Kannan Vijay C, Ramalanjaona Georges, Andriamalala Clara N, Reynolds Teri A
University of Texas Southwestern, Division of Emergency Medicine, Dallas, TX, USA.
Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, USA.
Afr J Emerg Med. 2016 Mar;6(1):5-11. doi: 10.1016/j.afjem.2015.12.001. Epub 2016 Feb 4.
Little is documented concerning the clinical practice of emergency care in low- and middle-income countries. The lack of structural models presents serious obstacles to the development of effective emergency care services. This study provides such a model by describing the clinical practice at the emergency centre of the Centre Hôpitalier Universitaire de Mahajanga in Madagascar.
This was a retrospective chart review of all adult patients presenting to the emergency centre from September to November 2012. Archived chart data were extracted into a computer database. Data included: age, sex, date, diagnostic investigations, procedures, medications, and diagnosis.
727 charts were reviewed, averaging eight patients per day. The three most frequent pathologies observed were trauma, gastrointestinal, and infectious disease. A total of 392 received diagnostic investigations. These were chiefly complete blood counts ( = 218), blood glucose ( = 155) and ECG ( = 92). Chest X-rays ( = 83), extremity X-rays ( = 55) and skull/face X-rays ( = 44) comprised the most common imaging. Ultrasounds were primarily abdominal ( = 9), renal/genitourinary ( = 6), and obstetric ( = 2). Therapeutic interventions were performed in 564 patients, most commonly intravenous access ( = 452) and wound/orthopaedic care ( = 185). Medications were administered to 568 patients, mostly anti-inflammatory/analgesics ( = 463) and antibiotics ( = 287).
This is the first descriptive study of the clinical practice of emergency medicine in Mahajanga, Madagascar. It provides both the Malagasy and international medical communities with an objective analysis of the practice of emergency care in Madagascar from both diagnostic and therapeutic standpoints. Emergency care here focuses on the management of traumatic injury and infectious disease. The diagnostic imaging, pharmacologic and procedural therapeutic interventions reflect the burdens placed upon this institution by these diseases. We hope this study will provide guidance for the further development of Malagasy-specific emergency care systems.
关于低收入和中等收入国家的急诊临床实践，相关记录较少。缺乏结构化模型给有效的急诊服务发展带来了严重障碍。本研究通过描述马达加斯加马任加大学中心医院急诊中心的临床实践，提供了这样一个模型。
这是一项对2012年9月至11月期间到急诊中心就诊的所有成年患者的回顾性病历审查。将存档的病历数据提取到计算机数据库中。数据包括：年龄、性别、日期、诊断检查、操作、药物和诊断。
共审查了727份病历，平均每天8名患者。观察到的三种最常见病症是创伤、胃肠道疾病和传染病。共有392人接受了诊断检查。主要是全血细胞计数（=218）、血糖（=155）和心电图（=92）。胸部X光（=83）、四肢X光（=55）和头颅/面部X光（=44）是最常见影像学检查。超声检查主要是腹部（=9）、肾脏/泌尿生殖系统（=6）和产科产科（=2）。564名患者接受了治疗干预，最常见的是静脉通路建立（=452）和伤口/骨科护理（=185）。568名患者接受了药物治疗，主要是抗炎/镇痛药（=463）和抗生素（=287）。
这是马达加斯加马任加急诊医学临床实践的首次描述性研究。它从诊断和治疗角度为马达加斯加和国际医学界提供了对马达加斯加急诊护理实践的客观分析。这里的急诊护理重点是创伤性损伤和传染病的管理。诊断影像学、药物和程序性治疗干预反映了这些疾病给该机构带来的负担。我们希望这项研究将为马达加斯加特定急诊护理系统的进一步发展提供指导。
