Epidemiology of patients presenting to the emergency centre of Princess Marina Hospital in Gaborone, Botswana

Chandra, Amit; Mullan, Paul C.; Ho-Foster, Ari; Langeveldt, Antanoid; Motsumi, Mpapho Joseph; Kestler, Andrew

doi:10.1016/j.afjem.2013.12.004

Cited by 27 publications

(32 citation statements)

References 5 publications

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“…In addition, data fields were occasionally left incomplete by triage nurses, resulting in missing data. We believe the effect of this missing data to be minimal, particularly since the results were consistent with the results of similar prior studies [9] , [36] , [37] , [38] , [39] , [40] , [48] . Additionally, EC data were collected during the month of August 2014, possibly resulting in missed seasonal variations in trauma.…”

Section: Discussionsupporting

confidence: 88%

“…This South African district hospital EC, with a small complement of non-EM trained physicians and no trauma surgical services, cared for a relatively high absolute number of trauma (565 total) cases in one month. By comparison, several tertiary centres serving much larger urban areas in Malawi, Botswana, Kenya, Rwanda, and Zambia are reported to care for smaller monthly number of trauma cases [9] , [36] , [37] , [38] , [39] , [40] . Wesfleur Hospital was the only major health facility serving a population of about one-quarter million people, which may explain the relatively high absolute monthly case load of trauma.…”

Section: Discussionmentioning

confidence: 97%

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The burden of trauma at a district hospital in the Western Cape Province of South Africa

Zaidi

Dixon

Lupez

et al. 2019

African Journal of Emergency Medicine

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Background Sub-Saharan Africa bears a disproportionate burden of mortality from trauma. District hospitals, although not trauma centres, play a critical role in the trauma care system by serving as frontline hospitals. However, the clinical characteristics of patients receiving trauma care in African district hospitals remains under-described and is a barrier to trauma care system development. We aim to describe the burden of trauma at district hospitals by analysing trauma patients at a prototypical district hospital emergency centre. Methods An observational study was conducted in August, 2014 at Wesfleur Hospital, a district facility in the Western Cape Province of South Africa. Data were manually collected from a paper registry for all patients visiting the emergency centre. Patients with trauma were selected for further analysis. Results Of 3299 total cases, 565 (17.1%) presented with trauma, of which 348 (61.6%) were male. Of the trauma patients, 256 (47.6%) were ages 18–34 and 298 (52.7%) presented on the weekend. Intentional injuries (assault, stab wounds, and gunshot wounds) represented 251 (44.4%) cases of trauma. There were 314 (55.6%) cases of injuries that were unintentional, including road traffic injuries. There were 144 (60%) intentionally injured patients that arrived overnight (7pm–7am). Patients with intentional injuries were three times more likely to be transferred (to higher levels of care) or admitted than patients with unintentional injuries. Conclusion This district hospital emergency centre, with a small complement of non-EM trained physicians and no trauma surgical services, cared for a high volume of trauma with over half presenting on weekends and overnight when personnel are limited. The high volume and rate of admission/ transfer of intentional injuries suggests the need for improving prehospital trauma triage and trauma referrals. The results suggest strengthening trauma care systems at and around this resource-limited district hospital in South Africa may help alleviate the high burden of post-trauma morbidity and mortality.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 97%

The burden of trauma at a district hospital in the Western Cape Province of South Africa

Zaidi

Dixon

Lupez

et al. 2019

African Journal of Emergency Medicine

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“…First, despite a low number of deaths in the short term, a high percentage of patients were admitted (60.5%). Comparable studies in other low- and middle-income countries, report about 40% admissions 16 . Identifying patients who can be safely discharged would substantially reduce unnecessary admissions and, therefore, health-care costs.…”

Section: Discussionmentioning

confidence: 99%

An observational study of adults seeking emergency care in Cambodia

Yan

Mahadevan

Yore

et al. 2014

Bull. World Health Organ.

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ObjectiveTo describe the characteristics and chief complaints of adults seeking emergency care at two Cambodian provincial referral hospitals.MethodsAdults aged 18 years or older who presented without an appointment at two public referral hospitals were enrolled in an observational study. Clinical and demographic data were collected and factors associated with hospital admission were identified. Patients were followed up 48 hours and 14 days after presentation.FindingsIn total, 1295 hospital presentations were documented. We were able to follow up 85% (1098) of patients at 48 hours and 77% (993) at 14 days. The patients’ mean age was 42 years and 64% (823) were females. Most arrived by motorbike (722) or taxi or tuk-tuk (312). Most common chief complaints were abdominal pain (36%; 468), respiratory problems (15%; 196) and headache (13%; 174). Of the 1050 patients with recorded vital signs, 280 had abnormal values, excluding temperature, on arrival. Performed diagnostic tests were recorded for 539 patients: 1.2% (15) of patients had electrocardiography and 14% (175) had diagnostic imaging. Subsequently, 783 (60%) patients were admitted and 166 of these underwent surgery. Significant predictors of admission included symptom onset within 3 days before presentation, abnormal vital signs and fever. By 14-day follow-up, 3.9% (39/993) of patients had died and 19% (192/993) remained functionally impaired.ConclusionIn emergency admissions in two public hospitals in Cambodia, there is high admission-to-death ratio and limited application of diagnostic techniques. We identified ways to improve procedures, including better documentation of vital signs and increased use of diagnostic techniques.

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“…3,4 Six EM registrars sat the CMSA primary EM examination in the 2011-2012 and were all successful, increasing morale and expanding the vision for EM and UB. As lecturers in EM they also worked clinically in the EM department of Princess Marina Hospital (PMH), the main referral and teaching hospital for Botswana.…”

Section: Early Em Developmentmentioning

confidence: 99%

“…EM research and projects in areas such as pre-hospital medicine, ultrasound and triage occurred, adding to the EM culture. 3,4 Six EM registrars sat the CMSA primary EM examination in the 2011-2012 and were all successful, increasing morale and expanding the vision for EM and UB.…”

Section: Early Em Developmentmentioning

confidence: 99%

ACEM involvement in a successful African emergency medicine programme

Cox

2018

Emerg Medicine Australasia

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In the past 5 years Botswana graduated its first home‐grown doctors and emergency medicine specialists for the country. The postgraduate emergency medicine specialist training arrangement between Botswana and South Africa was challenging in development, implementation and maintenance. Numerous varied supports from ACEM and its International Emergency Medicine Network were integral to these successes. This article encourages further investment of ACEM grants and scholarships in Africa by describing how ACEM supported significant advances in Botswana emergency medicine.

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Epidemiology of patients presenting to the emergency centre of Princess Marina Hospital in Gaborone, Botswana

Cited by 27 publications

References 5 publications

The burden of trauma at a district hospital in the Western Cape Province of South Africa

The burden of trauma at a district hospital in the Western Cape Province of South Africa

An observational study of adults seeking emergency care in Cambodia

ACEM involvement in a successful African emergency medicine programme

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