African Journal of Emergency Medicine最新文献

{"title":"Perceptions, availability and use of vasopressors for septic shock in emergency care settings in Tanzania","authors":"Said Kilindimo ,&nbsp;Forrest Turner ,&nbsp;Raya Musa ,&nbsp;Collin Russell ,&nbsp;Adeline Dozois ,&nbsp;Hendry Sawe","doi":"10.1016/j.afjem.2025.05.003","DOIUrl":"10.1016/j.afjem.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis carries a disproportionately high mortality in Sub-Saharan Africa. Current international guidelines for management of septic shock advocate for initial fluid resuscitation followed by vasopressors if there is ongoing concern for hypoperfusion. Emerging data suggest patients in sub-Saharan Africa who receives large fluid boluses may have increased mortality and thus earlier initiation of vasopressors may have clinical benefit. Little data exists on the perceptions, availability and use of vasopressors in Tanzania, which may impact the feasibility of this strategy. We aimed to describe the perception, availability and use of vasopressor in Tanzanian emergency care settings, including its barriers.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional web-based survey among clinicians and nurses from 19 different hospitals throughout Tanzania (national, zonal, regional and district hospitals). Collected data was kept by the principal investigator on a password encrypted computer whereby descriptive statistics were used to summarize the results.</div></div><div><h3>Results</h3><div>Sixty-five healthcare providers completed the survey of whom the majority 53 (81.5 %), work in the emergency medicine department and 50 (76.9 %) reported treating at least one patient with septic shock per week. However, three quarters of respondents from district hospitals and nearly half of those from regional hospitals had access to vasopressors in &lt;50 % of the time. The most common reported barriers to vasopressor use were lack of availability (50.8 %), and lack of comfort or knowledge (43.1 %). Overall, most respondents perceived that vasopressor use is generally safe and helpful for treating septic shock.</div></div><div><h3>Conclusions</h3><div>Nearly all Tanzanian healthcare providers in emergency care settings reported that they had limited access to vasopressors to treat septic shock, as it was not consistently available. In addition to unavailability, lack of knowledge on vasopressor use was also reported as barrier. Our findings suggest that ensuring availability of vasopressors and education in the use thereof would improve sepsis care in Tanzanian hospitals.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100879"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alphachloralose intoxication: A retrospective study on epidemiology, clinical presentation, and management in an adult emergency department in Morocco","authors":"El Mehdi Samali ,&nbsp;Abdelghafour El Koundi ,&nbsp;Amine Meskine ,&nbsp;Hicham Balkhi ,&nbsp;Mohammed Moussaoui","doi":"10.1016/j.afjem.2025.100887","DOIUrl":"10.1016/j.afjem.2025.100887","url":null,"abstract":"<div><h3>Background</h3><div>Alphachloralose, initially used as a hypnotic and anesthetic, is now restricted to rodenticides. Despite limited medical use, it remains accessible in North Africa, contributing to intentional poisonings. Poisoning primarily presents with neurological and respiratory symptoms, posing a significant public health concern. This study describes the epidemiological, clinical, and therapeutic characteristics of alphachloralose poisoning cases admitted to the adult emergency department of a university hospital in Casablanca, Morocco.</div></div><div><h3>Methods</h3><div>A retrospective study analyzed emergency department records for alphachloralose poisoning cases from October 2022 to June 2023. Poisoning was confirmed based on clinical presentation, witness accounts, and/or biological toxicological evidence. Data on demographics, exposure circumstances, clinical features, interventions, and outcomes were extracted. Severity was evaluated using the Poisoning Severity Score (PSS), grading the severity into five levels from 0 (no symptoms) to 4 (fatal). Hospital stay duration and complications were also assessed.</div></div><div><h3>Results</h3><div>Some 53 cases were included, with mean age of patients 27 years, and a male-to-female ratio of 0.83. Suicidal ingestion accounted for the vast majority of cases (98 %). Alphachloralose was exclusively ingested in powdered form, as no other formulations are available in Morocco. Neurological and respiratory disturbances were the most common clinical manifestations, with 28 % of cases classified as severe according to the PSS. Gastric lavage was performed in 52.8 % of cases, benzodiazepines were administered in 54 %, and 39.6 % of patients required intubation. The median time to admission to intensive care was 5 h. The average duration of hospitalization was 2.4 ± 1.2 days. Although one fatality occurred, 98 % of cases recovered fully without complications, emphasizing the importance of early and appropriate management.</div></div><div><h3>Conclusion</h3><div>Alphachloralose poisoning is a significant toxicological concern in North Africa due to its availability and misuse. Severe symptoms are frequent, but early intervention leads to favorable outcomes. Public health measures focusing on regulation and education are essential.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100887"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data completeness and quality of emergency triage in Ethiopian public tertiary hospitals: A multicenter study","authors":"Woldesenbet Waganew ,&nbsp;Ayalew Zewde ,&nbsp;Sisay Yifru Abera ,&nbsp;Menbau Sultan ,&nbsp;Temesgen Beyene ,&nbsp;Tesfaye Getachew ,&nbsp;Bethelehem Tebebe ,&nbsp;Zelalem Getahun ,&nbsp;Daniel Alemu ,&nbsp;Esubalew Gobegnew ,&nbsp;Etsegent Aklog ,&nbsp;Tigist Bacha ,&nbsp;Sisay Teklu ,&nbsp;Aklilu Azazh ,&nbsp;Asefu W∕Tsadik","doi":"10.1016/j.afjem.2025.100888","DOIUrl":"10.1016/j.afjem.2025.100888","url":null,"abstract":"<div><h3>Introduction</h3><div>Triage is a system of ranking sick or injured persons according to their severity. Its data is critical for evidence-based action. The aim of this study was to assess the quality and completeness of emergency department triage tool in three tertiary Ethiopian public hospitals.</div></div><div><h3>Method</h3><div>This study utilized a multicenter cross-sectional design with sample size estimation calculated using a single population proportion formula. Data were collected from multiple sites and analyzed using the Statistical Package for the Social Sciences (SPSS), version 25. All statistical analyses were conducted to evaluate the completeness of triage documentation.</div></div><div><h3>Result</h3><div>In a review of 450 client charts from three tertiary hospitals providing acute care, the completeness of triage data varied. Patient name, age, and gender were documented with a completeness of 79.1 %, 77.5 %, and 70.8 %, respectively. The cumulative analysis of the triage early warning score showed, highest recorded completeness was for heart rate (98.4 %), followed closely by respiratory rate (96.0 %). However, significant discrepancies were noted in other areas, such as systolic blood pressure, which had an overall completeness of 87.7 %. Temperature assessment was notably poor, with a cumulative completeness of only 59.3 %. Other parameters, including mobility and AVPU/CNS assessments, showed completeness of 86.4 % each.</div></div><div><h3>Conclusion</h3><div>This study identifies significant inconsistencies in triage documentation completeness across three Ethiopian hospitals, highlighting an urgent need for interventions. Standardized triage scales and continuous professional development focusing on documentation are crucial to enhance patient safety and optimize care delivery.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100888"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing the Safe Airway Checklist (SAC) at the emergency department of a major teaching hospital in Rwanda: A pre- and post-intervention study","authors":"Joseph Biramahire ,&nbsp;Matthew Pereira ,&nbsp;Appolinaire Manirafasha ,&nbsp;Doris Lorette Uwamahoro ,&nbsp;Jean Paul Mvukiyehe ,&nbsp;Paulin Banguti ,&nbsp;Eugene Tuyishime","doi":"10.1016/j.afjem.2025.03.002","DOIUrl":"10.1016/j.afjem.2025.03.002","url":null,"abstract":"<div><h3>Background</h3><div>Airway management is a critical aspect of emergency care, and adherence to standardized protocols can improve patient outcomes. However, in resource-limited settings such as Rwanda, the implementation of airway management protocols in the emergency department (ED) may face challenges. This study aims to evaluate the impact of implementing the Safe Airway Checklist (SAC) on airway management practices and post-intubation complications in a major teaching hospital in Rwanda.</div></div><div><h3>Methods</h3><div>A pre- and post-intervention study design was used to assess the impact of the SAC on intubation practices and post-intubation checklist in the ED at the University Teaching Hospital of Kigali. The study included a baseline assessment of residents’ intubation practices, followed by implementation of the SAC, and post-implementation data collection to evaluate changes in adherence to airway management practices and post-intubation complications.</div></div><div><h3>Results</h3><div>Among 77 intubation (40 pre-intervention and 37 post-intervention), the implementation of the SAC led to improvement in 4 key airway management practices (airway cart and glidescope setup, premedication use, restraining patients, and checking ABG within 10–15 min) in the ED. However, the reduction in rates of post-intubation complications was not statistically significant.</div></div><div><h3>Conclusion</h3><div>The implementation of the Safe Airway Checklist in the ED of a major teaching hospital in Rwanda significantly improved several critical aspects of airway management. While no statistically significant reduction in post-intubation complications were observed, the decreasing trend of complication rates suggests promising benefits that merit further exploration. These findings highlight the value of standardized checklists in enhancing clinical practices and underscore the need for ongoing research to fully understand their impact on patient outcomes especially in low resources settings.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100871"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes of geriatric injuries presenting to an urban emergency department in Ghana","authors":"Hussein A Yakubu ,&nbsp;Jonathan Boakye-Yiadom ,&nbsp;Richmond O Marfo ,&nbsp;Rockefeller Oteng ,&nbsp;George Oduro","doi":"10.1016/j.afjem.2025.05.007","DOIUrl":"10.1016/j.afjem.2025.05.007","url":null,"abstract":"<div><h3>Introduction</h3><div>The elderly population is rapidly increasing in sub-Saharan Africa. Yet, their trauma care needs are often overlooked, and the epidemiology of their injuries remains poorly understood. This study aimed to describe the characteristics and outcomes of injuries in elderly patients treated at an urban emergency department (ED) in Ghana. Additionally, it aimed to identify the predictors of mortality that require focused attention.</div></div><div><h3>Methods</h3><div>A prospective cross-sectional survey of patients ≥ 60 years presenting with traumatic injuries between November 2021 and March 2022 was conducted at the ED of Komfo Anokye Teaching Hospital (KATH), Ghana’s second-largest hospital. Eligible patients were identified upon arrival in triage. Following initial resuscitation, trained research assistants obtained informed consent and collected patient data, including sociodemographic information, comorbidities, injury characteristics, and in-patient complications.</div></div><div><h3>Results</h3><div>Of the 2242 ED patients evaluated, 101 (4.7 %) were included. The median age was 69 years and sex distribution was even. Hypertension (48.5 %) was the most prevalent comorbidity. Falls (52.5 %) and motor vehicle collisions (40.6 %) were the predominant injury mechanisms, and isolated lower extremity injuries (39.6 %) were the most common. The majority of injuries were mild (65.4 % had an Injury Severity Score &lt; 9). Venous thromboembolism was the most common in-patient complication. Median length of stay was 6 days, but patients with complications stayed longer. The overall hospital mortality rate was 11.9 %. Predictors of mortality were triage score, admission Glasgow Coma Score, admission pulse rate and Kampala Trauma Score.</div></div><div><h3>Conclusion</h3><div>Geriatric injuries constitute a small fraction of trauma admissions in this hospital. Triage score, Glasgow Coma Scale, pulse rate and Kampala Trauma Score predicted mortality and could form the basis for a simple screening protocol in low-resource EDs.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100883"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock","authors":"Trudy D Leong ,&nbsp;Rephaim Mpofu ,&nbsp;Sumaya Dadan ,&nbsp;Karen Cohen ,&nbsp;Halima Dawood ,&nbsp;Tamara Kredo ,&nbsp;Andy Parrish ,&nbsp;Marc Blockman ,&nbsp;P. Dean Gopalan","doi":"10.1016/j.afjem.2025.05.005","DOIUrl":"10.1016/j.afjem.2025.05.005","url":null,"abstract":"<div><div>Background: Septic shock is associated with significant mortality. The International Surviving Sepsis Campaign guidelines recommend noradrenaline as first-line vasopressor, whilst South African guidelines recommend adrenaline. Clinical trials show similar efficacy but suggest safety advantages for noradrenaline. We reviewed the evidence comparing noradrenaline and adrenaline in the initial management of adult patients with septic shock.</div><div>Methods: We searched PubMed, Epistemonikos, Cochrane Library, and clinical trial registries for clinical practice guidelines, health technology assessments, and systematic reviews of randomised controlled trials (RCTs) through July 2024. We appraised these using AGREE II and AMSTAR 2 tools and assessed eligible RCTs extracted from systematic reviews with Cochrane's Risk of Bias 2.0 Tool. We estimated random-effects rate ratios (RR) and mean differences (MD) with 95 % confidence intervals and rated certainty of evidence using GRADE. Key outcomes included mortality, time to shock reversal, and adverse effects. (PROSPERO: CRD42022368373).</div><div>Results: We identified three guidelines, one systematic review, from which five RCTs were extracted. Comparing adrenaline to noradrenaline, we found little to no difference in mortality (RR 0.99, 0.83 to 1.18), time to improvement of mean arterial pressure (MD 7.17 min, -16.74 to 31.08), vasopressor-free days (MD -0.05 days, -4.07 to 3.96), or dysrhythmias (RR 0.92, 0.59 to 1.45). Change in lactate concentrations 24 h after resuscitation was lower for noradrenaline than adrenaline. The certainty of evidence was assessed as low to very low.</div><div>Conclusion: Adrenaline and noradrenaline are associated with similar outcomes in managing septic shock. The choice of vasopressor should be based on availability, patient population, and cost.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100881"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144516976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses’ knowledge on trauma and emergency care and associated factors in Ghanaian district hospitals","authors":"Akua K Karikari ,&nbsp;Adam Gyedu ,&nbsp;Isaac Yankson ,&nbsp;Dorcas Doefe Amedzake ,&nbsp;Peter Agyei-Baffour ,&nbsp;Anthony K Edusei ,&nbsp;Peter Donkor ,&nbsp;Charles Mock","doi":"10.1016/j.afjem.2025.04.004","DOIUrl":"10.1016/j.afjem.2025.04.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Nurses’ knowledge of emergency care is a vital component of emergency capabilities. We sought to evaluate the factors that influence the knowledge on trauma and emergency care of nurses in district hospitals in Ghana.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, we administered a questionnaire on emergency care to 406 nurses working in 11 (out of 37) randomly-selected district hospitals in the Ashanti Region. This included 10 multiple-choice questions on trauma care and 10 on general medical/surgical emergency care to objectively assess knowledge on emergency care. Analysis involved descriptive statistics, inferential tests comparing tests scores with Student’s <em>t</em>-tests and ANOVA, and multivariable linear regression.</div></div><div><h3>Results</h3><div>Mean overall test score for knowledge was 60.1 % correct (SD 13.7 %). Results were tightly clustered with an inter-quartile range of 50 % to 70 %. Factors influencing the test scores on multivariable linear regression included: (a) gender (male nurses scored an adjusted 3.8 % higher than female nurses, <em>p</em> = 0.015; beta=3.8; 95 %CI 0.7–6.8); and (b) refresher training (nurses who had received refresher training on emergency care scored an adjusted 3.3 % higher than those who had not received such training, <em>p</em> = 0.018; beta=3.3; CI 0.6–6.0). The higher overall scores for male nurses were due solely to higher scores on trauma-related questions. Male nurses scored an average of an adjusted 5.1 % higher on the trauma questions (<em>p</em> = 0.023; beta=5.1; CI 0.7–9.5) than female nurses, but their scores on general emergency care were not significantly different.</div></div><div><h3>Conclusions</h3><div>Test scores for knowledge on emergency care for nurses working in Ghanaian district hospitals were generally adequate. While gender did influence test scores, the main actionable factor associated with higher test scores was having received refresher training in emergency care. There is a need for greater availability of such continuing professional development for nurses.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100876"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentation and management of snakebite envenomation at a District Hospital in the north-east of South Africa","authors":"Matamba Jean Benoit Kabeya ,&nbsp;Darryl Wood ,&nbsp;Peter Hodkinson","doi":"10.1016/j.afjem.2025.05.002","DOIUrl":"10.1016/j.afjem.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>Snakebites have been recognised as a neglected tropical disease by the World Health Organization and remain a potentially preventable cause of morbidity around the world, particularly in Africa. South Africa (SA) has a well-documented prevalence of snakebites, and there has been a recent surge in attention on snakebite due to dwindling antivenom stocks. uMkhanyakude District in the far northeast of SA has one of the highest incidences of snakebite and uses more antivenom than elsewhere in SA, and the impact of antivenom shortages and the high prevalence of disease has not been assessed recently.</div></div><div><h3>Methods</h3><div>A descriptive, retrospective, observational study was undertaken to describe victims of snakebites presenting from 1 September 2019 to 31 August 2022 to a district hospital, Mosvold Hospital. Data were manually extracted from patients’ medical records. Information about demographics, clinical presentations, treatments and outcomes was collected and analysed.</div></div><div><h3>Results</h3><div>A total of 155 snakebite cases presented, with an incidence rate of 58 snakebite cases per 100 000 people per year. Most patients were young, with a median age of 19 years (range 0–94 years), and most bites occurred outdoors (75/155, 48.4 %). Patients were most often bitten on the lower limbs (107/155, 69.0 %), and most presented with minimal swelling (117/155, 75.5 %). Antivenom was administered to 33 patients (33/155, 21.3 %), and 24 (24/33, 72.7 %) of those who received antivenom experienced some form of post-antivenom reaction. Three patients died during their hospital stay, resulting in a mortality rate of 1.2 deaths per 100 000 people per year. Antivenom shortages contributed to the outcomes of several patients.</div></div><div><h3>Conclusion</h3><div>Cytotoxic snakebites are a not infrequent presentation, many requiring admission, antivenom and subsequent management. Emergency personnel need to be familiar with local protocols for snakebite management, and have the resources to manage severe envenomation, including access to antivenom. Expanding knowledge and education about snakebites provided to community members might also improve outcomes and prevent bites.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100878"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health research abstracts: June ‘25","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2025.100886","DOIUrl":"10.1016/j.afjem.2025.100886","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100886"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time delays in emergency stroke care in a low-resource referral hospital in Ghana","authors":"Hussein A Yakubu ,&nbsp;Richmond O Marfo ,&nbsp;Jonathan Boakye-Yiadom ,&nbsp;Freda M Aidoo ,&nbsp;Fred S Sarfo ,&nbsp;Rockefeller A Oteng","doi":"10.1016/j.afjem.2025.05.006","DOIUrl":"10.1016/j.afjem.2025.05.006","url":null,"abstract":"<div><h3>Background</h3><div>Patients in sub-Saharan Africa face significant delays in receiving appropriate stroke care, which negatively impacts outcomes. This study aimed to quantify the time delays in acute stroke care at the Komfo Anokye Teaching Hospital (KATH) and determine the effect on mortality.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of prospectively collected data on patients ≥ 18 years with Computed Tomography (CT) scan-confirmed stroke treated at KATH’s adult emergency department (ED) from November 2021 to March 2022. Patients were initially enrolled in a pilot stroke registry by trained research assistants, who documented relevant time points in their care. Patient outcome (dead or alive) was determined at time of hospital discharge and three months post-discharge. Data was analyzed using STATA™ version 16. The median times from stroke onset to ED arrival, physician evaluation, CT scan imaging, and treatment were measured and the relationship with mortality determined.</div></div><div><h3>Results</h3><div>Eighty-six patients with confirmed stroke were analyzed, comprising 40 males and 46 females. Ages ranged between 29 and 86 years, with mean of 57.4 years (SD 14.3). The median time from stroke onset to arrival at KATH ED was 35.3 h (IQR: 12.3–79.5). The median time from ED arrival to first physician evaluation was 1.3 h (IQR: 0.5–2.6); to CT imaging was 14.1 h (IQR: 4.3–40.8); and to antiplatelet treatment (for ischemic stroke) was 31.1 h (IQR: 16.1–42.5). The cumulative mortality rates at three months post-discharge were 8.7 % for patients who arrived at KATH’s ED within 4 h of symptom onset, 43.5 % for those arriving between 4 and 24 h, and 47.8 % for those arriving after 24 h, <em>p</em> = 0.036.</div></div><div><h3>Conclusion</h3><div>Significant delays occurred in all stages of stroke care at KATH’s ED. Improving stroke education and implementing contextually appropriate stroke codes can enable early patient presentations, improve intervention times, and reduce mortality rates.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100882"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}