Patterns, Predictors and Outcome of Time to Presentation Among Critically ill Paediatric Patients at Emergency Department of Muhimbili National Hospital, Dar es Salaam, Tanzania

Abstract Background: Mortality among under-five children in Tanzania remains high. While early presentation for treatment increases likelihood of survival, delays to care are common and factors causing delay to presentation among critically ill children are unknown. Methodology: This was a prospective cohort study of critically ill children aged 28days to 14 years attending emergency department (ED) at Muhimbili National Hospital in Tanzania from September 2019 to January 2020. We documented demographics, time to ED presentation, ED interventions and 30-day outcome. The primary outcome was delay (>48 hours) from the onset of illness to ED presentation. Logistic regression and relative risk were calculated to measure the strength of the predictor and relationship between delay and mortality respectively. Results: We enrolled 440 (59.1%) critically ill children, their median age was 12 [IQR =9-60] months and 63.9% were males. The median time to ED arrival was 3 days [IQR=1-5] and more than half (56.6%) of critically ill children presented to ED in > 48 hours where by being an infant, self-referral and belonging to poor family were independent predictors of delay. Infants and those referred from other facilities had 2.2 (95% CI 1.3-3.8) and 1.7 (95% CI 1.1-2.7) times increased odds of presenting late to the ED respectively. The overall 30-day in-hospital mortality was 26.5% in which those who presented late were 1.3 more likely to die than those who presented early (RR=1.3, CI: 0.9-1.9). Majority died >24 hours of ED arrival (P-value=0.021).Conclusion: Delayed ED presentation of more than 48 hours from onset of illness was associated with in-hospital mortality. A larger study is needed to evaluate the care pathway of critically ill paediatric patients to identify preventable course of delay to tertiary care facility.

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Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility

The Egyptian Heart Journal ◽

10.1186/s43044-019-0018-y ◽

2019 ◽

Vol 71 (1) ◽

Cited By ~ 1

Author(s):

Hussein Hassan Rizk ◽

Ahmed Adel Elamragy ◽

Ghada Sayed Youssef ◽

Marwa Sayed Meshaal ◽

Ahmad Samir ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Tertiary Care ◽

Care Facility ◽

Period 2 ◽

Peripheral Embolization ◽

Tertiary Care Facility ◽

Few Data ◽

Healthcare Associated ◽

Complications And Mortality

Abstract Background Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. Results The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). Conclusion This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.

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Validated physiologic scoring systems are inadequate for predicting in-hospital mortality among critically ill emergency department patients

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2004.07.007 ◽

2004 ◽

Vol 44 (4) ◽

pp. S1

Author(s):

M.T. Fitch ◽

A.E. Jones ◽

J.A. Kline

Keyword(s):

Emergency Department ◽

Hospital Mortality ◽

Critically Ill ◽

Scoring Systems ◽

Emergency Department Patients

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Development of an Interfacility Transport Program for Critically Ill Cardiovascular Patients

AACN Advanced Critical Care ◽

10.4037/15597768-1990-1002 ◽

1990 ◽

Vol 1 (1) ◽

pp. 3-12 ◽

Cited By ~ 2

Author(s):

Adrienne Greco

Keyword(s):

Los Angeles ◽

Critically Ill ◽

Tertiary Care ◽

Care Facility ◽

Good Samaritan ◽

Tertiary Care Facility ◽

Cardiovascular Patients ◽

Ground Ambulance ◽

Tertiary Care Centers ◽

Interfacility Transport

The expanding use of newer coronary artery intervention modalities in the treatment of critically ill cardiac patients has produced a profound change in the manner in which acute care is rendered to these patients. To meet the needs of community hospitals and to improve the safety of interfacility transport to tertiary care centers, a transport program was developed at The Hospital of the Good Samaritan, Los Angeles, California. Rapid transport by helicopter, fixed-wing aircraft or specialized ground ambulance services has been used to improve patient transit time and safety of transfer between the community hospital and tertiary care facility. Experience at The Hospital of the Good Samaritan (1,012 consecutive patients) compares favorably with other programs and proves to be safe and beneficial.

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A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa

South African Journal of Child Health ◽

10.7196/sajch.2015.v9i4.913 ◽

2015 ◽

Vol 9 (4) ◽

pp. 112 ◽

Cited By ~ 1

Author(s):

Candice Royal ◽

N H McKerrow

Keyword(s):

South Africa ◽

Critically Ill ◽

Retrospective Review ◽

Tertiary Care ◽

Critically Ill Children ◽

Kwazulu Natal

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Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study

Peritoneal Dialysis International ◽

10.1177/0896860820975897 ◽

2020 ◽

pp. 089686082097589

Author(s):

Pallavi Choudhary ◽

Virendra Kumar ◽

Abhijeet Saha ◽

Archana Thakur

Keyword(s):

Mechanical Ventilation ◽

Peritoneal Dialysis ◽

Renal Impairment ◽

Critically Ill ◽

Tertiary Care ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Renal Outcome ◽

Severe Dengue ◽

Critically Ill Children

Background: Peritoneal dialysis (PD) is easily available and simple lifesaving procedure in children with renal impairment. There is paucity of reports on efficacy of PD in critically ill children in presence of shock and those requiring mechanical ventilation. Methods: In this prospective observational study, efficacy and outcome of PD were evaluated in 50 critically ill children aged 1 month to 14 years admitted in pediatric intensive care unit of a tertiary care teaching hospital in India. Results: Indication of PD was acute kidney injury (AKI) in 66% of patients followed by chronic kidney disease with acute deterioration due to infectious complications in 34%. Bacterial sepsis was the most common cause of AKI (22%), others being malaria (14%) and severe dengue (12%). At initiation of PD, 26% of patients were in shock and 46% were mechanically ventilated. PD was effective and improvement in pH, bicarbonate, and lactate started within hours, with consistent improvement in estimated glomerular filtration rate by 24 h, which continued till the end of procedure, including the subgroup of patients with shock and mechanical ventilation. Total complications were seen in 14% and of which peritonitis was present in 4.0% of patients. Mortality was seen in 14% (7/50) of patients. Shock at initiation of PD (odds ratio (OR), 5.03; 95% confidence interval (CI), 0.95–26.69; p < 0.04) and requirement of mechanical ventilation (OR, 9.17; 95% CI, 1.01–83.10; p < 0.02) were associated with mortality. Conclusions: Acute PD in critically ill children with renal impairment is a lifesaving procedure. Treatment of shock with resuscitative measures and respiratory failure with mechanical ventilation, along with PD, resulted in favorable renal outcome.

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admission patterns and outcomes of paediatric patients admitted at the diarrhea unit of muhimbili national hospital (MNH)

Dar Es Salaam Medical Students Journal ◽

10.4314/dmsj.v15i1.49591 ◽

2010 ◽

Vol 15 (1) ◽

Author(s):

S John ◽

P Nuru

Keyword(s):

Muhimbili National Hospital ◽

National Hospital ◽

Paediatric Patients

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An Assessment of Emergency Department Throughput and Provider Satisfaction after the Implementation of a Scribe Program

Advances in Emergency Medicine ◽

10.1155/2014/517319 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 20

Author(s):

Brandon Allen ◽

Ben Banapoor ◽

Emily C. Weeks ◽

Thomas Payton

Keyword(s):

Emergency Department ◽

Program Implementation ◽

Tertiary Care ◽

Care Facility ◽

Workplace Satisfaction ◽

Electronic Survey ◽

Left Without Being Seen ◽

Tertiary Care Facility ◽

Discharged Patients ◽

The Impact

Objectives. To assess the impact of a scribe program on an academic, tertiary care facility. Methods. A retrospective analysis of emergency department (ED) data, prior to and after scribe program implementation, was used to quantitatively assess the impact of the scribe program on measures of ED throughput. An electronic survey was distributed to all emergency medicine residents and advanced practice providers to qualitatively assess the impact of the scribe program on providers. Results. Several throughput time measures were significantly lower in the postscribe group, compared to prescribe implementation, including time to disposition. The left without being seen (LWBS) decrease was not statistically significant. A total of 30 providers responded to the survey. 100% of providers indicated scribes are a valuable addition to the department and they enjoy working with scribes. 90% of providers indicated scribes increase their workplace satisfaction and quality of life. Conclusions. Through evaluation of prescribe and postscribe implementation, the postscribe time period reflects many throughput improvements not present before scribes began. Scribe Program implementation led to improved ED throughput for discharged patients with further system-wide challenges needing to be addressed for admitted patients.

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