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Barro M, Ouattara CA, Sanogo B, Baby AA, Ouattara ABI, Nacro FS, Traoré IT, Kalmogho A, Ouermi AS, Ouoba RS, Cessouma KR, Nacro B. Risk factors for mortality in an African pediatric emergency department: case of Sourô Sanou Hospital, a prospective, cross-sectional study. J Trop Pediatr 2023; 70:fmad044. [PMID: 38099863 DOI: 10.1093/tropej/fmad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Childhood mortality rates remain high in sub-Saharan Africa. This study aimed to assess the causes and associated factors of pediatric emergency mortality at the Sourô Sanou University Hospital of Bobo-Dioulasso. METHODOLOGY This was a cross-sectional study with prospective collection from June to August 2020. We documented and analyzed demographic and clinical characteristics by means or proportions. Logistic regression was performed to identify the factors associated with childhood mortality. RESULTS From 618 pediatric patients admitted to pediatric emergency unit, 80 (12.9%) were documented as death outcomes. The mean age was 34.10 ± 36.38 months. The male sex represented 51.25%. The main diagnoses were severe malaria (61.25%), acute gastroenteritis (11.25%) and pneumonia (10%); 48.75% of the patients were malnourished and only 55% were fully immunized. The average length of hospitalization was 2.73 ± 3.03 days. Mortality was a strongly significant association with late come to the emergency unit (AOR = 1.11, CI = 1.04-1.18), young maternal age (AOR = 0.95, CI = 0.92-0.99) and incomplete vaccination (AOR = 1.94, CI = 1.13-3.31). CONCLUSION The in-hospital mortality rate was 12.94%; younger maternal age, delay in consultation, unimmunized or incompletely immunized status and shorter hospital stays were significantly associated with death.
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Affiliation(s)
- Makoura Barro
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | - Cheick Ahmed Ouattara
- Department of Public Health, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | - Bintou Sanogo
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | - Abdel Aziz Baby
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
- Emergency Reception, Service for Adults and Paediatrics, Niono Reference Health Center, Niono 45036, Mali
| | - Ad Bafa Ibrahim Ouattara
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | - Fatimata Sahoura Nacro
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | | | - Angèle Kalmogho
- Pediatric Department, Yalgado Ouédraogo University Hospital, 03 BP 7022 Ouagadougou 03, Burkina Faso
| | - Alain Saga Ouermi
- Pediatric Department, Ouahigouya Regional Hospital, Secteur 01 Ouahigouya, Burkina Faso
| | - Réné Souanguimpari Ouoba
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | | | - Boubacar Nacro
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
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Satılmış D, Güven R. The new prognostic factor in pre-intubation follow-up of critically ill patients: integrated pulmonary index monitoring. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221324. [PMID: 37729219 PMCID: PMC10511281 DOI: 10.1590/1806-9282.20221324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The objective of this study was to identify the integrated pulmonary index in the follow-up of non-intubated critically ill patients in the emergency department and its efficacy in deciding on advanced airway application in comparison with the Glasgow Coma Scale. METHODS This is a prospective, single-center, methodological study. In our study, we recorded the demographic characteristics, Glasgow Coma Scale, and the integrated pulmonary index of 90 patients with respiratory failure who were followed up in the emergency department between June 1, 2019 and September 1, 2019, and we compared the results of Glasgow Coma Scale and integrated pulmonary index in making the endotracheal intubation decision. RESULTS Endotracheal intubation was applied to 30% of the 90 patients included in the study. The area under the curve was calculated as 0.906 for integrated pulmonary index and 0.860 for Glasgow Coma Scale in predicting endotracheal intubation. There was no significant difference between the area under the curves of integrated pulmonary index and Glasgow Coma Scale. According to the best cutoff values determined in the estimation of endotracheal intubation, sensitivity was 74.07% and specificity was 95.24% for integrated pulmonary index, and sensitivity was 74.07% and specificity was 85.71% for Glasgow Coma Scale. CONCLUSION The integrated pulmonary index monitoring provides an objective evaluation in the follow-up of critically ill patients with spontaneous breathing in the emergency department and is predictive in deciding on timely endotracheal intubation.
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Affiliation(s)
- Dilay Satılmış
- University of Health Sciences, Sultan 2 Abdülhamid Han Training and Research Hospital, Department of Emergency Medicine – Istanbul, Turkey
| | - Ramazan Güven
- University of Health Sciences, Cam Sakura City Hospital, Department of Emergency Medicine – Istanbul, Turkey
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Hamdan M, Yang X, Mavura M, Saleh M, Kannani G, Haonan K, Al-Danakh A, Zhaohui X, Zezhong G, Hyokju R, Amado B, Yanying R, Xin C. Factors associated with delayed reporting for surgical care among patients with surgical acute abdomen attended at Muhimbili National Hospital: Tanzania. BMC Gastroenterol 2023; 23:59. [PMID: 36890435 PMCID: PMC9996925 DOI: 10.1186/s12876-023-02659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/24/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Surgical acute abdomen is a sudden onset of severe abdominal symptoms (pain, vomiting, constipation etc.) indicative of a possible life-threatening intra-abdominal pathology, with most cases requiring immediate surgical intervention. Most studies from developing countries have focused on complications related to delayed diagnosis of specific abdominal problems like intestinal obstruction or acute appendicitis and only a few studies have assessed factors related to the delay in patients with acute abdomen. This study focused on the time from the onset of a surgical acute abdomen to presentation to determine factors that led to delayed reporting among these patients at the Muhimbili National Hospital (MNH) and aimed to close the knowledge gap on the incidence, presentation, etiology, and death rates for acute abdomen in Tanzania. METHODS We conducted a descriptive cross-sectional study at MNH, Tanzania. Patients with a clinical diagnosis of the surgical acute abdomen were consecutively enrolled in the study over a period of 6 months and data on the onset of symptoms, time of presentation to the hospital, and events during the illness were collected. RESULTS Age was significantly associated with delayed hospital presentation, with older groups presenting later than younger ones. Informal education and being uneducated were factors contributing to delayed presentation, while educated groups presented early, albeit the difference was statistically insignificant (p = 0.121). Patients working in the government sector had the lowest percentage of delayed presentation compared to those in the private sector and self-employed individuals, however, the difference was statistically insignificant. Family and cohabiting individuals showed late presentation (p = 0.03). Deficiencies in health care staff on duty, unfamiliarity with the medical facilities, and low experience in dealing with emergency cases were associated with the factors for delayed surgical care among patients. Delays in the presentation to the hospital increased mortality and morbidity, especially among patients who needed emergency surgical care. CONCLUSION Delayed reporting for surgical care among patients with surgical acute abdomen in underdeveloped countries like Tanzania is often not due to a single reason. The causes are distributed across several levels including the patient's age and family, deficiency in medical staff on duty and lack of experience in dealing with emergency cases, educational level, working sectors, socioeconomic and sociocultural status of the country.
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Affiliation(s)
- Maryam Hamdan
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Xu Yang
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - M Mavura
- Department of General Surgery, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Mohammed Saleh
- Department allied, Health Science Zanzibar, Zanzibar, Tanzania
| | - George Kannani
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Kang Haonan
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Abdullah Al-Danakh
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xu Zhaohui
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Gong Zezhong
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Ri Hyokju
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Boureima Amado
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Ren Yanying
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Chen Xin
- Department of Hernia and Colorectal Surgery, Second Hospital of Dalian Medical University, Dalian, China.
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Mandeng Ma Linwa E, Binam Bikoi C, Tochie Noutakdie J, Ndoye Ndo E, Bikoy JM, Eposse Ekoube C, Fogue Mogoung R, Simo Ghomsi I, Budzi MN, Ngo Linwa EE, Meh MG, Mekolo D. In-ICU Outcomes of Critically Ill Patients in a Reference Cameroonian Intensive Care Unit: A Retrospective Cohort Study. Crit Care Res Pract 2023; 2023:6074700. [PMID: 37197155 PMCID: PMC10185429 DOI: 10.1155/2023/6074700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
Introduction Mortality rate amongst critically ill patients admitted to the intensive care unit (ICU) is disproportionately high in sub-Saharan African countries such as Cameroon. Identifying factors associated with higher in-ICU mortality guides more aggressive resuscitative measures to curb mortality, but the dearth of data on predictors of in-ICU mortality precludes this action. We aimed to determine predictors of in-ICU mortality in a major referral ICU in Cameroon. Methodology. This was a retrospective cohort study of all patients admitted to the ICU of Douala Laquintinie Hospital from 1st of March 2021 to 28th February 2022. We performed a multivariable analysis of sociodemographic, vital signs on admission, and other clinical and laboratory variables of patients discharged alive and dead from the ICU to control for confounding factors. Significance level was set at p < 0.05. Results Overall, the in-ICU mortality rate was 59.4% out of 662 ICU admissions. Factors independently associated with in-ICU mortality were deep coma (aOR = 0.48 (0.23-0.96), 95% CI, p = 0.043), and hypernatremia (>145 meq/L) (aOR = 0.39 (0.17-0.84) 95% CI, p = 0.022). Conclusion The in-ICU mortality rate in this major referral Cameroonian ICU is high. Six in 10 patients admitted to the ICU die. Patients were more likely to die if admitted with deep coma and high sodium levels in the blood.
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Affiliation(s)
- Edgar Mandeng Ma Linwa
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Intensive Care Unit, Laquintinie Hospital Douala, Douala, Cameroon
| | | | | | | | - Jean Moise Bikoy
- Anaesthesiology Unit, Laquintinie Hospital Douala, Douala, Cameroon
| | | | - Raissa Fogue Mogoung
- Intensive Care Unit, Laquintinie Hospital Douala, Douala, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Igor Simo Ghomsi
- Intensive Care Unit, Laquintinie Hospital Douala, Douala, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | | | | | - Martin Geh Meh
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - David Mekolo
- Intensive Care Unit, Laquintinie Hospital Douala, Douala, Cameroon
- Emergency Unit, Laquintinie Hospital Douala, Douala, Cameroon
- Anaesthesiology Unit, Laquintinie Hospital Douala, Douala, Cameroon
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