%0 Journal Article
%T Presenting complaints and mortality in a cohort of 22 000 adult emergency patients at a local hospital in Nepal
%J Journal of global health
%D 2019
%A Giri, Samita
%A Rogne, Tormod
%A Uleberg, Oddvar
%A Skovlund, Eva
%A Shrestha, Sanu Krishna
%A Koju, Rajendra
%A Damås, Jan Kristian
%A Solligård, Erik
%A Risnes, Kari R.
%V 9
%N 2
%P 020403-020403
%X 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.
Language: en
%G en %I Edinburgh University Global Health Society %@ 2047-2978 %U http://dx.doi.org/10.7189/jogh.09.020403