Abstract
Background & Objective:Understanding the demographics of mortality and its burden in the emergency department of a tertiary care setup can lead to better planning and allocation of resources to streamline process flow. This can be achieved systematically through mortality audit that can identify the loopholes and areas of improvement. Our objective was to characterize the epidemiology of ED mortality in a tertiary care hospital of Karachi, Pakistan.Methods:A five-year retrospective chart review of 322 adult mortalities presenting between January l, 2014 – December 31, 2018 was conducted in the emergency department (ED) of The Indus Hospital (TIH), Karachi. All expiries in ED were included while those brought dead and with do not resuscitate order (DNAR) were excluded.Results:Mortality incidence of 0.076% (7.6/10,000 ED visits in five years) was reported. Amongst 507,759 adult ED visits, 322 mortalities were documented. Mean time lapse before presentation was 44±147 hours and mean length of stay before death was 3.4±2.8 hours. Acute coronary syndrome (ACS) was the predominant cause of death with 109 (33.8%) expiries. Significant association was reported between no history of prior care and high priority (P1) cases (p=0.013).Conclusions:This study identified the contributing factors to adverse outcome such as delayed presentation with systemic gaps in management and unknown disposition. The need to improve these factors at local and national level can lead to improvement in Pakistani healthcare sector.
Highlights
The role of emergency medicine is to provide care to patients with acute and unexpected fatal illnesses.[1,2,3,4,5,6] emergency department (ED) mortality is a reflection of healthcare and mortality rates of 0.77/1000 have been reported in USA.[2]
The The Indus Hospital (TIH) ED treated 507,759 (71.8%) patients, of which 18,953 (3.7%) were admitted in wards. 291,209 patients (57.4%) were successfully discharged from ED and 29,776 (5.9%) patients left against medical advice (LAMA) or were discharged on request (DOR)
At TIH, Karachi we reported an ED mortality rate of 0.076% (7.6 per 10,000 visits in five years)
Summary
The role of emergency medicine is to provide care to patients with acute and unexpected fatal illnesses.[1,2,3,4,5,6] ED mortality is a reflection of healthcare and mortality rates of 0.77/1000 have been reported in USA.[2]. Pak J Med Sci May - June 2021 Vol 37 No 3 www.pjms.org.pk 633 the need to strengthen emergency care capacity of health systems in low and middle income countries (LMIC).[7] In 2015, 28.3 million deaths globally were attributed to emergency cases. This burden is 4.4 times higher in LMICs but may be reduced by upgrading access to emergency care.[8,9] Emergency medicine has been under-prioritized and is an emerging field in Pakistan with the potential to expend.[5,6]. The need to improve these factors at local and national level can lead to improvement in Pakistani healthcare sector
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