title: An observational study of adults seeking emergency care in Cambodia.
abstract: OBJECTIVE
  To describe the characteristics and chief complaints of adults seeking emergency care at two Cambodian provincial referral hospitals.
  
  
  METHODS
  Adults aged 18 years or older who presented without an appointment at two public referral hospitals were enrolled in an observational study. Clinical and demographic data were collected and factors associated with hospital admission were identified. Patients were followed up 48 hours and 14 days after presentation.
  
  
  RESULTS
  In total, 1295 hospital presentations were documented. We were able to follow up 85% (1098) of patients at 48 hours and 77% (993) at 14 days. The patients' mean age was 42 years and 64% (823) were females. Most arrived by motorbike (722) or taxi or tuk-tuk (312). Most common chief complaints were abdominal pain (36%; 468), respiratory problems (15%; 196) and headache (13%; 174). Of the 1050 patients with recorded vital signs, 280 had abnormal values, excluding temperature, on arrival. Performed diagnostic tests were recorded for 539 patients: 1.2% (15) of patients had electrocardiography and 14% (175) had diagnostic imaging. Subsequently, 783 (60%) patients were admitted and 166 of these underwent surgery. Significant predictors of admission included symptom onset within 3 days before presentation, abnormal vital signs and fever. By 14-day follow-up, 3.9% (39/993) of patients had died and 19% (192/993) remained functionally impaired.
  
  
  CONCLUSIONS
  In emergency admissions in two public hospitals in Cambodia, there is high admission-to-death ratio and limited application of diagnostic techniques. We identified ways to improve procedures, including better documentation of vital signs and increased use of diagnostic techniques.
authors.affiliation: Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States of America (USA).
authors.forename: Lily D
authors.initials: LD
authors.lastname: Yan
authors.affiliation: Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States of America (USA).
authors.forename: Swaminatha V
authors.initials: SV
authors.lastname: Mahadevan
authors.affiliation: Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States of America (USA).
authors.forename: Mackensie
authors.initials: M
authors.lastname: Yore
authors.affiliation: Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States of America (USA).
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Pirrotta
authors.affiliation: University Research Co. Centre for Human Services, Phnom Penh, Cambodia .
authors.forename: Joan
authors.initials: J
authors.lastname: Woods
authors.affiliation: University Research Co. Centre for Human Services, Phnom Penh, Cambodia .
authors.forename: Koy
authors.initials: K
authors.lastname: Somontha
authors.affiliation: Deutsche Gesellschaft für Internationale Zusammenarbeit, Phnom Penh, Cambodia .
authors.forename: Yim
authors.initials: Y
authors.lastname: Sovannra
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, USA .
authors.forename: Maya
authors.initials: M
authors.lastname: Raman
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, USA .
authors.forename: Erika
authors.initials: E
authors.lastname: Cornell
authors.affiliation: University Research Co. Centre for Human Services, Phnom Penh, Cambodia .
authors.forename: Christophe
authors.initials: C
authors.lastname: Grundmann
authors.affiliation: Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States of America (USA).
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Strehlow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002160:Cambodia; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult