Estimation of the burden of out-of-hospital traumatic cardiac arrest in Karachi, Pakistan, using a cross-sectional capture-recapture analysis

Minaz Mawani,Junaid Abdul Razzak,Zainab Samad,Muhammad Masood Kadir,Iqbal Azam

doi:10.1186/s12245-020-00283-z

Abstract

BackgroundThe burden of trauma-related-out-of-hospital cardiac arrest (OHCA) in developing countries like Pakistan remains largely unexplored due to a lack of organized pre-hospital systems. In order to estimate the burden, we used a two-sample capture-recapture method which has been used in several domains to estimate difficult-to-count populations.MethodsWe obtained 3-month data from two sources: Records of two major EMS (emergency medical services) systems and five major hospitals providing coverage to the city’s population. All adults with traumatic OHCA were included. Information on variables such as name, age, gender, date and time of arrest, cause of arrest, and destination hospital were obtained for these cases and data were compared to obtain a matched sample. Utilizing an equation and different levels of restrictive criteria, estimates were obtained for burden.ResultsThe EMS records reported 788 and hospital records reported 344 cases of traumatic OHCA. The capture-recapture analysis estimated the annual traumatic OHCA incidence as 45.7/100,000 (95% CI: 44.2 to 47.3). Estimation of the burden from individual hospital or EMS records underestimated and calculated only 14.6% and 33.9% of the total burden, respectively. Most of the traumatic arrest victims had gunshot wound (GSW) (65.2%) followed by road traffic injuries (RTI) (20.8%).ConclusionThe actual burden of traumatic OHCA in Pakistan is larger than the burden reported by either the hospitals or EMS services alone. Most of the cases occurred due to GSW and RTI. A multipronged approach is required to manage the problem; from prevention to developing organized trauma care systems and training lay responders in pre-hospital trauma care is vital.

Highlights

The burden of trauma-related-out-of-hospital cardiac arrest (OHCA) in developing countries like Pakistan remains largely unexplored due to a lack of organized pre-hospital systems
During 3 months’ time period (Jan-April 2013), a total of 788 traumatic out-of-hospital cardiac arrest patients were identified from the two major Emergency medical services (EMS) services and 344 from five major hospitals in Karachi
A higher percentage of RTAs was found from the hospital sample whereas a higher percentage of the gunshot was found in the EMS sample (P < 0.001) (Table 2)

Summary

Introduction

The burden of trauma-related-out-of-hospital cardiac arrest (OHCA) in developing countries like Pakistan remains largely unexplored due to a lack of organized pre-hospital systems. Trauma is the leading cause of death between the ages of one and 44 years [1]. It causes over 5 million deaths each year globally, mostly involving young and productive members of the population [2]. In 2013, nearly 1.4 million people died due to road traffic injuries globally and 88% of these occurred in low- and middle-income countries. An estimated 118558 deaths due to injuries occurred in Pakistan [4]. No data is available on out of hospital traumatic cardiac arrests from low- and lower-middle-income countries

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Conclusion