (p = 0.023; beta=5.1; CI 0.7–9.5) than female nurses, but their scores on general emergency care were not significantly different.

Conclusions

Test scores for knowledge on emergency care for nurses working in Ghanaian district hospitals were generally adequate. While gender did influence test scores, the main actionable factor associated with higher test scores was having received refresher training in emergency care. There is a need for greater availability of such continuing professional development for nurses.

护士的急救知识是急救能力的重要组成部分。我们试图评估影响加纳地区医院护士创伤和急救知识的因素。方法在横断面研究中，我们对阿散蒂地区随机选择的11家（37家）区级医院的406名护士进行了急诊护理问卷调查。其中包括10道创伤护理的多项选择题和10道普通内科/外科急诊护理的多项选择题，以客观评估急救知识。分析包括描述性统计、与学生t检验和方差分析比较测试成绩的推理检验以及多变量线性回归。结果平均总知识测试分数正确率为60.1%（标准差为13.7%）。结果紧密聚类，四分位数间范围为50%至70%。多变量线性回归的影响因素包括：(a)性别(调整后男护士得分比女护士高3.8%,p = 0.015；β= 3.8;95% ci 0.7-6.8)；(b)进修培训(接受过急诊进修培训的护士得分比未接受过此类培训的护士高3.3%,p = 0.018；β= 3.3;可信区间0.6 - -6.0)。男护士的总体得分较高仅仅是因为在创伤相关问题上得分较高。男护士在创伤问题上的平均得分高出5.1% (p = 0.023；β= 5.1;CI 0.7 ~ 9.5)高于女护士，但在普通急诊护理方面的得分差异无统计学意义。结论加纳地区医院护士急救知识测试得分总体较好。虽然性别确实影响考试成绩，但与较高考试成绩相关的主要可采取行动的因素是接受过紧急护理方面的进修培训。有必要为护士提供更多的这种持续的专业发展。

{"title":"Nurses’ knowledge on trauma and emergency care and associated factors in Ghanaian district hospitals","authors":"Akua K Karikari , Adam Gyedu , Isaac Yankson , Dorcas Doefe Amedzake , Peter Agyei-Baffour , Anthony K Edusei , Peter Donkor , Charles Mock","doi":"10.1016/j.afjem.2025.04.004","DOIUrl":"10.1016/j.afjem.2025.04.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Nurses’ knowledge of emergency care is a vital component of emergency capabilities. We sought to evaluate the factors that influence the knowledge on trauma and emergency care of nurses in district hospitals in Ghana.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, we administered a questionnaire on emergency care to 406 nurses working in 11 (out of 37) randomly-selected district hospitals in the Ashanti Region. This included 10 multiple-choice questions on trauma care and 10 on general medical/surgical emergency care to objectively assess knowledge on emergency care. Analysis involved descriptive statistics, inferential tests comparing tests scores with Student’s <em>t</em>-tests and ANOVA, and multivariable linear regression.</div></div><div><h3>Results</h3><div>Mean overall test score for knowledge was 60.1 % correct (SD 13.7 %). Results were tightly clustered with an inter-quartile range of 50 % to 70 %. Factors influencing the test scores on multivariable linear regression included: (a) gender (male nurses scored an adjusted 3.8 % higher than female nurses, <em>p</em> = 0.015; beta=3.8; 95 %CI 0.7–6.8); and (b) refresher training (nurses who had received refresher training on emergency care scored an adjusted 3.3 % higher than those who had not received such training, <em>p</em> = 0.018; beta=3.3; CI 0.6–6.0). The higher overall scores for male nurses were due solely to higher scores on trauma-related questions. Male nurses scored an average of an adjusted 5.1 % higher on the trauma questions (<em>p</em> = 0.023; beta=5.1; CI 0.7–9.5) than female nurses, but their scores on general emergency care were not significantly different.</div></div><div><h3>Conclusions</h3><div>Test scores for knowledge on emergency care for nurses working in Ghanaian district hospitals were generally adequate. While gender did influence test scores, the main actionable factor associated with higher test scores was having received refresher training in emergency care. There is a need for greater availability of such continuing professional development for nurses.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100876"},"PeriodicalIF":1.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239989","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

Characteristics and outcomes of geriatric injuries presenting to an urban emergency department in Ghana 加纳城市急诊科老年损伤的特点和结果

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-06-10 DOI: 10.1016/j.afjem.2025.05.007

Hussein A Yakubu , Jonathan Boakye-Yiadom , Richmond O Marfo , Rockefeller Oteng , George Oduro

Introduction

The elderly population is rapidly increasing in sub-Saharan Africa. Yet, their trauma care needs are often overlooked, and the epidemiology of their injuries remains poorly understood. This study aimed to describe the characteristics and outcomes of injuries in elderly patients treated at an urban emergency department (ED) in Ghana. Additionally, it aimed to identify the predictors of mortality that require focused attention.

Methods

A prospective cross-sectional survey of patients ≥ 60 years presenting with traumatic injuries between November 2021 and March 2022 was conducted at the ED of Komfo Anokye Teaching Hospital (KATH), Ghana’s second-largest hospital. Eligible patients were identified upon arrival in triage. Following initial resuscitation, trained research assistants obtained informed consent and collected patient data, including sociodemographic information, comorbidities, injury characteristics, and in-patient complications.

Results

Of the 2242 ED patients evaluated, 101 (4.7 %) were included. The median age was 69 years and sex distribution was even. Hypertension (48.5 %) was the most prevalent comorbidity. Falls (52.5 %) and motor vehicle collisions (40.6 %) were the predominant injury mechanisms, and isolated lower extremity injuries (39.6 %) were the most common. The majority of injuries were mild (65.4 % had an Injury Severity Score < 9). Venous thromboembolism was the most common in-patient complication. Median length of stay was 6 days, but patients with complications stayed longer. The overall hospital mortality rate was 11.9 %. Predictors of mortality were triage score, admission Glasgow Coma Score, admission pulse rate and Kampala Trauma Score.

Conclusion

Geriatric injuries constitute a small fraction of trauma admissions in this hospital. Triage score, Glasgow Coma Scale, pulse rate and Kampala Trauma Score predicted mortality and could form the basis for a simple screening protocol in low-resource EDs.

在撒哈拉以南非洲地区，老年人口正在迅速增加。然而，他们的创伤护理需求往往被忽视，他们受伤的流行病学仍然知之甚少。本研究旨在描述在加纳城市急诊科（ED）治疗的老年患者损伤的特征和结果。此外，它还旨在确定需要重点关注的死亡率预测因素。方法在加纳第二大医院Komfo Anokye教学医院（KATH）的急诊科对2021年11月至2022年3月期间出现创伤性损伤的≥60岁患者进行前瞻性横断面调查。符合条件的患者在到达后进行分诊。初步复苏后，训练有素的研究助理获得知情同意并收集患者数据，包括社会人口统计信息、合并症、损伤特征和住院并发症。结果在2242例ED患者中，101例（4.7%）入选。年龄中位数为69岁，性别分布均匀。高血压（48.5%）是最常见的合并症。跌倒（52.5%）和机动车碰撞（40.6%）是主要的损伤机制，孤立性下肢损伤（39.6%）最为常见。大多数损伤是轻微的(65.4%有损伤严重程度评分<；9)。静脉血栓栓塞是最常见的住院并发症。中位住院时间为6天，但有并发症的患者住院时间更长。医院总死亡率为11.9%。死亡率预测因子为分诊评分、入院格拉斯哥昏迷评分、入院脉搏率和坎帕拉创伤评分。结论老年损伤在本院创伤住院患者中只占一小部分。分诊评分、格拉斯哥昏迷量表、脉搏率和坎帕拉创伤评分可预测死亡率，并可构成低资源急诊科简单筛查方案的基础。

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引用次数: 0

Differences in quality indicators of emergency care between on- and off-hours at Ghanaian district hospitals 加纳地区医院工作时间和非工作时间急诊质量指标的差异

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-06-03 DOI: 10.1016/j.afjem.2025.05.004

Paa Forson , Richard Owusu , George Oduro , Peter Donkor , Charles Mock

Introduction

Quality of off-hours care (nights, weekends) for many emergency conditions frequently proves inadequate. Most studies on this topic are from high-income countries. Given existing resource restrictions in low- and middle-income countries, it is especially relevant to know how care is impacted during off-hours, when resources are usually less. We assessed differences in quality indicators of emergency care between on- and off-hours at two district hospitals.

Methods

In this prospective cohort study conducted from June 2021 to May 2023, patients presenting to the emergency unit between 8 AM and 8 PM on weekdays were categorized as presenting during on-hours. Those presenting between 8 PM and 8 AM or anytime on weekends were considered off-hours. Completion of 16 quality indicators was compared between patients who received care during on- and off-hours.

Results

Data were gathered on 7831 patients: 5019 (64.1 %) presenting during on-hours and 2812 (35.9 %) during off-hours. Overall achievement of quality indicators ranged from 27.1 % (recording GCS) to 98.3 % (documentation of diagnosis). Twelve indicators were performed in <80 % of patients. Four indicators were performed more often during on-hours: primary survey for trauma patients; blood glucose; documentation of diagnosis; and Glasgow Coma Scale. Three indicators were performed more often during off-hours: splinting of long-bone fractures; analgesics given to patients reporting pain; and recording of complete initial vital signs. Although there were significant differences in seven indicators, differences were small (<10 %) in six.

Conclusion

There were limited differences in performance of quality indicators between on- and off-hours, indicating a general consistency of quality of care across daily and weekly cycles. However, most indicators were performed in <80 % of patients. Monitoring of quality indicators of emergency care should be done more consistently as a way to standardise care and improve patient outcomes.

许多紧急情况的非工作时间（夜间、周末）护理质量往往不足。关于这一主题的大多数研究都来自高收入国家。鉴于低收入和中等收入国家现有的资源限制，了解资源通常较少的非工作时间对护理的影响尤为重要。我们评估了两个地区医院在工作时间和非工作时间之间急诊护理质量指标的差异。方法在2021年6月至2023年5月进行的这项前瞻性队列研究中，在工作日上午8点至晚上8点到急诊室就诊的患者被归类为在上班时间就诊。那些在晚上8点到早上8点之间或周末任何时候出席会议的人都被认为是非工作时间。16项质量指标的完成情况比较了在上班时间和下班时间接受治疗的患者。结果7831例患者的数据：5019例（64.1%）在上班时间就诊，2812例（35.9%）在下班时间就诊。总体质量指标的实现范围从27.1%（记录GCS）到98.3%（诊断文件）。80%的患者进行了12项指标的检查。四项指标在非工作时间更常被执行：对创伤患者的初步调查；血糖;诊断文件；和格拉斯哥昏迷量表。有三项指标在非工作时间更常做：长骨骨折夹板；对报告疼痛的患者给予镇痛药；并记录完整的初始生命体征。虽然在7个指标上存在显著差异，但在6个指标上差异很小（< 10%）。结论上班时间和下班时间的质量指标表现差异有限，表明每日和每周周期的护理质量总体上是一致的。然而，80%的患者执行了大多数指标。应更加一致地监测急诊护理的质量指标，以此作为标准化护理和改善患者预后的一种方式。

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引用次数: 0

Perceptions, availability and use of vasopressors for septic shock in emergency care settings in Tanzania 在坦桑尼亚的紧急护理环境中，对感染性休克血管加压药的认识、可得性和使用

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-06-02 DOI: 10.1016/j.afjem.2025.05.003

Said Kilindimo , Forrest Turner , Raya Musa , Collin Russell , Adeline Dozois , Hendry Sawe

Background

Sepsis carries a disproportionately high mortality in Sub-Saharan Africa. Current international guidelines for management of septic shock advocate for initial fluid resuscitation followed by vasopressors if there is ongoing concern for hypoperfusion. Emerging data suggest patients in sub-Saharan Africa who receives large fluid boluses may have increased mortality and thus earlier initiation of vasopressors may have clinical benefit. Little data exists on the perceptions, availability and use of vasopressors in Tanzania, which may impact the feasibility of this strategy. We aimed to describe the perception, availability and use of vasopressor in Tanzanian emergency care settings, including its barriers.

Methods

We conducted a cross-sectional web-based survey among clinicians and nurses from 19 different hospitals throughout Tanzania (national, zonal, regional and district hospitals). Collected data was kept by the principal investigator on a password encrypted computer whereby descriptive statistics were used to summarize the results.

Results

Sixty-five healthcare providers completed the survey of whom the majority 53 (81.5 %), work in the emergency medicine department and 50 (76.9 %) reported treating at least one patient with septic shock per week. However, three quarters of respondents from district hospitals and nearly half of those from regional hospitals had access to vasopressors in <50 % of the time. The most common reported barriers to vasopressor use were lack of availability (50.8 %), and lack of comfort or knowledge (43.1 %). Overall, most respondents perceived that vasopressor use is generally safe and helpful for treating septic shock.

Conclusions

Nearly all Tanzanian healthcare providers in emergency care settings reported that they had limited access to vasopressors to treat septic shock, as it was not consistently available. In addition to unavailability, lack of knowledge on vasopressor use was also reported as barrier. Our findings suggest that ensuring availability of vasopressors and education in the use thereof would improve sepsis care in Tanzanian hospitals.

在撒哈拉以南非洲，败血症的死亡率高得不成比例。目前的国际感染性休克管理指南主张，如果持续担心灌注不足，应进行初始液体复苏，然后使用血管加压剂。新出现的数据表明，撒哈拉以南非洲接受大剂量液体治疗的患者死亡率可能增加，因此早期开始使用血管加压药物可能具有临床益处。关于坦桑尼亚血管加压剂的认知、可得性和使用情况的数据很少，这可能会影响这一战略的可行性。我们的目的是描述感知，可用性和使用血管加压药在坦桑尼亚的紧急护理设置，包括其障碍。方法我们对坦桑尼亚19家不同医院（国家、地区、区域和区级医院）的临床医生和护士进行了一项基于网络的横断面调查。收集的数据由首席研究员保存在密码加密的计算机上，并使用描述性统计来总结结果。结果65名医护人员完成了调查，其中53名（81.5%）在急诊科工作，50名（76.9%）报告每周至少治疗1例脓毒性休克患者。然而，四分之三来自地区医院的应答者和近一半来自区域医院的应答者在50%的时间内获得血管加压药。最常见的使用血管加压素的障碍是缺乏可用性（50.8%），以及缺乏舒适性或知识（43.1%）。总的来说，大多数应答者认为血管加压素的使用通常是安全的，有助于治疗感染性休克。结论：几乎所有坦桑尼亚紧急护理机构的医疗服务提供者都报告说，他们使用血管加压剂治疗感染性休克的机会有限，因为这种药物并不总是可用的。除了无法获得外，缺乏血管加压素使用知识也被报道为障碍。我们的研究结果表明，确保血管加压药的可用性和使用血管加压药的教育将改善坦桑尼亚医院的败血症护理。

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引用次数: 0

Time delays in emergency stroke care in a low-resource referral hospital in Ghana 加纳一家资源匮乏的转诊医院的紧急中风护理时间延误

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-06-02 DOI: 10.1016/j.afjem.2025.05.006

Hussein A Yakubu , Richmond O Marfo , Jonathan Boakye-Yiadom , Freda M Aidoo , Fred S Sarfo , Rockefeller A Oteng

Background

Patients in sub-Saharan Africa face significant delays in receiving appropriate stroke care, which negatively impacts outcomes. This study aimed to quantify the time delays in acute stroke care at the Komfo Anokye Teaching Hospital (KATH) and determine the effect on mortality.

Methods

This was a secondary analysis of prospectively collected data on patients ≥ 18 years with Computed Tomography (CT) scan-confirmed stroke treated at KATH’s adult emergency department (ED) from November 2021 to March 2022. Patients were initially enrolled in a pilot stroke registry by trained research assistants, who documented relevant time points in their care. Patient outcome (dead or alive) was determined at time of hospital discharge and three months post-discharge. Data was analyzed using STATA™ version 16. The median times from stroke onset to ED arrival, physician evaluation, CT scan imaging, and treatment were measured and the relationship with mortality determined.

Results

Eighty-six patients with confirmed stroke were analyzed, comprising 40 males and 46 females. Ages ranged between 29 and 86 years, with mean of 57.4 years (SD 14.3). The median time from stroke onset to arrival at KATH ED was 35.3 h (IQR: 12.3–79.5). The median time from ED arrival to first physician evaluation was 1.3 h (IQR: 0.5–2.6); to CT imaging was 14.1 h (IQR: 4.3–40.8); and to antiplatelet treatment (for ischemic stroke) was 31.1 h (IQR: 16.1–42.5). The cumulative mortality rates at three months post-discharge were 8.7 % for patients who arrived at KATH’s ED within 4 h of symptom onset, 43.5 % for those arriving between 4 and 24 h, and 47.8 % for those arriving after 24 h, p = 0.036.

Conclusion

Significant delays occurred in all stages of stroke care at KATH’s ED. Improving stroke education and implementing contextually appropriate stroke codes can enable early patient presentations, improve intervention times, and reduce mortality rates.

撒哈拉以南非洲地区的患者在接受适当的卒中治疗方面面临严重延误，这对治疗结果产生了负面影响。本研究旨在量化Komfo Anokye教学医院（KATH）急性卒中护理的时间延迟，并确定其对死亡率的影响。方法：本研究是对2021年11月至2022年3月期间在KATH成人急诊科（ED）接受计算机断层扫描（CT）确诊卒中治疗的≥18岁患者的前瞻性数据进行二次分析。患者最初由训练有素的研究助理在卒中试点登记处登记，并记录其护理的相关时间点。患者预后（死亡或存活）在出院时和出院后3个月确定。使用STATA™版本16分析数据。测量了从中风发作到ED到达、医生评估、CT扫描成像和治疗的中位时间，并确定了与死亡率的关系。结果本组共分析确诊脑卒中患者86例，其中男性40例，女性46例。年龄29 ~ 86岁，平均57.4岁（SD 14.3）。从卒中发作到到达KATH ED的中位时间为35.3 h （IQR: 12.3-79.5）。从急诊科到达到首次医生评估的中位时间为1.3 h (IQR: 0.5-2.6)；到CT成像14.1 h (IQR: 4.3 ~ 40.8)；抗血小板治疗（缺血性卒中）为31.1 h （IQR: 16.1-42.5）。在症状出现后4小时内到达KATH急诊科的患者，出院后3个月的累积死亡率为8.7%，4 - 24小时到达的患者为43.5%，24小时后到达的患者为47.8%,p = 0.036。结论：KATH急诊科卒中治疗的所有阶段都出现了明显的延迟。改善卒中教育和实施情境适当的卒中编码可以使患者早期就诊，缩短干预时间，降低死亡率。

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引用次数: 0

Presentation and management of snakebite envenomation at a District Hospital in the north-east of South Africa 南非东北部地区医院毒蛇咬伤中毒的表现和处理

IF 1.4 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-05-29 DOI: 10.1016/j.afjem.2025.05.002

Matamba Jean Benoit Kabeya , Darryl Wood , Peter Hodkinson

Background

Snakebites have been recognised as a neglected tropical disease by the World Health Organization and remain a potentially preventable cause of morbidity around the world, particularly in Africa. South Africa (SA) has a well-documented prevalence of snakebites, and there has been a recent surge in attention on snakebite due to dwindling antivenom stocks. uMkhanyakude District in the far northeast of SA has one of the highest incidences of snakebite and uses more antivenom than elsewhere in SA, and the impact of antivenom shortages and the high prevalence of disease has not been assessed recently.

Methods

A descriptive, retrospective, observational study was undertaken to describe victims of snakebites presenting from 1 September 2019 to 31 August 2022 to a district hospital, Mosvold Hospital. Data were manually extracted from patients’ medical records. Information about demographics, clinical presentations, treatments and outcomes was collected and analysed.

Results

A total of 155 snakebite cases presented, with an incidence rate of 58 snakebite cases per 100 000 people per year. Most patients were young, with a median age of 19 years (range 0–94 years), and most bites occurred outdoors (75/155, 48.4 %). Patients were most often bitten on the lower limbs (107/155, 69.0 %), and most presented with minimal swelling (117/155, 75.5 %). Antivenom was administered to 33 patients (33/155, 21.3 %), and 24 (24/33, 72.7 %) of those who received antivenom experienced some form of post-antivenom reaction. Three patients died during their hospital stay, resulting in a mortality rate of 1.2 deaths per 100 000 people per year. Antivenom shortages contributed to the outcomes of several patients.

Conclusion

Cytotoxic snakebites are a not infrequent presentation, many requiring admission, antivenom and subsequent management. Emergency personnel need to be familiar with local protocols for snakebite management, and have the resources to manage severe envenomation, including access to antivenom. Expanding knowledge and education about snakebites provided to community members might also improve outcomes and prevent bites.

蛇咬伤已被世界卫生组织认定为一种被忽视的热带疾病，并且仍然是世界各地，特别是非洲的一种潜在可预防的发病原因。南非（SA）有充分的证据表明蛇咬伤的流行，由于抗蛇毒血清库存的减少，最近对蛇咬伤的关注激增。南非最东北部的uMkhanyakude地区是蛇咬伤发生率最高的地区之一，使用的抗蛇毒血清比南非其他地方更多，抗蛇毒血清短缺和疾病高流行率的影响最近尚未得到评估。方法对2019年9月1日至2022年8月31日在莫斯沃尔德医院某地区医院就诊的蛇咬伤患者进行描述性、回顾性、观察性研究。数据是手动从患者的医疗记录中提取的。收集和分析了有关人口统计学、临床表现、治疗和结果的信息。结果全年共报告蛇咬伤病例155例，每10万人年蛇咬伤发生率为58例。大多数患者为年轻人，中位年龄19岁（范围0-94岁），大多数咬伤发生在室外（75/155,48.4%）。患者最常被咬伤的部位为下肢（107/155,69.0%），最常出现轻微肿胀（117/155,75.5%）。33例患者（33/155,21.3%）接受抗蛇毒血清治疗，24例患者（24/33,72.7%）出现某种形式的抗蛇毒血清后反应。3名患者在住院期间死亡，导致每年每10万人中有1.2人死亡。抗蛇毒血清的短缺导致了一些患者的结果。结论细胞毒性蛇咬伤是一种常见的疾病，多数需要住院治疗、抗蛇毒血清和后续治疗。急救人员需要熟悉当地的蛇咬伤管理方案，并拥有管理严重中毒的资源，包括获得抗蛇毒血清。向社区成员提供有关蛇咬伤的知识和教育，也可能改善结果并预防咬伤。

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引用次数: 0