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Journal Cover African Journal of Emergency Medicine
  [SJR: 0.344]   [H-I: 6]   [4 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2211-419X
   Published by Elsevier Homepage  [3031 journals]
  • Uchunguzi (Journal Watch/ Montre de Journal)

    • Authors: Benjamin W. Wachira
      Pages: 38 - 39
      Abstract: Publication date: March 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 1
      Author(s): Benjamin W. Wachira


      PubDate: 2017-03-08T08:14:05Z
      DOI: 10.1016/j.afjem.2017.02.001
       
  • Evaluation of a point-of-care ultrasound scan list in a resource-limited
           emergency department in Addis Ababa Ethiopia

    • Authors: Maja Stachura; Megan Landes; Fasika Aklilu; Raghu Venugopal; Cheryl Hunchak; Sara Berman; James Maskalyk; Josee Sarrazin; Tesfaye Kebede; Aklilu Azazh
      Abstract: Publication date: Available online 17 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Maja Stachura, Megan Landes, Fasika Aklilu, Raghu Venugopal, Cheryl Hunchak, Sara Berman, James Maskalyk, Josee Sarrazin, Tesfaye Kebede, Aklilu Azazh
      Introduction Emergency centres (EC) in low- and middle-income countries often have limited diagnostic imaging capabilities. Point-of-care ultrasound (POCUS) is used in high-income countries to diagnose and guide treatment of life-threatening conditions. This study aims to identify high impact POCUS scans most relevant to practice in an Ethiopian EC. Methods A prospective observational study where patients presenting to Tikur Anbessa Specialized Hospital EC in Addis Ababa were eligible for inclusion. Physicians referred patients with a clinical indication for POCUS from a pre-determined 15-scan list. Scans were performed and interpreted, at the bedside, by qualified emergency physicians with POCUS training. Results A convenience sample of 118 patients with clinical indications for POCUS was enrolled. The mean age was 35years and 42% were female. In total, 338 scans were performed for 145 indications in 118 patients. The most common scans performed were pericardial (n=78; 23%), abdominal free fluid (n=73; 22%), pleural effusion/haemothorax (n=51; 15%), inferior vena cava (n=43; 13%), pneumothorax (n=38; 11%), and global cardiac activity (n=25; 7%). One hundred and twelve (95%) POCUS scans provided clinically useful information. In 53 (45%) patients, ultrasound findings changed patient management plans by altering the working diagnosis (n=32; 27%), resulting in a new treatment intervention (n=28; 24%), resulting in a procedure/surgical intervention (n=17; 14%) leading to consultation with a specialist (n=16; 14%), and/or changing a disposition decision (n=9; 8%). Discussion In this urban, low-resource, academic EC in Ethiopia, POCUS provided clinically relevant information for patient management, particularly for polytrauma, undifferentiated shock and undifferentiated dyspnea. Results have subsequently been used to develop a locally relevant emergency department ultrasound curriculum for Ethiopia’s first emergency medicine residency program.

      PubDate: 2017-05-19T03:45:02Z
      DOI: 10.1016/j.afjem.2017.04.011
       
  • Quality improvement in emergency service delivery: Assessment of knowledge
           and skills amongst emergency nurses at Connaught Hospital, Sierra Leone

    • Authors: Hedda Bøe Nyhus; Michael M. Kamara
      Abstract: Publication date: Available online 16 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Hedda Bøe Nyhus, Michael M. Kamara
      Introduction The ability to deliver quality emergency care services is reliant on a well-trained workforce. Since Sierra Leone was declared Ebola free in December 2015, the country has now moved into the post-Ebola reconstructive phase focusing on specialty training of healthcare workers. This development aligns well to the growing momentum for improved emergency medicine as a speciality in other regions of Sub-Saharan Africa. The first stage in assessing how to develop an emergency nursing speciality in Sierra Leone is to conduct an assessment of what is needed in terms of educational interventions. Concurrently enhancing emergency nursing capacity requires a comprehensive understanding of the role, function and emergency nurse educational requirements. This study was conducted to fully understand the current context, elucidate current nursing functions and gain knowledge of the educational desires and needs of nurses in the emergency centre at Connaught Hospital, the largest referral hospital in Sierra Leone. Methods This mixed-methods study comprised self-assessment, one multiple-choice questionnaire, focus group interviews and observational methods. Results Emergency nurses scored relatively low on the multiple-choice questionnaire, indicating through the self-assessment that they aspired to learn more about several topics within emergency care, and identified several themes which were considered to be barriers to delivery of care through focus group discussions and observations in the emergency centre. Conclusion This study has identified key aspects of emergency nursing speciality training to be developed through theoretical and skill-based education provided by the nursing schools and hospital clinical facilities in Sierra Leone.

      PubDate: 2017-05-19T03:45:02Z
      DOI: 10.1016/j.afjem.2017.04.002
       
  • Libyan healthcare system during the armed conflict: Challenges and
           restoration

    • Authors: Mohamed A. Daw
      Abstract: Publication date: Available online 9 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Mohamed A. Daw


      PubDate: 2017-05-14T03:28:45Z
      DOI: 10.1016/j.afjem.2017.04.010
       
  • What intracranial pathologies are most likely to receive intervention? A
           preliminary study on referrals from an emergency centre with no on-site
           neurosurgical capabilities

    • Authors: Lara Nicole Goldstein; Craig Beringer; Lumé Morrow
      Abstract: Publication date: Available online 6 May 2017
      Source:African Journal of Emergency Medicine
      Author(s): Lara Nicole Goldstein, Craig Beringer, Lumé Morrow
      Introduction Access to neurosurgical facilities remains limited in resource-restricted medical environments worldwide, including Africa. Many hospitals refer patients to off-site facilities if they require intervention. Unnecessary referrals, however, can be detrimental to the patient and/or costly to the healthcare system itself. The aim of this study was to determine the frequency and associated intracranial pathology of patients who did and did not receive active neurosurgical intervention after having presented to an academic emergency centre at a hospital without on-site neurosurgical capabilities. Methods A one-year, retrospective record review of all patients who presented with potential neurosurgical pathology to a tertiary academic emergency centre in Johannesburg, South Africa was conducted. Results A total of 983 patients received a computed tomography brain scan for suspected neurosurgical pathology. There were 395 positive scans; 67.8% with traumatic brain injury (TBI) and 32.3% non-traumatic brain injury (non-TBI). Only 14.4% of patients received neurosurgical intervention, mostly non-TBI-related. The main intervention was a craniotomy for both TBI and non-TBI patients. The main TBI haemorrhages that received an intervention were subdural (SDH) (16.5%) and extradural (10.4%) haemorrhages. More than half the patients with non-TBI SDHs as well as those with aneurysms and subarachnoid haemorrhages received an intervention. Discussion Based on this study’s findings, in a resource-restricted setting, the patients who should receive preference for neurosurgical referral and intervention are (1) those with intracranial haemorrhages (2) those with non-traumatic SDH more than traumatic SDH and (3) those patients with non-traumatic subarachnoid haemorrhages caused by aneurysms.

      PubDate: 2017-05-08T23:28:13Z
      DOI: 10.1016/j.afjem.2017.04.012
       
  • Traumatic chylothorax in a young child: Case report and management

    • Authors: Haiko K. Jahn; Jodie H. Frost; A.B. (Sebastian) van As
      Abstract: Publication date: Available online 20 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Haiko K. Jahn, Jodie H. Frost, A.B. (Sebastian) van As
      Introduction A chylothorax is an uncommon feature of paediatric chest trauma. Case report We report a case of traumatic chylothorax following blunt chest trauma in an eight year-old girl with polytrauma after being hit by a motor vehicle. She was initially found to have a bilateral frontal skull fracture extending into the left parietal area, pulmonary contusions, left posterior rib fractures, left clavicular fracture and a degloving injury of her left foot. On the fifth day of her admission she developed progressive dyspnoea with signs of a pleural effusion, which was confirmed radiologically and drained by tube thoracostomy. Biochemical analysis confirmed chylothorax, which was managed conservatively with a fat free diet. The chest tube was removed after it stopped draining over 20ml per 12h and she made a full recovery. Discussion Initial management of chylothorax is conservative with tube thoracostomy drainage and fat free diet. Traumatic chylothroax is a rare complication following chest trauma and can take days to develop and to become clinically apparent. It is therefore important to be vigilant for potential late complications in blunt chest trauma in children, especially if there are extensive rib fractures, a sign of major transmission of force to the thorax.

      PubDate: 2017-04-26T20:56:10Z
      DOI: 10.1016/j.afjem.2017.04.007
       
  • Poisoning cases and their management in emergency centres of government
           hospitals in northwest Ethiopia

    • Authors: Getnet Mequanint Adinew; Asegedech Tsegaw Woredekal; Elizabeth L. DeVos; Eshetie Melese Biru; Mohammed Birhan Abdulwahib
      Abstract: Publication date: Available online 20 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Getnet Mequanint Adinew, Asegedech Tsegaw Woredekal, Elizabeth L. DeVos, Eshetie Melese Biru, Mohammed Birhan Abdulwahib
      Introduction With the widespread availability of a vast number of chemicals and drugs, acute poisoning is a common medical emergency worldwide. In spite of the success of interventions to prevent toxic ingestions, acute poisoning continues to be an important public health problem. Because of weak regulations and limited health care services in developing countries, adverse outcomes from poisoning are more prevalent than in the developed world. Due to the limited Ethiopian literature on this topic, the primary objective of this study was to evaluate and report poisoning cases, their management and outcome in northwest Ethiopia. Methods This is a retrospective study of all poisoning cases admitted and managed in the emergency centres of Gondar Teaching Referral Hospital and Metema and Debark district hospitals, from September 2010 to December 2014. Data was collected through retrospective chart review of patients who were admitted due to poisoning. Results There were 543 registered poisoning cases listed in the registry during the study period, of which 344 cases (63.4%) had complete data and were included in the final analysis. There were 48,619 emergency centre visits during the study period, with poisoning cases accounting for 1.1%. Females (60%) were predominant among intentional as well as unintentional poisoning cases. Patients between 15 and 24years of age accounted for 55% of the cases. Patients poisoned with organophosphate and bleaching agents accounted for 35% and 25%, respectively. Among the poisoning patients, 74% were treated with decontamination, while those exposed to organophosphate were treated with atropine 45.5% (55/121) of the time. Discussion Young females comprise a group at increased risk for suicidal poisonings. As a developing nation, pesticide and bleaching agents remain a significant cause of acute poisonings in Ethiopia. Intentional poisoning remains the most significant identified cause of poisoning overall.

      PubDate: 2017-04-26T20:56:10Z
      DOI: 10.1016/j.afjem.2017.04.005
       
  • Attitude of interns towards implementation aand contribution of
           undergraduate Emergency Medicine training: Experience of an Ethiopian
           Medical School

    • Authors: Temesgen Beyene; Aklilu Azazh; Janis P. Tupesis
      Abstract: Publication date: Available online 20 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Temesgen Beyene, Aklilu Azazh, Janis P. Tupesis
      Introduction Emergency Medicine is a medical specialty based on knowledge and skills required for the prevention, diagnosis and management of the acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. Addis Ababa University School of Medicine started its Emergency Medicine Residency in 2010 and Emergency Medicine training for fourth-year medical students started in 2013. This study aims to assess attitudes of fifth year medical students towards Emergency Medicine training and its contribution to their final year of medical school training. Methods 200 fifth year medical students participated in the study by convenience sampling. Self-administered questionnaires and Likert scales were used for data collection. Descriptive frequencies and chi-square analysis were done for categorical data. Ethical oversight was provided by the Institutional Review Board of the Addis Ababa University College of Health Sciences. Results Of the 200 participants, 150 were male and 50 were female. 80% agreed its relevance for undergraduates. Relevance was significantly associated with recommendation to other medical schools (χ 2 =8.34, Pr=0.004). 72% of respondents agreed lectures are appropriate teaching methods, 70% agreed group activity, 68.5% skill sessions, 67.5% morning discussions, 64% diagnostic session, 60% duty exposures and 45% seminars. Difficulties faced during internship are primarily attributed to lack of facilities, ranging from the setup of the emergency centre to instruments and emergency drugs. 60% of respondents agreed that Emergency Medicine training is important to future careers. 65% agreed recommending training to other medical schools. Conclusion An Emergency Medicine rotation during the final year of medical school provides opportunities to learn about undifferentiated medical emergencies and it should be included for other medical schools in the country. Participants suggest that leadership aspects of Emergency Medicine need more emphasis as the curriculum is further developed in the future.

      PubDate: 2017-04-26T20:56:10Z
      DOI: 10.1016/j.afjem.2017.04.008
       
  • A survey of emergency medicine and orthopaedic physicians’ knowledge,
           attitude, and practice towards the use of peripheral nerve blocks

    • Authors: Ayalew Zewdie; Finot Debebe; Aklilu Azazh; Margaret Salmon; Christian Salmon
      Abstract: Publication date: Available online 20 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Ayalew Zewdie, Finot Debebe, Aklilu Azazh, Margaret Salmon, Christian Salmon
      Introduction Peripheral nerve blocks (also known as regional anaesthesia) are currently used by many anaesthesiologists and emergency physicians for perioperative and procedural pain management. Methods This is a cross sectional descriptive study conducted to evaluate knowledge, attitudes, and current practice towards use of peripheral nerve blocks for lower extremity injuries at Black Lion Hospital, a tertiary trauma centre in Addis Ababa. Results A standardised survey was conducted with 64 participants working in emergency medicine [30/64 (46.9%)] and orthopaedics [34/64 (53.1%)]. Twenty-three of 64 (35.9%) respondents had received formal training. Knowledge was acquired from didactic/workshop format for 15/23 (65.2%), followed by peer training 6/23 (39.1%). The majority, 62/64 (96.9%), believed that knowledge of general anatomy and nerve blocks are very important. Thirty-one of 64 (48%) of the respondents did not routinely perform peripheral nerve blocks. A majority, 27/31 (87.1%) stated they lacked the required skills. Ultrasound guidance of the femoral nerve 16/33 (48.5%) was the most commonly performed peripheral nerve block, followed by ankle block using anatomic landmarks 15/33 (45.5%). Almost all (15/16) ultrasound-guided nerve blocks were done by emergency medicine providers, while all anatomic land mark guided blocks were done by orthopaedic teams. A majority of the respondents (93.8%) (n=60) were optimistic that their practice on peripheral nerve blocks would increase in future. A highly significant association was found between previous training on peripheral nerve blocks and the number of peripheral nerve blocks performed in a month; p value – 0.006. Discussion This study indicates peripheral nerve blocks are likely underutilised due to lack of training. There was a positive attitude towards peripheral nerve blocks but gaps on knowledge and practice.

      PubDate: 2017-04-26T20:56:10Z
      DOI: 10.1016/j.afjem.2017.04.003
       
  • Describing the categories of people that contribute to an Emergency Centre
           crowd at Khayelitsha hospital, Western Cape, South Africa

    • Authors: Emmanuel Ahiable; Sa'ad Lahri; Stevan Bruijns
      Abstract: Publication date: Available online 20 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Emmanuel Ahiable, Sa'ad Lahri, Stevan Bruijns
      Introduction Emergency Centre (EC) crowding has globally been recognised to adversely affect patients, staff and visitors. Anecdotally, local ECs are perceived to be fairly crowded, however, not much is known about the size of this crowd and what constitutes it. Although more reliable, resource restrictions render more detailed flow studies less achievable. This study describes the EC crowd at Khayelitsha hospital in Cape Town, South Africa as the number and different categories of people, at predefined times during the day over a four-week period. Methods A prospective, cross-sectional design was used. Headcounts were made by predefined groups at 09h00, 14h00, and 21h00 every day for four weeks. Predefined groups included doctors, nurses, visitors, patients, and other allied health staff. Summary statistics were used to describe the data. Precision was described using the 95% confidence interval. Results A total of 16,353 people were counted during the study period. On average, 6370 (39%) of the groups were staff, 5231 (32%) were patients and 4752 (29%) were visitors. Of the staff, 586 (3.6%) were EC doctors, 733 (4.4%) were non-EC doctors, 1488 (9%) were EC nurses, and 445 (3%) were non-EC nurses. Although patient numbers in the EC remained constant, visitors and non-EC staff varied significantly with visitors peaking in the afternoon and non-EC staff drastically reducing in the evening. The EC was consistently crowded – average occupancy: 130%. Conclusion Staff levels fluctuated predictably, reducing at night and over weekends, while patient levels remained constant. Non-EC doctors more than doubled during the day on week shifts, in significantly more numbers than EC doctors, suggesting that many of the patients in the EC were likely to be admissions boarding in the EC. Visitor numbers were substantial during visiting hours and further aggravated crowding. Resource-light studies involving flow are important to explore crowding in low- and middle income settings.

      PubDate: 2017-04-26T20:56:10Z
      DOI: 10.1016/j.afjem.2017.04.004
       
  • Poor adherence to Tranexamic acid guidelines for adult, injured patients
           presenting to a district, public, South African hospital

    • Authors: Jacobus G.G. Wiese; Daniël J. van Hoving; Luke Hunter; Sa'ad Lahri; Stevan R. Bruijns
      Abstract: Publication date: Available online 19 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Jacobus G.G. Wiese, Daniël J. van Hoving, Luke Hunter, Sa'ad Lahri, Stevan R. Bruijns
      Introduction In South Africa’s high injury prevalent setting, it is imperative that injury mortality is kept to a minimum. The CRASH-2 trial showed that Tranexamic acid (TXA) in severe injury reduces mortality. Implementation of this into injury protocols has been slow despite the evidence. The 2013 Western Cape Emergency Medicine Guidelines adopted the use of TXA. This study aims to describe compliance. Methods A retrospective study of TXA use in adult injury patients presenting to Khayelitsha Hospital was done. A sample of 301 patients was randomly selected from Khayelitsha’s resuscitation database and data were supplemented through chart review. The primary endpoint was compliance with local guidance: systolic blood pressure <90 or heart rate >110 or a significant risk of haemorrhage. Injury Severity Score (ISS) was used as a proxy for the latter. ISS >16 was interpreted as high risk of haemorrhage and ISS <8 as low risk. Linear regression and Fischer’s Exact test were used to explore assumptions. Results Overall compliance was 58% (172 of 295). For those without an indication, this was 96% (172 of 180). Of the 115 patients who had an indication, only eight (18%) received the first dose of TXA and none received a follow-up infusion. Compliance with the protocol was significantly better if an indication for TXA did not exist, compared to when one did (p<0.001). Increased TXA use was associated only with ISS >15 (p<0.001). Discussion TXA is not used in accordance with local guidelines. It was as likely not to be used when indicated than when not indicated. Reasons for this are multifactorial and likely include stock levels, lack of administration equipment, time to reach definitive care, poor documentation and hesitancy to use. Further investigation is needed to understand the barriers to administration.

      PubDate: 2017-04-19T20:18:48Z
      DOI: 10.1016/j.afjem.2017.04.006
       
  • Percutaneous coronary intervention still not accessible for many South
           Africans

    • Authors: Willem Stassen; Lee Wallis; Craig Lambert; Maaret Castren; Lisa Kurland
      Abstract: Publication date: Available online 19 April 2017
      Source:African Journal of Emergency Medicine
      Author(s): Willem Stassen, Lee Wallis, Craig Lambert, Maaret Castren, Lisa Kurland
      Introduction The incidence of myocardial infarction is rising in Sub-Saharan Africa. In order to reduce mortality, timely reperfusion by percutaneous coronary intervention (PCI) or thrombolysis followed by PCI is required. South Africa has historically been characterised by inequities in healthcare access based on geographic and socioeconomic status. We aimed to determine the coverage of PCI-facilities in South Africa and relate this to access based on population and socio-economic status. Methods This cross-sectional study obtained data from literature, directories, organisational databases and correspondence with Departments of Health and hospital groups. Data was analysed descriptively while Spearman’s Rho sought correlations between PCI-facility resources, population, poverty and medical insurance status. Results South Africa has 62 PCI-facilities. Gauteng has the most PCI-facilities (n=28) while the Northern Cape has none. Most PCI-facilities (n=48; 77%) are owned by the private sector. A disparity exists between the number of private and state-owned PCI-facilities when compared to the poverty (r=0.01; p=0.17) and insurance status of individuals (r=−0.4; p=0.27). Conclusion For many South Africans, access to PCI-facilities and primary PCI is still impossible given their socio-economic status or geographical locale. Research is needed to determine the specific PCI-facility needs based on geographic and epidemiological aspects, and to develop a contextualised solution for South Africans suffering a myocardial infarction.

      PubDate: 2017-04-19T20:18:48Z
      DOI: 10.1016/j.afjem.2017.04.009
       
  • Student paramedic rapid sequence intubation in Johannesburg, South Africa:
           A case series

    • Authors: Christopher Stein
      Abstract: Publication date: Available online 7 March 2017
      Source:African Journal of Emergency Medicine
      Author(s): Christopher Stein
      Introduction Pre-hospital rapid sequence intubation was introduced within paramedic scope of practice in South Africa seven years ago. Since then, little data has been published on this high-risk intervention as practiced operationally or by students learning rapid sequence intubation in the pre-hospital environment. The objective of this study was to describe a series of pre-hospital rapid sequence intubation cases, including those that South African University paramedic students had participated in. Methods A University clinical learning database was searched for all endotracheal intubation cases involving the use of neuromuscular blockers between 1 January 2011 and 31 December 2015. Data from selected cases were extracted and analysed descriptively. Results Data indicated that most patients were young adult trauma victims with a dominant injury mechanism of vehicle-related accidents. The majority of cases utilised ketamine and suxamethonium, with a low rate of additional paralytic medication administration. 63% and 72% of patients received post-intubation sedation and analgesia, respectively. The overall intubation success rate from complete records was 99.6%, with a first pass success rate of 87.9%. Students were successful in 92.4% of attempts with a first-pass success rate of 85.2%. Five percent of patients experienced cardiac arrest between rapid sequence intubation and hospital arrival. Discussion Students demonstrated a good intubation success and first pass-success rate. However, newly qualified paramedics require strict protocols, clinical governance, and support to gain experience and perform pre-hospital rapid sequence intubation at an acceptable level in operational practice. More research is needed to understand the low rate of post-intubation paralysis, along with non-uniform administration of post-intubation sedation and analgesia, and the 5% prevalence of cardiac arrest.

      PubDate: 2017-03-08T08:14:05Z
      DOI: 10.1016/j.afjem.2017.01.005
       
  • In this issue…

    • Abstract: Publication date: March 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 1


      PubDate: 2017-03-08T08:14:05Z
       
  • Global research highlights

    • Abstract: Publication date: March 2017
      Source:African Journal of Emergency Medicine, Volume 7, Issue 1


      PubDate: 2017-03-08T08:14:05Z
       
  • Stability of warmed and cooled intravenous fluids used in Emergency Room

    • Authors: Doudou Nzaumvila; Indiran Govender
      Abstract: Publication date: Available online 14 February 2017
      Source:African Journal of Emergency Medicine
      Author(s): Doudou Nzaumvila, Indiran Govender


      PubDate: 2017-02-16T10:39:50Z
      DOI: 10.1016/j.afjem.2017.01.008
       
  • Emergency care capabilities in the Kingdom of Swaziland, Africa

    • Authors: Erika Phindile Chowa; Janice A. Espinola; Ashley F. Sullivan; Masitsela Mhlanga; Carlos A. Camargo
      Abstract: Publication date: Available online 28 January 2017
      Source:African Journal of Emergency Medicine
      Author(s): Erika Phindile Chowa, Janice A. Espinola, Ashley F. Sullivan, Masitsela Mhlanga, Carlos A. Camargo
      Introduction Emergency care is available in many forms in Swaziland, and to our knowledge there has never been a systematic study of emergency centres (ECs) in the country. The purpose of this study was to describe the characteristics, resources and capacity of emergency centres in the Kingdom. Methods The National Emergency Department Inventory (NEDI)-International survey instrument (www.emnet-nedi.org) was used to survey all Swaziland ECs accessible to the general public 24/7. EC staff were asked about calendar year 2014. Data were entered directly into Lime Survey, a free, web-based, open-source survey application. Responses were analysed using descriptive statistics, including proportions and medians with interquartile ranges (IQR). Results Sixteen of 17 ECs participated (94% response rate). Participating ECs were either in hospitals (69%) or health centres (31%). ECs had a median of 53,399 visits per year (IQR 15,000–97,895). Fourteen (88%) ECs had a contiguous layout, and the other two (12%) were non-contiguous. Overall, eight (53%) had access to cardiac monitors and 11 (69%) had a 24/7 clinical laboratory available. Only 1 (6%) EC had a dedicated CT scanner, while 2 (13%) others had limited access through their hospital. The typical EC length-of-stay was between 1 and 6h (44%). The most commonly available specialists were general surgeons, with 9 (56%) ECs having them available for in-person consultation. No ECs had a plastic surgeon or psychiatrist available. Overall, 75% of ECs reported running at overcapacity. Discussion Swaziland ECs were predominantly contiguous and running at overcapacity, with high patient volumes and limited resources. The limited access to technology and specialists are major challenges. We believe that these data support greater resource allocation by the Swaziland government to the emergency care sector.

      PubDate: 2017-02-02T08:52:48Z
      DOI: 10.1016/j.afjem.2017.01.004
       
  • African emergency care providers’ attitudes and practices towards
           research

    • Authors: D.J. van Hoving; P. Brysiewicz
      Abstract: Publication date: Available online 28 January 2017
      Source:African Journal of Emergency Medicine
      Author(s): D.J. van Hoving, P. Brysiewicz
      Introduction Emergency care research in Africa is not on par with other world regions. The study aimed to assess the perceptions and practices towards research among current emergency care providers in Africa. Methods A survey was sent to all individual members of the African Federation of Emergency Medicine. The survey was available in English and French. Results One hundred and sixty-eight responses were analysed (invited n=540, responded n=188, 34.8%, excluded n=20). Responders’ mean age was 36.3years (SD=9.1); 122 (72.6%) were male, 104 (61.9%) were doctors, and 127 (75.6%) were African trained. Thirty-seven (22%) have never been involved in research; 33 (19.6%) have been involved in ⩾5 research projects. African related projects were mostly relevant to African audiences (n=106, 63.1%). Ninety-four (56%) participants have never published. Forty-one (24.4%) were not willing to publish in open access journals requesting a publication fee; 65 (38.7%) will consider open access journals if fees are sponsored. Eighty responders (47.6%) frequently experienced access block to original articles due to subscription charges. Lack of research funding (n=108, 64.3%), lack of research training (n=86, 51.2%), and lack of allocated research time (n=76, 45.2%) were the main barriers to research involvement. Improvement of research skills (n=118, 70.2%) and having research published (n=117, 69.6%) were the top motivational factors selected. Responders agreed that research promotes critical thinking (n=137, 81.5%) and serve as an important educational tool (n=134, 80.4%). However, 134 (79.8%) feel that emergency care workers need to be shown how to use research to improve clinical practice. Most agreed that insufficient emergency care research is being conducted in Africa (n=113, 67.3%). Discussion There is scope to increase research involvement in emergency care in Africa, but solutions need to be find to address lack of research-related funding, training and time.

      PubDate: 2017-02-02T08:52:48Z
      DOI: 10.1016/j.afjem.2017.01.003
       
  • Case mix of patients managed in the resuscitation area of a district-level
           public hospital in Cape Town

    • Authors: L.D. Hunter; S. Lahri; D.J. van Hoving
      Abstract: Publication date: Available online 28 January 2017
      Source:African Journal of Emergency Medicine
      Author(s): L.D. Hunter, S. Lahri, D.J. van Hoving


      PubDate: 2017-02-02T08:52:48Z
      DOI: 10.1016/j.afjem.2017.01.001
       
  • Cervical collars and immobilisation: A South African best practice
           recommendation

    • Authors: D. Stanton; T. Hardcastle; D. Muhlbauer; D. van Zyl
      Abstract: Publication date: Available online 28 January 2017
      Source:African Journal of Emergency Medicine
      Author(s): D. Stanton, T. Hardcastle, D. Muhlbauer, D. van Zyl
      Introduction The consequences of spinal injury as a result of trauma can be devastating. Spinal immobilisation using hard trauma boards and rigid cervical collars has traditionally been the standard response to suspected spinal injury patients even though the risk may be extremely low. Recently, adverse events due to the method of immobilisation have challenged the need for motion restriction in all trauma patients. International guidelines have been published for protection of the spine during transport and this article brings those guidelines into the South African context. Recommendations Trauma patients need to be properly assessed using both an approved list of high and low risk factors, as well as a thorough examination. They should then be managed accordingly. Internationally validated assessment strategies have been developed, and should be used as part of the patient assessment. The method of motion restriction should be selected to suit the situation. The use of a vacuum mattress is the preferable technique, with the use of a trauma board being the least desirable. Conclusion The need for motion restriction in suspected spinal injury should be properly evaluated and appropriate action taken. Not all trauma patients require spinal motion restriction.

      PubDate: 2017-02-02T08:52:48Z
      DOI: 10.1016/j.afjem.2017.01.007
       
  • A description of pharmacological analgesia administration by public sector
           advanced life support paramedics in the City of Cape Town

    • Authors: Ryan Matthews; Michael McCaul; Wayne Smith
      Abstract: Publication date: Available online 28 January 2017
      Source:African Journal of Emergency Medicine
      Author(s): Ryan Matthews, Michael McCaul, Wayne Smith
      Introduction Emergency Medical Services are ideally placed to provide relief of acute pain and discomfort. The objectives of this study were to describe pre-hospital pain management practices by Emergency Medical Services in the Western Cape, South Africa. Methods A retrospective, descriptive survey was undertaken of analgesic drug administration by advanced life support paramedics. Patient care records generated in the City of Cape Town during an 11-month period containing administrations of morphine, ketamine, nitrates and 50% nitrous oxide/oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. Results A total of 530 patient care records were included (n=530). Morphine was administered in 371 (70%, 95% CI 66–74) cases, nitrates in 197 (37%, 95% CI 33–41) and ketamine in 9 (1.7%, 95% CI 1–3) cases. A total of 5mg or less of morphine was administered in 278 (75%, 95% CI 70–79) cases, with the median dose being 4mg (IQR 3–6). Single doses were administered to 268 (72.2%, 95% CI 67–77) morphine administrations, five (56%, 95% CI 21–86) ketamine administrations and 161 (82%, 95% CI 76–87) of nitrate administrations. Chest pain was the reason for pain management in 226 (43%) cases. Advanced Life Support Providers had a median experience level of two years (IQR 2–4). Discussion Pre-hospital acute pain management in the Western Cape does not appear to conform to best practice as Advanced Life Support providers in the Western Cape use low doses of morphine. Chest pain is an important reason for drug administration in acute pre-hospital pain. Multimodal analgesia is not a feature of care in this pre-hospital service. The development of a Clinical Practice Guideline for and training in pre-hospital pain should be viewed as imperative.

      PubDate: 2017-02-02T08:52:48Z
      DOI: 10.1016/j.afjem.2017.01.002
       
  • A systematic review of burn injuries in low- and middle-income countries:
           Epidemiology in the WHO-defined African Region

    • Authors: Megan M. Rybarczyk; Jesse M. Schafer; Courtney M. Elm; Shashank Sarvepalli; Pavan A. Vaswani; Kamna S. Balhara; Lucas C. Carlson; Gabrielle A. Jacquet
      Abstract: Publication date: Available online 28 January 2017
      Source:African Journal of Emergency Medicine
      Author(s): Megan M. Rybarczyk, Jesse M. Schafer, Courtney M. Elm, Shashank Sarvepalli, Pavan A. Vaswani, Kamna S. Balhara, Lucas C. Carlson, Gabrielle A. Jacquet
      Introduction According to the World Health Organization (WHO), burns result in the loss of approximately 18 million disability adjusted life years (DALYs) and more than 250,000 deaths each year, more than 90% of which are in low- and middle-income countries (LMICs). The epidemiology of these injuries, especially in the WHO-defined African Region, has yet to be adequately defined. Methods We performed a systematic review of the literature regarding the epidemiology of thermal, chemical, and electrical burns in the WHO-defined African Region. All articles indexed in PubMed, EMBASE, Web of Science, Global Health, and the Cochrane Library databases as of October 2015 were included. Results The search resulted in 12,568 potential abstracts. Through multiple rounds of screening using criteria determined a priori, 81 manuscripts with hospital-based epidemiology as well as eleven manuscripts that included population-based epidemiology were identified. Although the studies varied in methodology, several trends were noted: young children appear to be at most risk; most individuals were burned at home; and hot liquids and flame are the most common aetiologies. Discussion While more population-based research is essential to identifying specific risk factors for targeted prevention strategies, our review identifies consistent trends for initial efforts at eliminating these often devastating and avoidable injuries.

      PubDate: 2017-02-02T08:52:48Z
      DOI: 10.1016/j.afjem.2017.01.006
       
  • Bedside ultrasound as a simple non-invasive method of assessing
           intracranial pressure in limited resource setting

    • Authors: Ayalew Zewdie; Haymanot Tesema; Abenezer Tirsit Aklilu; Tsegazeab Laeke Teklemariam; Tigist Zewdu; Yordanos Ashagre; Yemsrach Bizuneh; Aklilu Azazh; Getaw Worku Hassen
      Abstract: Publication date: Available online 22 July 2016
      Source:African Journal of Emergency Medicine
      Author(s): Ayalew Zewdie, Haymanot Tesema, Abenezer Tirsit Aklilu, Tsegazeab Laeke Teklemariam, Tigist Zewdu, Yordanos Ashagre, Yemsrach Bizuneh, Aklilu Azazh, Getaw Worku Hassen
      Introduction Increased intracranial pressure is usually measured with invasive methods that are not practical in resource-limited countries. However, bedside ultrasound, a non-invasive method, measures the optic nerve sheath diameter and could be a safe and accurate alternative to measure intracranial pressure, even in children. Case report We report a case of a 15-year old patient who presented with severe headache, projectile vomiting, and neck pain for two months. The bedside ultrasound showed a 10mm optic nerve sheath diameter and a Computed Tomography scan of her brain revealed obstructive hydrocephalus secondary to a mass in the fourth ventricle. After intervening, we were able to monitor the decrease in her optic nerve sheath diameter with ultrasound. Conclusion Performing invasive procedures continues to be a challenge in the resource limited setting. However, bedside ultrasound can be a useful tool in emergency centres for early detection and monitoring of intracranial pressure.

      PubDate: 2016-07-26T00:41:59Z
      DOI: 10.1016/j.afjem.2016.06.002
       
  • South African pre-hospital guidelines: Report on progress and way forward

    • Authors: Michael McCaul; Ben de Waal; Peter Hodkinson; Karen Grimmer
      Pages: 113 - 115
      Abstract: Publication date: Available online 20 August 2016
      Source:African Journal of Emergency Medicine
      Author(s): Michael McCaul, Ben de Waal, Peter Hodkinson, Karen Grimmer


      PubDate: 2016-08-25T11:09:38Z
      DOI: 10.1016/j.afjem.2016.08.004
       
  • Developing metrics for emergency care research in low- and middle-income
           countries

    • Authors: Samer Abujaber; Cindy Y. Chang; Teri A. Reynolds; Hani Mowafi; Ziad Obermeyer
      Pages: 116 - 124
      Abstract: Publication date: Available online 12 August 2016
      Source:African Journal of Emergency Medicine
      Author(s): Samer Abujaber, Cindy Y. Chang, Teri A. Reynolds, Hani Mowafi, Ziad Obermeyer
      Introduction There is little research on emergency care delivery in low- and middle-income countries (LMICs). To facilitate future research, we aimed to assess the set of key metrics currently used by researchers in these settings and to propose a set of standard metrics to facilitate future research. Methods Systematic literature review of 43,109 published reports on general emergency care from 139 LMICs. Studies describing care for subsets of emergency conditions, subsets of populations, and data aggregated across multiple facilities were excluded. All facility- and patient-level statistics reported in these studies were recorded and the most commonly used metrics were identified. Results We identified 195 studies on emergency care delivery in LMICs. There was little uniformity in either patient- or facility-level metrics reported. Patient demographics were inconsistently reported: only 33% noted average age and 63% the gender breakdown. The upper age boundary used for paediatric data varied widely, from 5 to 20years of age. Emergency centre capacity was reported using a variety of metrics including annual patient volume (n =175, 90%); bed count (n =60, 31%), number of rooms (n =48, 25%); frequently none of these metrics were reported (n =16, 8%). Many characteristics essential to describe capabilities and performance of emergency care were not reported, including use and type of triage; level of provider training; admission rate; time to evaluation; and length of EC stay. Conclusion We found considerable heterogeneity in reporting practices for studies of emergency care in LMICs. Standardised metrics could facilitate future analysis and interpretation of such studies, and expand the ability to generalise and compare findings across emergency care settings.

      PubDate: 2016-08-15T10:01:39Z
      DOI: 10.1016/j.afjem.2016.06.003
       
  • Bedside ultrasound training at Muhimbili National Hospital in Dar es
           Salaam, Tanzania and Hospital San Carlos in Chiapas, Mexico

    • Authors: Teri A. Reynolds; Jeanne Noble; Gehres Paschal; Hendry Robert Sawe; Aparajita Sohoni; Sachita Shah; Bret Nicks; Victor Mwafongo; John Stein
      Pages: 125 - 131
      Abstract: Publication date: Available online 7 April 2016
      Source:African Journal of Emergency Medicine
      Author(s): Teri A. Reynolds, Jeanne Noble, Gehres Paschal, Hendry Robert Sawe, Aparajita Sohoni, Sachita Shah, Bret Nicks, Victor Mwafongo, John Stein
      Introduction In resource-rich settings, bedside ultrasound has rapidly evolved to be a crucial part of emergency centre practice and a growing part of critical care practice. This portable and affordable technology may be even more valuable in resource-limited environments where other imaging modalities are inaccessible, but the optimal amount of training required to achieve competency in bedside ultrasound is largely unknown. We sought to evaluate the feasibility of implementation of a mixed-modality bedside ultrasound training course for emergency and generalist acute care physicians in limited resource settings, and to provide a description of our core course components, including specific performance goals, to facilitate implementation of similar initiatives. Methods We conducted a standardised training course at two distinct sites—one large, urban tertiary hospital in Tanzania with a dedicated Emergency Centre, and one small, rural, hospital in southern Mexico with a general, acute intake area. We report on pre-training ultrasound use at both sites, as well as pre- and post-training views on most useful indications. Results Overall, participants were very satisfied with the course, although approximately one-third of the providers at both sites would have preferred more hands-on training. All participants passed a standardised exam requiring image acquisition and interpretation. Discussion Introducing bedside ultrasound training in two distinct resource-limited settings was feasible and well-received. After a brief intensive period of training, participants successfully passed a comprehensive examination, including demonstration of standardised image acquisition and accurate interpretation of normal and abnormal studies.

      PubDate: 2016-04-08T23:57:06Z
      DOI: 10.1016/j.afjem.2016.03.001
       
  • A pilot training program for point-of-care ultrasound in Kenya

    • Authors: Greg Bell; Benjamin Wachira; Gerene Denning
      Pages: 132 - 137
      Abstract: Publication date: Available online 6 April 2016
      Source:African Journal of Emergency Medicine
      Author(s): Greg Bell, Benjamin Wachira, Gerene Denning
      Introduction Ultrasound is an effective and affordable clinical diagnostic tool highly attractive for use in low and middle income countries (LMICs), but access to training programs in these countries is limited. The objective of our study was to develop and pilot a program for healthcare providers in Kenya in the use of point-of-care ultrasound. Methods Trainees were recruited in district hospitals for participation in three all-day workshops held every 3–5months from September 2013 through November 2014. Prior to the initial workshop, trainees were asked to study a training manual, and a knowledge test was administered. Ultrasound-credentialed emergency physicians provided brief didactic lessons then hands-on training for eFAST and obstetric training. This was followed by an observed assessment of scanning image quality (IM) and diagnostic interpretation (IN). Results Eighty-one trainees enrolled in four initial training sessions and 30 attended at least one refresher session. Among those trainees who attended refresher sessions, there was an increase in the proportion passing both the knowledge and practical tests at the follow-up, as compared to the initial session. Overall, mean practical skill scores also trended toward an increase over time, with a significantly higher mean score in November (2.64+0.38, p =0.02) as compared to March (2.26+0.54), p <0.05. Pre-workshop preparation evolved over time with the goal of maximizing trainee readiness for the hands-on course. A strong correlation was observed between knowledge and practical skill scores illustrating the importance of pre-workshop training. Conclusions Our pilot workshop showed promise in promoting knowledge and practical skills among participants, as well as increasing use in patient care. Results also suggest that refresher training may provide additional benefits for some participants. These findings provide a strong rationale for expanding the training program and for measuring its clinical impact.

      PubDate: 2016-04-07T23:52:35Z
      DOI: 10.1016/j.afjem.2016.03.002
       
  • Added value of graded compression ultrasound to the Alvarado score in
           cases of right iliac fossa pain

    • Authors: Mohamed Samir; Mohamed Hefzy; Mohamed Gaber; Khaled Moghazy
      Pages: 138 - 143
      Abstract: Publication date: Available online 7 April 2016
      Source:African Journal of Emergency Medicine
      Author(s): Mohamed Samir, Mohamed Hefzy, Mohamed Gaber, Khaled Moghazy
      Introduction Acute appendicitis is one of the most common emergencies treated by the general surgeon. Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality, and surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. The aim of this study was to evaluate the sensitivity and specificity of the Alvarado score combined with ultrasounds of the abdomen and pelvis in cases of right iliac fossa pain with suspected acute appendicitis. Methods 100 patients admitted to the Department of Surgery at Alexandria Main University Hospital in 2013 complaining of right iliac fossa pain with suspected acute appendicitis were studied prospectively. The demographic information, histopathology, physical examination, laboratory data, Alvarado score, sonography report and histopathological reports of these patients were gathered. The treating surgeon made decisions for surgery or conservative management without any intervention from the research team. Results A combination of methods showed that Alvarado alone was 100% sensitive in excluding appendicitis at scores below five and was highly specific at scores above eight (91.9%) with no added value when combining it with ultrasound in those scores. On the other hand, ultrasound was beneficial only in patients with Alvarado scores between five and eight for detecting appendicitis and not excluding it (increasing specificity to 100% and not affecting sensitivity). Conclusion Ultrasound is a good adjuvant examination in cases with Alvarado scores between five and eight in order to diagnose appendicitis. Negative ultrasound results do not exclude appendicitis and further assessment by other modalities should be performed.

      PubDate: 2016-04-07T23:52:35Z
      DOI: 10.1016/j.afjem.2016.02.004
       
  • Conservative management of gunshot oesophageal injuries: A report of two
           consecutive exceptional cases

    • Authors: Francesco Virdis; Sharfuddin Chowdhury; Andrew John Nicol; Pradeep Harkison Navsaria
      Pages: 144 - 147
      Abstract: Publication date: Available online 29 June 2016
      Source:African Journal of Emergency Medicine
      Author(s): Francesco Virdis, Sharfuddin Chowdhury, Andrew John Nicol, Pradeep Harkison Navsaria
      Introduction Oesophageal trauma carries high mortality and morbidity. For penetrating intrathoracic oesophageal injury, surgical repair has been the standard for decades to avoid its devastating consequences. Case report Both patients presented with a thoracoabdominal gunshot wound and retained intraabdominal missile. Although there were no visible signs of perforation on oesophagoscopy or contrast swallow, the presence of an intraluminal bullet highly suggested a thoracic oesophageal injury. Discussion Non-operative management of intrathoracic oesophageal perforation is controversial. Small perforations or contained leaks diagnosed within 24–48h in a stable patient with no mediastinitis or empyema can be managed non-operatively with antibiotics and nasogastric feeds. These two case reports support the notion of selective non-operative management of asymptomatic patients with penetrating injury to the oesophagus.

      PubDate: 2016-07-20T00:03:30Z
      DOI: 10.1016/j.afjem.2016.05.007
       
  • Message in a bottle. The use of chest radiography for diagnosis of
           pericardial effusion

    • Authors: James Foley; Lai Pun Tong; Navin Ramphul
      Pages: 148 - 150
      Abstract: Publication date: Available online 29 June 2016
      Source:African Journal of Emergency Medicine
      Author(s): James Foley, Lai Pun Tong, Navin Ramphul
      Introduction The diagnosis of pericardial effusion may be elusive, and only diagnosed with echocardiography. Case reports Here we report the cases of two patients who presented to the emergency centre (EC) with dyspnoea, and their chest X-rays (CXR) revealed the “water bottle sign”, which is the typical appearance of the cardiac silhouette that is present when there is a large pericardial effusion. Discussion This clinched the diagnosis of pericardial effusion, where the diagnosis may have otherwise been delayed. We discuss these cases, and the relevant literature and discuss the benefits of standard chest radiography in aiding in the diagnosis of pericardial effusion.

      PubDate: 2016-07-20T00:03:30Z
      DOI: 10.1016/j.afjem.2016.01.004
       
  • In this issue…

    • Abstract: Publication date: December 2016
      Source:African Journal of Emergency Medicine, Volume 6, Issue 4


      PubDate: 2016-12-10T15:04:57Z
       
  • An assessment of nurse-led triage at Connaught Hospital, Sierra Leone in
           the immediate post-Ebola period

    • Authors: Richard Lowsby; Cecilia Kamara; Michael Kamara; Hedda Nyhus; Nathaniel Williams; Michael Bradfield; Hooi-Ling Harrison
      Abstract: Publication date: Available online 12 November 2016
      Source:African Journal of Emergency Medicine
      Author(s): Richard Lowsby, Cecilia Kamara, Michael Kamara, Hedda Nyhus, Nathaniel Williams, Michael Bradfield, Hooi-Ling Harrison


      PubDate: 2016-11-13T01:46:15Z
      DOI: 10.1016/j.afjem.2016.10.003
       
  • Global research highlights

    • Abstract: Publication date: Available online 8 November 2016
      Source:African Journal of Emergency Medicine


      PubDate: 2016-11-13T01:46:15Z
       
  • Uchunguzi (Journal Watch/Montre de Journal)

    • Authors: Benjamin Wachira
      Abstract: Publication date: Available online 5 November 2016
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin W. Wachira


      PubDate: 2016-11-06T01:36:49Z
       
  • Emergency care conference in the land of a thousand hills

    • Authors: Gabin Mbanjumucyo; Giles N. Cattermole
      Abstract: Publication date: Available online 5 November 2016
      Source:African Journal of Emergency Medicine
      Author(s): Gabin Mbanjumucyo, Giles N. Cattermole


      PubDate: 2016-11-06T01:36:49Z
      DOI: 10.1016/j.afjem.2016.11.002
       
  • A brave African discussion on emergency medicine

    • Authors: Jocelyn Park-Ross
      Abstract: Publication date: Available online 5 November 2016
      Source:African Journal of Emergency Medicine
      Author(s): Jocelyn Park-Ross


      PubDate: 2016-11-06T01:36:49Z
      DOI: 10.1016/j.afjem.2016.11.001
       
  • The first Tanzanian Conference on Emergency Medicine

    • Authors: Hendry R. Sawe; Elizabeth M. Rojo; Marwa Obogo; Juma A. Mfinanga; Irene Kulola; Upendo George; Victor G. Mwafongo
      Abstract: Publication date: Available online 5 November 2016
      Source:African Journal of Emergency Medicine
      Author(s): Hendry R. Sawe, Elizabeth M. Rojo, Marwa Obogo, Juma A. Mfinanga, Irene Kulola, Upendo George, Victor G. Mwafongo


      PubDate: 2016-11-06T01:36:49Z
      DOI: 10.1016/j.afjem.2016.11.003
       
  • The role of wilderness medicine training in resource-limited settings

    • Authors: Jay Matthew
      Abstract: Publication date: Available online 5 November 2016
      Source:African Journal of Emergency Medicine
      Author(s): Jay Matthew


      PubDate: 2016-11-06T01:36:49Z
      DOI: 10.1016/j.afjem.2016.11.004
       
  • Epidemiology of injuries and outcomes among trauma patients receiving
           prehospital care at a tertiary teaching hospital in Kigali, Rwanda

    • Authors: Gabin Mbanjumucyo; Naomi George; Alexis Kearney; Naz Karim; Adam R. Aluisio; Zeta Mutabazi; Olivier Umuhire; Samuel Enumah; John W. Scott; Eric Uwitonze; Jeanne D’Arc Nyinawankusi; Jean Claude Byiringiro; Ignace Kabagema; Georges Ntakiyiruta; Sudha Jayaraman; Robert Riviello; Adam C. Levine
      Abstract: Publication date: Available online 28 October 2016
      Source:African Journal of Emergency Medicine
      Author(s): Gabin Mbanjumucyo, Naomi George, Alexis Kearney, Naz Karim, Adam R. Aluisio, Zeta Mutabazi, Olivier Umuhire, Samuel Enumah, John W. Scott, Eric Uwitonze, Jeanne D’Arc Nyinawankusi, Jean Claude Byiringiro, Ignace Kabagema, Georges Ntakiyiruta, Sudha Jayaraman, Robert Riviello, Adam C. Levine
      Introduction Injury accounts for 9.6% of the global mortality burden, disproportionately affecting those living in low- and middle-income countries. In an effort to improve trauma care in Rwanda, the Ministry of Health developed a prehospital service, Service d’Aide Médicale Urgente (SAMU), and established an emergency medicine training program. However, little is known about patients receiving prehospital and emergency trauma care or their outcomes. The objective was to develop a linked prehospital–hospital database to evaluate patient characteristics, mechanisms of injury, prehospital and hospital resource use, and outcomes among injured patients receiving acute care in Kigali, Rwanda. Methods A retrospective cohort study was conducted at University Teaching Hospital – Kigali, the primary trauma centre in Rwanda. Data was included on all injured patients transported by SAMU from December 2012 to February 2015. SAMU’s prehospital database was linked to hospital records and data were collected using standardised protocols by trained abstractors. Demographic information, injury characteristics, acute care, hospital course and outcomes were included. Results 1668 patients were transported for traumatic injury during the study period. The majority (77.7%) of patients were male. The median age was 30years. Motor vehicle collisions accounted for 75.0% of encounters of which 61.4% involved motorcycles. 48.8% of patients sustained injuries in two or more anatomical regions. 40.1% of patients were admitted to the hospital and 78.1% required surgery. The overall mortality rate was 5.5% with nearly half of hospital deaths occurring in the emergency centre. Conclusion A linked prehospital and hospital database provided critical epidemiological information describing trauma patients in a low-resource setting. Blunt trauma from motor vehicle collisions involving young males constituted the majority of traumatic injury. Among this cohort, hospital resource utilisation was high as was mortality. This data can help guide the implementation of interventions to improve trauma care in the Rwandan setting.

      PubDate: 2016-10-29T22:50:11Z
      DOI: 10.1016/j.afjem.2016.10.001
       
  • Development of a trauma and emergency database in Kigali, Rwanda

    • Authors: Alexis S. Kearney; Lise M. Kabeja; Naomi George; Naz Karim; Adam R. Aluisio; Zeta Mutabazi; Jean Eric Uwitonze; Jeanne D’Arc Nyinawankusi; Jean Claude Byiringiro; Adam C. Levine
      Abstract: Publication date: Available online 28 October 2016
      Source:African Journal of Emergency Medicine
      Author(s): Alexis S. Kearney, Lise M. Kabeja, Naomi George, Naz Karim, Adam R. Aluisio, Zeta Mutabazi, Jean Eric Uwitonze, Jeanne D’Arc Nyinawankusi, Jean Claude Byiringiro, Adam C. Levine
      Introduction Injuries account for 10% of the global burden of disease, resulting in approximately 5.8 million deaths annually. Trauma registries are an important tool in the development of a trauma system; however, limited resources in low- and middle-income countries (LMIC) make the development of high-quality trauma registries challenging. We describe the development of a LMIC trauma registry based on a robust retrospective chart review, which included data derived from prehospital, emergency centre and inpatient records. Methods This paper outlines our methods for identifying and locating patients and their medical records using pragmatic and locally appropriate record linkage techniques. A prehospital database was queried to identify patients transported to University Teaching Hospital – Kigali, Rwanda from December 2012 through February 2015. Demographic information was recorded and used to create a five-factor identification index, which was then used to search OpenClinic GA, an online open source hospital information system. The medical record number and archive number obtained from OpenClinic GA were then used to locate the physical medical record for data extraction. Results A total of 1668 trauma patients were transported during the study period. 66.7% were successfully linked to their medical record numbers and archive codes. 94% of these patients were successfully linked to their medical record numbers and archive codes were linked by four or five of the five pre-set identifiers. 945 charts were successfully located and extracted for inclusion in the trauma registry. Record linkage and chart extraction took approximately 1256h. Conclusion The process of record linkage and chart extraction was a resource-intensive process; however, our unique methodology resulted in a high linkage rate. This study suggests that it is feasible to create a retrospective trauma registry in LMICs using pragmatic and locally appropriate record linkage techniques.

      PubDate: 2016-10-29T22:50:11Z
      DOI: 10.1016/j.afjem.2016.10.002
       
  • Mawasiliano (Correspondence/Correspondance)

    • Abstract: Publication date: Available online 17 October 2016
      Source:African Journal of Emergency Medicine


      PubDate: 2016-10-29T22:50:11Z
       
  • In this issue…

    • Abstract: Publication date: September 2016
      Source:African Journal of Emergency Medicine, Volume 6, Issue 3


      PubDate: 2016-09-19T13:07:50Z
       
  • Focused assessment with sonography for HIV-associated tuberculosis (FASH)
           case series from a Rwandan district hospital

    • Authors: Gabin Mbanjumucyo; Patricia C. Henwood
      Abstract: Publication date: Available online 6 September 2016
      Source:African Journal of Emergency Medicine
      Author(s): Gabin Mbanjumucyo, Patricia C. Henwood
      Introduction The majority of HIV-TB co-infection worldwide is reported in Africa. The risk of developing extra-pulmonary tuberculosis (EPTB) increases as immune deficiency progresses but is difficult to diagnose. Point-of-care ultrasonography (POCUS) can be an effective adjunct to identify and treat EPTB-associated findings using the focused assessment with sonography for HIV-associated TB (FASH) protocol. Case report Three HIV-infected patients without known history of EPTB presented to a Rwandan district hospital with fever and unclear infection. Initial testing did not reveal a source. Each patient was then evaluated with the FASH protocol by a Rwandan emergency physician with POCUS training. All patients had findings suggestive of EPTB by ultrasound. Anti-TB treatment was initiated, and all subsequently demonstrated symptom improvement. Discussion This case series demonstrates the additional clinical information obtained. It describes how management was changed using POCUS and the FASH in a resource-limited setting in Rwanda and calls for further FASH protocol validation studies.

      PubDate: 2016-09-09T12:06:49Z
      DOI: 10.1016/j.afjem.2016.07.001
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Authors: Michael Gottlieb
      Abstract: Publication date: Available online 4 September 2016
      Source:African Journal of Emergency Medicine
      Author(s): Michael Gottlieb


      PubDate: 2016-09-09T12:06:49Z
      DOI: 10.1016/j.afjem.2016.08.007
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Authors: Michael Gottlieb
      Abstract: Publication date: Available online 3 September 2016
      Source:African Journal of Emergency Medicine
      Author(s): Michael Gottlieb


      PubDate: 2016-09-03T11:51:18Z
      DOI: 10.1016/j.afjem.2016.08.007
       
  • Uchunguzi (Journal Watch/Montre de Journal)

    • Authors: Benjamin Wachira
      Abstract: Publication date: Available online 21 August 2016
      Source:African Journal of Emergency Medicine
      Author(s): Benjamin W. Wachira


      PubDate: 2016-08-25T11:09:38Z
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Authors: Emmanuel Kwasi Acheampong
      Abstract: Publication date: Available online 16 August 2016
      Source:African Journal of Emergency Medicine
      Author(s): Emmanuel Kwasi Acheampong


      PubDate: 2016-08-20T10:39:13Z
      DOI: 10.1016/j.afjem.2016.08.001
       
  • Seeking health care from a general hospital in Uganda following a fracture
           or a dislocation

    • Authors: Isaac Kajja; Cees Th. Smit Sibinga
      Abstract: Publication date: Available online 25 July 2016
      Source:African Journal of Emergency Medicine
      Author(s): Isaac Kajja, Cees Th. Smit Sibinga
      Introduction Selecting a treatment approach and a facility to get treated from, poses a challenge in musculoskeletal injuries in Africa. The study aimed at determining demographic and injury characteristics of patients with musculoskeletal injuries and how these impact the time and reason for presenting to a general hospital in Uganda. Methods An observational study was carried out at Entebbe general hospital on patients presenting with musculoskeletal injuries between 1 November 2014 and 28 February 2015. The patient demographics, injury characteristics, duration of injury to presentation for treatment and reason for seeking treatment from this hospital were noted. Results A total of 101 patients were recruited. Of these, 95 had fractures while six had dislocations. Patients took an average of 96h before presenting for care, females taking significantly longer than males (191.2 and 58.6h respectively, p =0.005). The fractured segment of bone significantly influenced the patients’ choice for care at this hospital (p =0.02). Discussion Entebbe General Hospital serves a young and unemployed population for musculoskeletal injuries. These patients present late for care, especially females. Patients base their choice for care from this hospital on the character of the injury.

      PubDate: 2016-07-26T00:41:59Z
      DOI: 10.1016/j.afjem.2016.05.008
       
  • The clinical profile and acute care of patients with traumatic spinal cord
           injury at a tertiary care emergency centre in Addis Ababa, Ethiopia

    • Authors: Finot Debebe; Assefu Woldetsadik; Adam D. Laytin; Aklilu Azazh; James Maskalyk
      Abstract: Publication date: Available online 22 July 2016
      Source:African Journal of Emergency Medicine
      Author(s): Finot Debebe, Assefu Woldetsadik, Adam D. Laytin, Aklilu Azazh, James Maskalyk
      Introduction Traumatic spinal cord injuries can have catastrophic physical, psychological, and social consequences, particularly in low resource settings. Since many of these injuries result in irreversible damages, it is essential to understand risk factors for them and focus on primary prevention strategies. The objectives of this study are to describe the demographics, injury characteristics, and management of traumatic spinal cord injury victims presenting to the Adult Emergency Centre of Tikur Anbessa Specialised Hospital in Addis Ababa, the tertiary referral centre for emergency care in Ethiopia. Methods A prospective cross sectional survey was conducted from October 2013 to March 2014 in the Adult Emergency Centre of Tikur Anbessa Specialised Hospital. Patients were identified at triage and followed through admission to discharge from the emergency centre. Results Eighty-four patients with traumatic spinal cord injuries were identified. The mean age was 33years and 86% were male. The most common mechanisms of injury were motor vehicle collisions (37%), falls (31%), and farming injuries (11%). The cervical spine (48%) was the most commonly injured region and 41% were complete spinal cord injuries. Most patients (77%) did not receive any prehospital care or medical care at other facilities prior to arrival in the Emergency Centre. Conclusion In our context, traumatic spinal cord injuries predominantly affect young men, and the majority of victims suffer severe injuries with little chance of recovery. Attention to occupational and road traffic safety is essential to mitigate the personal and societal burdens of traumatic spinal cord injuries. It is also imperative to focus on improving prehospital care and rehabilitation services for traumatic spinal cord injury victims.

      PubDate: 2016-07-26T00:41:59Z
      DOI: 10.1016/j.afjem.2016.06.001
       
  • Ujuzi (Practical Pearl/Perle Pratique)

    • Authors: Johanna Catharina Botha
      Abstract: Publication date: Available online 26 March 2016
      Source:African Journal of Emergency Medicine
      Author(s): Johanna Catharina Botha


      PubDate: 2016-03-30T23:18:34Z
      DOI: 10.1016/j.afjem.2016.02.002
       
 
 
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