title: Emergency care in 59 low- and middle-income countries: a systematic review.
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CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers.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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America (USA).
authors.forename: Ziad
authors.initials: Z
authors.lastname: Obermeyer
authors.affiliation: Brigham and Women's Hospital, Boston, USA .
authors.forename: Samer
authors.initials: S
authors.lastname: Abujaber
authors.affiliation: Brigham and Women's Hospital, Boston, USA .
authors.forename: Maggie
authors.initials: M
authors.lastname: Makar
authors.affiliation: Harvard Affiliated Emergency Medicine Residency Program, Boston, USA .
authors.forename: Samantha
authors.initials: S
authors.lastname: Stoll
authors.affiliation: Brigham and Women's Hospital, Boston, USA .
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Kayden
authors.affiliation: University of Cape Town, Cape Town, South Africa .
authors.forename: Lee A
authors.initials: LA
authors.lastname: Wallis
authors.affiliation: University of California at San Francisco, San Francisco, USA .
authors.forename: Teri A
authors.initials: TA
authors.lastname: Reynolds
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D016208:Databases, Factual; D003906:Developing Countries; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010564:Personnel, Hospital / Q000193:education / Q000706:statistics & numerical data; D011203:Poverty; D011787:Quality of Health Care; D014944:World Health Organization; D055815:Young Adult