A two-year review of adult emergency department mortality at Tikur Anbesa specialized tertiary hospital, Addis Ababa, Ethiopia

Abstract

Background Adult emergency department mortality remains high in resource-limited lower-income countries. The majority of deaths occur within the first 24 h of presentation to the emergency department. Many of these mortality’s can be alleviated with appropriate interventions. This study was aimed to assess the magnitude, cause, and factors related to very early mortality in patients presented to the emergency department of Tikur Anbesa Specialized Tertiary Hospital, Ethiopia from March 2018 to 2020. Methods This is a cross-sectional retrospective chart review. Retrospective data were collected from the records of all patients who died within 72 h of emergency department presentation from March 2018 to 2020. Data entered using Epi data 4.2.1 and analyzed using SPSS Version 23. Using the Chi-square test, binary and multiple logistic regression analysis were carried out to measure the association of variables of interest and very early emergency mortality. P-value < 0.05, odds ratio with 95% CI were used to identify the significant factors. Results Between March 2018 to 2020, 30,086 patients visited the ED and 604 patients died within 72 h of presentation (274 died within 24 h and 232 within > 24–72 h). Shock (36.7%) and road traffic accidents (3.16%) were the major causes of death. Triage category red AOR 0.23 95% CI 0.1–0.55 and duration of illness 4–24 h AOR 0.47 95% CI 0.26–0.87 were significantly associated with decreased very early emergency department mortality. Meanwhile, co-morbid disease HIV AIDS AOR 2.72 95% CI 1.01–7.30 and residence Addis Ababa AOR 2.78 95% CI 1.36–5.68 and Oromia AOR 3.23 95% CI 1.58–6.54 were found significantly associated with increased very early emergency department mortality. Conclusions and recommendations The mortality burden of a road traffic accident and shock in the TASTH is significant and the magnitude of ED mortality differs between these groups. Residence Addis Ababa and Oromia, triage category red, co-morbid disease HIV AIDS, and duration of symptom 4–24 h were significantly associated with early emergency department mortality. Early detection and intervention are required to minimize emergency mortality.

Current patterns of care at adult emergency department in Ethiopian tertiary university hospital

“…However, the mortality rate in our ED was higher compared to those found in high-income countries 0.1% in France [ 8 ]. We also found that males had relatively higher mortality rate than females at the ED (ratio = 1.2:1) and it is supported by multiple previous studies (1.2:1 [ 11 ]; 1.4:1 [ 13 ]; 1.3:1 [ 10 ]; 1.3:1 [ 12 ]). This could be due to higher exposure of males to situations that might lead to emergency conditions such as trauma [ 13 ].…”

“…This mortality rate is comparable to previously reported rates in low- and middle-income countries [ 10 , 13 ]. However, higher mortality rates were also reported by previous studies which counted death on arrival as an ED death [ 11 , 12 ]. In our study, we included only patients who had signs of life during arrival at the ED and died later.…”

“…Pneumonia with/without COVID-19 was the leading cause of death (15.5%) followed by poisoning and different types of shock. Respiratory diseases are regularly mentioned as one of the commonest causes of ED death, predominantly during the current ongoing COVID-19 pandemic era [ 11 – 13 , 15 , 28 , 29 ]. We even expect more undetected pneumonia with COVID-19 mortality as our resource-limited setup in a low-income country had very low screening capacity.…”

“…Most of the ED deaths occur in low- and middle-income countries in which ED deaths occur over 5% higher rates compared to high-income countries [ 9 , 10 ]. Previous studies in low-income settings have identified cardiovascular diseases, trauma, shock, respiratory diseases, and cancer as the leading causes of death in the ED [ 11 – 13 ].…”

Clinical profile and predictors of renal failure in emergency department patients at a tertiary level hospital, a cross sectional study

“…In contrast, it could also be that the Tanzanian cohort of ED patients spent less time in the ED compared to those in this study seeing as to how the mortality rate rose to 14 times the initial for the overall study after leaving the ED [2] . Mortality in ED has been reported to be at least five times higher in SSA [19] and patient delays in the ED and suboptimal infrastructure contribute to high mortality…”