title: Emergency department deaths despite active management: experience from a tertiary care centre in a low-income country.
abstract: To determine the frequency and causes of ED deaths despite active management, in a tertiary care centre of a low-income country.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Sepsis is the leading cause of death in patients of all age groups in the ED of this hospital.
authors.affiliation: Section of Emergency Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan. nadeemullah.khan@aku.edu
authors.forename: Nadeem U
authors.initials: NU
authors.lastname: Khan
authors.forename: Junaid A
authors.initials: JA
authors.lastname: Razzak
authors.forename: Syed M H
authors.initials: SMH
authors.lastname: Alam
authors.forename: Humaid
authors.initials: H
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D002423:Cause of Death; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D011795:Surveys and Questionnaires