Management of patients with non-traumatic hypotension presenting at emergency department Muhimbili national hospital

Abstract

Hypotension is associated with high morbidity and mortality among emergency department (ED) patients. The diagnostic workup and management may vary greatly based on suspected aetiology and regional burden of disease. Little is known about ED diagnostic evaluation, treatment, and discharge diagnoses of patients with non-traumatic hypotension in sub-Saharan Africa. This study aims to characterize the diagnostic test utilization, treatment, and final ED diagnosis for patients presenting to the Muhimbili ED with non-traumatic hypotension. A prospective descriptive cohort study was carried out from April to November 2012 at Muhimbili ED. Adult 65 patients with non-traumatic hypotension were enrolled. Data collected included history, physical examination findings, diagnostic testing, and final ED diagnosis. Follow-up data included hospital length of stay, discharge diagnosis, and 24-h and in-hospital mortality. 53 of 65 patients (88%) were referred from other hospitals, and 12 (18%) were self-referred. Mean SBP at arrival was 84 mmHg. 54 (83%) patients had ECGs done, of which 32 (59%) were abnormal. Bedside Ultrasound done in all 65, with 45 (69%) abnormal. 15(23%) received X-rays, abnormal in 11(73%). All patients underwent laboratory work up. Only 20 (38%) of the 53 referred patients received fluids prior to arrival. In the ED 63 patients (97%) received fluids. Mean SBP after intervention was 91 mmHg (median 90 mmHg). The mean hospital stay was 2 days in those who died and 4 days for those who survived to discharge. In 78%, the ED diagnosis matched hospital discharge diagnosis. Overall mortality in this study was 26% (17) patients, with 7 (48%) of these deaths occurring in the first 24 h . The most common diagnostic tests performed in the ED were Ultrasound, ECG, plain X-Rays and bedside bloods. There was a high overall mortality in these patients with almost half within the first 24 h.