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Epidemiology and outcomes of critically ill patients in the emergency department of a tertiary teaching hospital in Rwanda
Background The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to Emergency Departments (ED) globally,...
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| Published in: | International journal of emergency medicine 2024-11, Vol.17 (1), p.170-8, Article 170 |
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| container_start_page | 170 |
| container_title | International journal of emergency medicine |
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| creator | Kamunga B., Laurent Gamy Bearnot, Courtney J. Martin, Kyle D. Uwamahoro, Doris L. Cattermole, Giles N. |
| description | Background
The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to Emergency Departments (ED) globally, the aim of this study was to describe the characteristics of critically ill patients, the critical care interventions performed, and the outcomes of critically ill patients presenting to the KUTH ED with the goal of informing future research into the root causes of mortality of critically ill ED patients and of identifying high yield topics for didactic and procedural training.
Methods
A descriptive observational prospective cohort pilot study analyzed all patients ≥15 years who presented to KUTH between April and June 2022 with modified South African Triage Scores of Red with alarm, Red without alarm, and Orange.
Results
Of 320 patients, 66.9% were male and median age was 40 years. Patients were triaged as Orange (65.3%), Red without alarm (22.8%), and Red with alarm (11.9%). Presentations were categorized as: medical emergencies (48.0%), traumatic injury (44.5%), and surgical emergencies (7.6%). Median length of stay was 31 h (IQR 28, 56) and boarding was 23 h (IQR 8, 48). Overall mortality was 12.2% and highest among medical emergencies (16.5%,
p
= 0.048) and increased significantly with triage color: Red with alarm (47.4%), Red without alarm (16.4%), and Orange (4.3%,
p
|
| doi_str_mv | 10.1186/s12245-024-00736-9 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_097e35349edb4e0e85cc8587e584da42</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_097e35349edb4e0e85cc8587e584da42</doaj_id><sourcerecordid>3124248855</sourcerecordid><originalsourceid>FETCH-LOGICAL-c422t-d3256248708df97eea0a709ef798fec9dc0158bf8766a697da3f39c7c884c5383</originalsourceid><addsrcrecordid>eNp9kU2LFDEQhhtRcF39A54Cnlvz2UlOIsu6LiwIoueQSap7MqQ7bZJRxl9vZntR9-IpRarepz7erntN8FtC1PCuEEq56DHlPcaSDb1-0l20hOgJU_jpP_Hz7kUpB4wHwgdy0f26XoOHOaSYphOyi0fpWF2aoaA0IpdDDc7GeEIhRrTaGmCpBYUF1T0gmCFPsLgT8rDaXOeWPMssqpBrsPnUAuv2YZnQPpU1VBvP2i8_WyP7sns22ljg1cN72X37eP316lN_9_nm9urDXe84pbX3jIqBciWx8qOWABZbiTWMUqsRnPYOE6F2o5LDYActvWUj0046pbgTTLHL7nbj-mQPZs1hboOZZIO5_0h5Mm324CIY3PhMMK7B7zhgUMI5JZQEobi3nDbW-421HnczeNcWzjY-gj7OLGFvpvTDECLYoNiZ8OaBkNP3I5RqDumYl3YAwwjlbVElRKuiW5XLqZQM458WBJuz42Zz3DTHzb3jRjcR20SlFS8T5L_o_6h-A3wPsT4</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3124248855</pqid></control><display><type>article</type><title>Epidemiology and outcomes of critically ill patients in the emergency department of a tertiary teaching hospital in Rwanda</title><source>Publicly Available Content Database</source><source>Springer Nature - SpringerLink Journals - Fully Open Access </source><source>PubMed Central</source><creator>Kamunga B., Laurent Gamy ; Bearnot, Courtney J. ; Martin, Kyle D. ; Uwamahoro, Doris L. ; Cattermole, Giles N.</creator><creatorcontrib>Kamunga B., Laurent Gamy ; Bearnot, Courtney J. ; Martin, Kyle D. ; Uwamahoro, Doris L. ; Cattermole, Giles N.</creatorcontrib><description>Background
The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to Emergency Departments (ED) globally, the aim of this study was to describe the characteristics of critically ill patients, the critical care interventions performed, and the outcomes of critically ill patients presenting to the KUTH ED with the goal of informing future research into the root causes of mortality of critically ill ED patients and of identifying high yield topics for didactic and procedural training.
Methods
A descriptive observational prospective cohort pilot study analyzed all patients ≥15 years who presented to KUTH between April and June 2022 with modified South African Triage Scores of Red with alarm, Red without alarm, and Orange.
Results
Of 320 patients, 66.9% were male and median age was 40 years. Patients were triaged as Orange (65.3%), Red without alarm (22.8%), and Red with alarm (11.9%). Presentations were categorized as: medical emergencies (48.0%), traumatic injury (44.5%), and surgical emergencies (7.6%). Median length of stay was 31 h (IQR 28, 56) and boarding was 23 h (IQR 8, 48). Overall mortality was 12.2% and highest among medical emergencies (16.5%,
p
= 0.048) and increased significantly with triage color: Red with alarm (47.4%), Red without alarm (16.4%), and Orange (4.3%,
p
< 0.0001). Cardiopulmonary resuscitation (CPR) (10.3%), endotracheal intubation (8.8%), and vasopressor administration (3.1%) were the most frequent critical interventions performed. Survival after cardiac arrest was 9.1% and 32.1% after intubation. Mortality was associated with the following interventions: CPR, intubation, and use of vasopressors (
p
< 0.05).
Conclusions
This pilot study identified the most common critical care interventions performed and a high mortality among patients who required these interventions in the ED of a tertiary teaching hospital in Rwanda. These findings will inform didactics and procedural training for emergency care providers. Future research should focus on the root causes of mortality in these specific patient populations and identify areas of system strengthening to reduce mortality.</description><identifier>ISSN: 1865-1380</identifier><identifier>ISSN: 1865-1372</identifier><identifier>EISSN: 1865-1380</identifier><identifier>DOI: 10.1186/s12245-024-00736-9</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Angiology ; Cardiology ; Cardiopulmonary resuscitation ; CPR ; Critical care ; Emergency care ; Emergency medical care ; Emergency Medicine ; Internal Medicine ; Intubation ; LMIC ; Medicine ; Medicine & Public Health ; Mortality ; Pediatrics ; Pilot projects ; Resuscitation ; Rwanda ; Teaching hospitals</subject><ispartof>International journal of emergency medicine, 2024-11, Vol.17 (1), p.170-8, Article 170</ispartof><rights>The Author(s) 2024</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c422t-d3256248708df97eea0a709ef798fec9dc0158bf8766a697da3f39c7c884c5383</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/3124248855/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/3124248855?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,25731,27901,27902,36989,44566,53766,53768,74869</link.rule.ids></links><search><creatorcontrib>Kamunga B., Laurent Gamy</creatorcontrib><creatorcontrib>Bearnot, Courtney J.</creatorcontrib><creatorcontrib>Martin, Kyle D.</creatorcontrib><creatorcontrib>Uwamahoro, Doris L.</creatorcontrib><creatorcontrib>Cattermole, Giles N.</creatorcontrib><title>Epidemiology and outcomes of critically ill patients in the emergency department of a tertiary teaching hospital in Rwanda</title><title>International journal of emergency medicine</title><addtitle>Int J Emerg Med</addtitle><description>Background
The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to Emergency Departments (ED) globally, the aim of this study was to describe the characteristics of critically ill patients, the critical care interventions performed, and the outcomes of critically ill patients presenting to the KUTH ED with the goal of informing future research into the root causes of mortality of critically ill ED patients and of identifying high yield topics for didactic and procedural training.
Methods
A descriptive observational prospective cohort pilot study analyzed all patients ≥15 years who presented to KUTH between April and June 2022 with modified South African Triage Scores of Red with alarm, Red without alarm, and Orange.
Results
Of 320 patients, 66.9% were male and median age was 40 years. Patients were triaged as Orange (65.3%), Red without alarm (22.8%), and Red with alarm (11.9%). Presentations were categorized as: medical emergencies (48.0%), traumatic injury (44.5%), and surgical emergencies (7.6%). Median length of stay was 31 h (IQR 28, 56) and boarding was 23 h (IQR 8, 48). Overall mortality was 12.2% and highest among medical emergencies (16.5%,
p
= 0.048) and increased significantly with triage color: Red with alarm (47.4%), Red without alarm (16.4%), and Orange (4.3%,
p
< 0.0001). Cardiopulmonary resuscitation (CPR) (10.3%), endotracheal intubation (8.8%), and vasopressor administration (3.1%) were the most frequent critical interventions performed. Survival after cardiac arrest was 9.1% and 32.1% after intubation. Mortality was associated with the following interventions: CPR, intubation, and use of vasopressors (
p
< 0.05).
Conclusions
This pilot study identified the most common critical care interventions performed and a high mortality among patients who required these interventions in the ED of a tertiary teaching hospital in Rwanda. These findings will inform didactics and procedural training for emergency care providers. Future research should focus on the root causes of mortality in these specific patient populations and identify areas of system strengthening to reduce mortality.</description><subject>Angiology</subject><subject>Cardiology</subject><subject>Cardiopulmonary resuscitation</subject><subject>CPR</subject><subject>Critical care</subject><subject>Emergency care</subject><subject>Emergency medical care</subject><subject>Emergency Medicine</subject><subject>Internal Medicine</subject><subject>Intubation</subject><subject>LMIC</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Pediatrics</subject><subject>Pilot projects</subject><subject>Resuscitation</subject><subject>Rwanda</subject><subject>Teaching hospitals</subject><issn>1865-1380</issn><issn>1865-1372</issn><issn>1865-1380</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp9kU2LFDEQhhtRcF39A54Cnlvz2UlOIsu6LiwIoueQSap7MqQ7bZJRxl9vZntR9-IpRarepz7erntN8FtC1PCuEEq56DHlPcaSDb1-0l20hOgJU_jpP_Hz7kUpB4wHwgdy0f26XoOHOaSYphOyi0fpWF2aoaA0IpdDDc7GeEIhRrTaGmCpBYUF1T0gmCFPsLgT8rDaXOeWPMssqpBrsPnUAuv2YZnQPpU1VBvP2i8_WyP7sns22ljg1cN72X37eP316lN_9_nm9urDXe84pbX3jIqBciWx8qOWABZbiTWMUqsRnPYOE6F2o5LDYActvWUj0046pbgTTLHL7nbj-mQPZs1hboOZZIO5_0h5Mm324CIY3PhMMK7B7zhgUMI5JZQEobi3nDbW-421HnczeNcWzjY-gj7OLGFvpvTDECLYoNiZ8OaBkNP3I5RqDumYl3YAwwjlbVElRKuiW5XLqZQM458WBJuz42Zz3DTHzb3jRjcR20SlFS8T5L_o_6h-A3wPsT4</recordid><startdate>20241105</startdate><enddate>20241105</enddate><creator>Kamunga B., Laurent Gamy</creator><creator>Bearnot, Courtney J.</creator><creator>Martin, Kyle D.</creator><creator>Uwamahoro, Doris L.</creator><creator>Cattermole, Giles N.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><general>BMC</general><scope>C6C</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20241105</creationdate><title>Epidemiology and outcomes of critically ill patients in the emergency department of a tertiary teaching hospital in Rwanda</title><author>Kamunga B., Laurent Gamy ; Bearnot, Courtney J. ; Martin, Kyle D. ; Uwamahoro, Doris L. ; Cattermole, Giles N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-d3256248708df97eea0a709ef798fec9dc0158bf8766a697da3f39c7c884c5383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Angiology</topic><topic>Cardiology</topic><topic>Cardiopulmonary resuscitation</topic><topic>CPR</topic><topic>Critical care</topic><topic>Emergency care</topic><topic>Emergency medical care</topic><topic>Emergency Medicine</topic><topic>Internal Medicine</topic><topic>Intubation</topic><topic>LMIC</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Pediatrics</topic><topic>Pilot projects</topic><topic>Resuscitation</topic><topic>Rwanda</topic><topic>Teaching hospitals</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kamunga B., Laurent Gamy</creatorcontrib><creatorcontrib>Bearnot, Courtney J.</creatorcontrib><creatorcontrib>Martin, Kyle D.</creatorcontrib><creatorcontrib>Uwamahoro, Doris L.</creatorcontrib><creatorcontrib>Cattermole, Giles N.</creatorcontrib><collection>SpringerOpen (Open Access)</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>International journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kamunga B., Laurent Gamy</au><au>Bearnot, Courtney J.</au><au>Martin, Kyle D.</au><au>Uwamahoro, Doris L.</au><au>Cattermole, Giles N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidemiology and outcomes of critically ill patients in the emergency department of a tertiary teaching hospital in Rwanda</atitle><jtitle>International journal of emergency medicine</jtitle><stitle>Int J Emerg Med</stitle><date>2024-11-05</date><risdate>2024</risdate><volume>17</volume><issue>1</issue><spage>170</spage><epage>8</epage><pages>170-8</pages><artnum>170</artnum><issn>1865-1380</issn><issn>1865-1372</issn><eissn>1865-1380</eissn><abstract>Background
The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to Emergency Departments (ED) globally, the aim of this study was to describe the characteristics of critically ill patients, the critical care interventions performed, and the outcomes of critically ill patients presenting to the KUTH ED with the goal of informing future research into the root causes of mortality of critically ill ED patients and of identifying high yield topics for didactic and procedural training.
Methods
A descriptive observational prospective cohort pilot study analyzed all patients ≥15 years who presented to KUTH between April and June 2022 with modified South African Triage Scores of Red with alarm, Red without alarm, and Orange.
Results
Of 320 patients, 66.9% were male and median age was 40 years. Patients were triaged as Orange (65.3%), Red without alarm (22.8%), and Red with alarm (11.9%). Presentations were categorized as: medical emergencies (48.0%), traumatic injury (44.5%), and surgical emergencies (7.6%). Median length of stay was 31 h (IQR 28, 56) and boarding was 23 h (IQR 8, 48). Overall mortality was 12.2% and highest among medical emergencies (16.5%,
p
= 0.048) and increased significantly with triage color: Red with alarm (47.4%), Red without alarm (16.4%), and Orange (4.3%,
p
< 0.0001). Cardiopulmonary resuscitation (CPR) (10.3%), endotracheal intubation (8.8%), and vasopressor administration (3.1%) were the most frequent critical interventions performed. Survival after cardiac arrest was 9.1% and 32.1% after intubation. Mortality was associated with the following interventions: CPR, intubation, and use of vasopressors (
p
< 0.05).
Conclusions
This pilot study identified the most common critical care interventions performed and a high mortality among patients who required these interventions in the ED of a tertiary teaching hospital in Rwanda. These findings will inform didactics and procedural training for emergency care providers. Future research should focus on the root causes of mortality in these specific patient populations and identify areas of system strengthening to reduce mortality.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1186/s12245-024-00736-9</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | International journal of emergency medicine, 2024-11, Vol.17 (1), p.170-8, Article 170 |
| issn | 1865-1380 1865-1372 1865-1380 |
| language | eng |
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| source | Publicly Available Content Database; Springer Nature - SpringerLink Journals - Fully Open Access ; PubMed Central |
| subjects | Angiology Cardiology Cardiopulmonary resuscitation CPR Critical care Emergency care Emergency medical care Emergency Medicine Internal Medicine Intubation LMIC Medicine Medicine & Public Health Mortality Pediatrics Pilot projects Resuscitation Rwanda Teaching hospitals |
| title | Epidemiology and outcomes of critically ill patients in the emergency department of a tertiary teaching hospital in Rwanda |
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