EMF4 Characterization of Emergency Presentations at Regional Referral Hospital in a Low-Income Country

Emergency care remains largely underdeveloped and underfunded in low-income countries. There is little information about the epidemiology of emergency presentations in these countries, which leaves educators and policy makers with little guidance when developing educational programs and allocating resources toward emergency care. Furthermore, lack of pre-intervention outcome data complicates assessment of the impact that newly introduced emergency care programs have on important patient oriented outcomes. This study documents the epidemiology and outcome of patients with emergent illnesses and injuries at a Ugandan Regional Referral Hospital. This was a prospective cohort of acutely ill and injured patients presenting for care between November 1, 2014 and February 28, 2015 at Masaka Regional Referral Hospital in central Uganda. A database of emergent patient visits was created and data was collected on all patients presenting to the hospital emergency department and on all patients under twelve years of age who reported to the out-patient clinic. A standardized protocol that had previously been developed in Uganda was used to follow-up all patients three days after their index visit. Patients who remained in the hospital three days after presentation were followed up on the ward. Those who were discharged initially or were discharged from ward before the third day had follow-up attempted via phone call. A total of 8,549 patient presentations occurred during the study period, of which 4,554 were triaged to the emergency department (ED). Of patients triaged to the ED 18.5% were under 5 years, 14.3% were between 5-18, and 7.9% were over 65 years old. Fifty patients (0.6%) either expired in the ED or were dead on arrival. Providers tested 25.8% of ED patients for malaria (5.5% were positive). Less than 1% of all patients were tested for HIV. Trauma accounted for 22.9% of all ED visits and 63.6% of traumatic deaths (21 of 33) occurred in the ED. Three-day mortality for the ED cohort was 3.5% for all patients and 3.2% for trauma patients. Three-day mortality for children under five was 3.1%. Three-day follow-up rates improved from 53.8% to 72.8% over the first four months of the program. This regional referral hospital emergently manages a mixture of communicable and non-communicable diseases. There is a very high acuity as evidenced by in-ED mortality rate and three-day mortality rate, but overall mortality rate was lower than expected. Using a standardized protocol allowed for three-day follow-up in approximately 70% of patients over the study period.