坦桑尼亚主要三级医院开设满负荷运转的公共急诊科后的死亡率趋势。
Trends in mortality associated with opening of a full-capacity public emergency department at the main tertiary-level hospital in Tanzania.
作者信息
Sawe Hendry R, Mfinanga Juma A, Mwafongo Victor, Reynolds Teri A, Runyon Michael S
机构信息
Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania ; Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania ; Department of Emergency Medicine and Global Health Sciences, University of California San Francisco, San Francisco, CA USA.
出版信息
Int J Emerg Med. 2015 Jul 22;8:24. doi: 10.1186/s12245-015-0073-4. eCollection 2015.
BACKGROUND
Emergency medicine is an emerging specialty in Sub-Saharan Africa, and most hospitals do not have a fully functional emergency department (ED). We describe the mortality rates of the Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania before and after the opening of a full-capacity ED.
METHODS
This retrospective study investigated ED and hospital mortality rates for patients admitted to MNH from January 2008 to January 2012. This period represents 2 years before and 2 years after the opening of the full-capacity ED in January 2010. Trained abstractors analyzed patient care logbooks, attendance registers, nurse report books, and death certificates. The January 2008 to December 2009 data are from the limited-capacity casualty room (precursor of the ED), and for February 2010 to January 2012, they are from the new ED. Data are presented as proportions or differences with 95 % confidence intervals (CIs).
RESULTS
During the 4-year study period, the number of visits increased from 53,660 (January 2008 to December 2009) in the casualty room to 77,164 (February 2010 to January 2012) in the new ED. During this time, the overall hospital mortality rate decreased from 13.6 % (95 % CI 13.3-13.9 %) in the January 2008 to December 2009 period to 8.2 % (95 % CI 8.0-8.3 %) in the February 2010 to January 2012 period. The corresponding casualty room and ED mortality rates were 0.34 % (95 % CI 0.25-0.35 %) and 0.74 % (95 % CI 0.68-0.80 %), respectively. In the casualty room, the most commonly reported cause of death was lower respiratory tract infection and least common was poisoning. In the new ED, the most commonly reported cause of death was congestive cardiac failure and the least common was cancer.
CONCLUSIONS
The opening of a full-capacity ED in a tertiary-level hospital in sub-Saharan Africa was associated with a significant decrease in hospital mortality. This is despite a small, but significant, increase in the mortality rate in the ED as compared to that in the casualty room that it replaced.
背景
急诊医学在撒哈拉以南非洲是一个新兴专业，大多数医院没有功能完备的急诊科（ED）。我们描述了坦桑尼亚达累斯萨拉姆市穆希姆比利国家医院（MNH）在全功能急诊科开业前后的死亡率。
方法
这项回顾性研究调查了2008年1月至2012年1月入住MNH的患者的急诊科和医院死亡率。这段时间代表了2010年1月全功能急诊科开业前2年和开业后2年。经过培训的摘要员分析了患者护理日志、出勤登记簿、护士报告册和死亡证明。2008年1月至2009年12月的数据来自容量有限的急救室（急诊科的前身），2010年2月至2012年1月的数据来自新的急诊科。数据以比例或差异形式呈现，并带有95%置信区间（CI）。
结果
在4年的研究期间，就诊次数从急救室的53660次（2008年1月至2009年12月）增加到新急诊科的77164次（2010年2月至2012年1月）。在此期间，医院总体死亡率从2008年1月至2009年12月期间的13.6%（95%CI 13.3 - 13.9%）降至2010年2月至2012年1月期间的8.2%（95%CI 8.0 - 8.3%）。相应的急救室和急诊科死亡率分别为0.34%（95%CI 0.25 - 0.35%）和0.74%（95%CI 0.68 - 0.80%）。在急救室，最常报告的死亡原因是下呼吸道感染，最不常见的是中毒。在新的急诊科，最常报告的死亡原因是充血性心力衰竭，最不常见的是癌症。
结论
撒哈拉以南非洲一家三级医院全功能急诊科的开业与医院死亡率的显著下降相关。尽管与它所取代的急救室相比，急诊科的死亡率有小幅但显著的上升。
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