Emergency medicine matters: epidemiology of medical pathology and changes in patient outcomes after implementation of a post-graduate training program at a Tertiary Teaching Hospital in Kigali, Rwanda

Katelyn Moretti,Doris Lorette Uwamahoro,Naz Karim,Chantal Uwamahoro,Sonya Naganathan,Menales Nkeshimana,Adam R Aluisio

doi:10.1186/s12245-021-00331-2

Katelyn Moretti, Doris Lorette Uwamahoro + Show 5 more

Open Access

https://doi.org/10.1186/s12245-021-00331-2

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Abstract

BackgroundEmergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years. This study describes the epidemiology of medical emergencies and the impact of formalized emergency care training on patient outcomes for medical conditions in Rwanda.MethodsA retrospective cohort study was performed using a database of randomly sampled patients presenting to the emergency center (EC) at the University Teaching Hospital of Kigali. All patients, > 15 years of age treated for medical emergencies pre- and post-implementation of an Emergency Medicine (EM) residency training program were eligible for inclusion. Patient characteristics and final diagnosis were described by time period (January 2013–September 2013 versus September 2015–June 2016). Univariate chi-squared analysis was performed for diagnoses, EC interventions, and all cause EC and inpatient mortality stratified by time period.ResultsA random sample of 1704 met inclusion with 929 patients in the pre-residency time period and 775 patients in the post-implementation period. Demographics, triage vital signs, and shock index were not different between time periods. Most frequent diagnoses included gastrointestinal, infectious disease, and neurologic pathology. Differences by time period in EC management included antibiotic use (37.2% vs. 42.2%, p = 0.04), vasopressor use (1.9% vs. 0.5%, p = 0.01), IV crystalloid fluid (IVF) use (55.5% vs. 47.6%, p = 0.001) and mean IVF administration (2057 ml vs. 2526 ml, p < 0.001). EC specific mortality fell from 10.0 to 1.4% (p < 0.0001) across time periods.ConclusionsMortality rates fell across top medical diagnoses after implementation of an EM residency program. Changes in resuscitation care may explain, in part, this mortality decrease. This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality.

Highlights

Health initiatives worldwide have historically focused on primary preventative strategies and communicable disease specific interventions [1]
Mortality rates fell across top medical diagnoses after implementation of an emergency medicine (EM) residency program
This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality

Summary

Introduction

Health initiatives worldwide have historically focused on primary preventative strategies and communicable disease specific interventions [1]. In 2019, The World Health Organization recognized the importance of a functional emergency care system and named it “an essential component of quality care, and that millions of deaths and long-term disabilities could be prevented if emergency care services exist and patients reach them in time.” [2]. Clear data from low- and middle-income countries (LMICs) on the impact of quality emergency care is relegated to a specific disease states and the outcomes from systemic integration of emergency care into the healthcare system is overlooked [4]. One barrier highlighted was the underreporting of the burden of acute diseases; medical conditions have been estimated to account for 92% of all disability-adjusted life years across Africa [3]. Emergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years.

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