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J Glob Health. 2019 Dec;9(2):020403. doi: 10.7189/jogh.09.020403.

Presenting complaints and mortality in a cohort of 22 000 adult emergency patients at a local hospital in Nepal.

Author information

1
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
2
Department of Community Programs, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal.
3
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
4
Gemini Center for Sepsis Research, St. Olav's hospital, Trondheim University Hospital, Trondheim, Norway.
5
Department of Emergency Medicine and Pre-Hospital Services, St. Olav's Hospital Trondheim University Hospital, Trondheim, Norway.
6
Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
7
Department of Emergency, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal.
8
Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal.
9
Department of Infectious Diseases, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
10
Clinic of Anesthesia and Intensive Care, St. Olav's hospital, Trondheim University Hospital, Trondheim, Norway.
11
Childrens Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.

Abstract

Background:

There is a need to develop sustainable emergency health care systems in low-resource settings, but data that analyses emergency health care needs in these settings are scarce. We aimed at assessing presenting complaints (PCs) and post-discharge mortality in a large emergency department population in Nepal.

Methods:

Characteristics of adult patients who entered the emergency department (ED) in a hospital in Nepal were prospectively recorded in the local emergency registry from September 2013 until December 2016. To assess post-ED mortality, patient households were followed-up by telephone interviews at 90 days.

Results:

In 21892 included adults, the major PC categories were injuries (29%), abdominal complaints (23%), and infections (16%). Median age was 40 years and sex distribution was balanced. Among 3793 patients followed at 90 days, 8% had died. For respiratory and cardiovascular PCs, 90-day mortality were 25% and 23%. The highest mortality was in individuals with known chronic lung disease, in this group 32% had died by 90 days of ED discharge, regardless of PC. In women, illiteracy compared to literacy (adjusted odds ratio (aOR) = 7.0, 95% confidence interval (CI) = 2.1-23.6) and being both exposed to tobacco-smoking and traditional cooking stove compared to no smoke (aOR = 2.8, 95% CI = 1.6-4.9) were associated with mortality. The mortality was much higher among family-initiated discharged patients (17%, aOR = 5.4, 95% CI = 3.3-8.9) compared to doctor-initiated discharged (3%).

Conclusions:

Our report suggests that nearly one in ten patients seeking emergency health care died within 90 days. This finding is alarming and novel. Post-discharge studies need to be replicated and appropriate follow-up programs in low-resource settings where primary health care is underdeveloped are urgently needed.

PMID:
31489186
PMCID:
PMC6708590
DOI:
10.7189/jogh.09.020403
[Indexed for MEDLINE]
Free PMC Article

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