Limits...
Emergency care in 59 low- and middle-income countries: a systematic review.

Obermeyer Z, Abujaber S, Makar M, Stoll S, Kayden SR, Wallis LA, Reynolds TA, Acute Care Development Consorti - Bull. World Health Organ. (2015)

Bottom Line: We extracted data on patient outcomes and demographics as well as facility and provider characteristics.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America (USA).

ABSTRACT

Objective: To conduct a systematic review of emergency care in low- and middle-income countries (LMICs).

Methods: We searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards.

Findings: We identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2-5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3-8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5-6.3%). The median number of patients was 30 000 per year (IQR: 10 296-60 000), most of whom were young (median age: 35 years; IQR: 6.9-41.0) and male (median: 55.7%; IQR: 50.0-59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care.

Conclusion: Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings.

No MeSH data available.


Flowchart for the selection of records on the delivery of emergency care in low- and middle-income countries
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4581659&req=5

Figure 1: Flowchart for the selection of records on the delivery of emergency care in low- and middle-income countries

Mentions: Fig. 1 shows the results of our literature search. Of the 195 relevant published studies identified (Table 1; available at: http://www.who.int/bulletin/volumes/93/14/07-148338), 170 (87%) were descriptive reports on hospital-based emergency departments whereas the other 25 (13%) described the impact of an intervention. We obtained relevant unpublished data on a further 16 facilities. After combining multiple reports from the same facility and separating paediatric and adult data – for the three facilities with disaggregated data – we had data on 192 individual facilities in 59 countries. Of the 192 facilities, 107 (56%) were academically affiliated, 11 (6%) were in rural areas and 36 (19%) served paediatric patients exclusively; in the remaining 38, facility type could not be identified. Further information on the health facilities is available from the corresponding author.


Emergency care in 59 low- and middle-income countries: a systematic review.

Obermeyer Z, Abujaber S, Makar M, Stoll S, Kayden SR, Wallis LA, Reynolds TA, Acute Care Development Consorti - Bull. World Health Organ. (2015)

Flowchart for the selection of records on the delivery of emergency care in low- and middle-income countries
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4581659&req=5

Figure 1: Flowchart for the selection of records on the delivery of emergency care in low- and middle-income countries
Mentions: Fig. 1 shows the results of our literature search. Of the 195 relevant published studies identified (Table 1; available at: http://www.who.int/bulletin/volumes/93/14/07-148338), 170 (87%) were descriptive reports on hospital-based emergency departments whereas the other 25 (13%) described the impact of an intervention. We obtained relevant unpublished data on a further 16 facilities. After combining multiple reports from the same facility and separating paediatric and adult data – for the three facilities with disaggregated data – we had data on 192 individual facilities in 59 countries. Of the 192 facilities, 107 (56%) were academically affiliated, 11 (6%) were in rural areas and 36 (19%) served paediatric patients exclusively; in the remaining 38, facility type could not be identified. Further information on the health facilities is available from the corresponding author.

Bottom Line: We extracted data on patient outcomes and demographics as well as facility and provider characteristics.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America (USA).

ABSTRACT

Objective: To conduct a systematic review of emergency care in low- and middle-income countries (LMICs).

Methods: We searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards.

Findings: We identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2-5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3-8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5-6.3%). The median number of patients was 30 000 per year (IQR: 10 296-60 000), most of whom were young (median age: 35 years; IQR: 6.9-41.0) and male (median: 55.7%; IQR: 50.0-59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care.

Conclusion: Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings.

No MeSH data available.