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Emergency department deaths despite active management: Experience from a tertiary care centre in a low‐income country
Author(s) -
Khan Nadeem U,
Razzak Junaid A,
Alam Syed MH,
Ahmad Humaid
Publication year - 2007
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2007.00920.x
Subject(s) - medicine , sepsis , emergency department , confidence interval , pneumonia , retrospective cohort study , myocarditis , pediatrics , emergency medicine , myocardial infarction , psychiatry
Objective: To determine the frequency and causes of ED deaths despite active management, in a tertiary care centre of a low‐income country. Methods: We conducted a retrospective chart review over a 2 year period (January 2001–December 2002) for all patients who died despite active management in an ED in Karachi, Pakistan. Results: Of the 78 418 patient visits, 601 patients (0.7%) were pronounced dead. Of these, 577 patients had complete records. Seventy per cent of these were dead‐on‐arrival, 1% had do‐not‐resuscitate orders and 29% ( n = 166; 95% confidence interval [CI] 25–32%) died despite active management. Initial vital signs were found to be abnormal in almost all cases (98%). The leading causes of death were sepsis (23%; 95% CI 19–26%), myocardial infarction (19.7%; 95% CI 16–22%), cerebrovascular accident (10.7%; 95% CI 8–13%) and pneumonia (8.2%; 95% CI 6–10%) among adults and sepsis (36.4%; 95% CI 32–40%), myocarditis (15.9%; 95% CI 13–18%) and pneumonia (9.1%; 95% CI 6–11%) among children. Conclusion: Sepsis is the leading cause of death in patients of all age groups in the ED of this hospital.