Patterns and predictors of early mortality among emergency department patients in Addis Ababa, Ethiopia.
BACKGROUND
Ethiopian emergency department (ED) patients have a considerable burden of illness and injury for which all-cause mortality rates have not previously been published. This study sought to characterize the burden of and to identify predictors for early all-cause mortality among patients presenting to the Tikur Anbessa Specialized Hospital ED (TASH-ED) in Ethiopia.


METHODS
Data was prospectively collected from the records of all patients who died within 72 h of ED presentation. Pearson's Chi square and Fisher's exact tests were used to investigate associations between two outcome variables: (a) time to death and (b) immediate cause of death in relation to specific demographic and clinical factors. Time from ED presentation to death was dichotomized as 'very early' mortality within ≤6 h and death >6-72 h and logistic regression was used to assess the adjusted impact of these demographic and clinical variables on the probability of dying within 6 h of ED presentation.


RESULTS
Between October 2012 and May 2013, 9956 patients visited the ED and 220 patients died within 72 h of admission. After excluding patients dead on arrival (n = 34), the average age of death was 43.1 years and the overall mortality rate was 1.9 %. Head injury (21.5 %) and sepsis (18.8 %) were the most common causes of death. Relative to medical patients, trauma patients were more likely to be male (p < 0.01), less likely to have had prior recent ED visits (p < 0.01) and more likely to be triaged as higher acuity (p = 0.04). The sole statistically significant predictor of death within 6 h from our multivariable logistic regression model was symptom duration less than 4 h (4-48 h vs. <4 h: OR = 0.20, 95 % CI 0.07, 0.53, p < 0.01; >48 h vs. <4 h: OR = 0.27, 95 % CI 0.09, 0.81, p = 0.02).


CONCLUSIONS
The mortality burden of trauma and sepsis in the TASH-ED is substantial, and mortality patterns differ between these groups. As emergency medicine develops as a specialty in the Ethiopian health system, the potential impact of context-specific clinical care protocol development, trauma prevention advocacy and ED care re-organization initiatives to reduce mortality among these young, previously well patients warrants exploration.
Department of Family and Community Medicine, Schwartz/Reisman Emergency Medicine Institute, Mount Sinai Hospital, University of Toronto, 600 University Avenue Rm 206, Toronto, ON, M5G 1X5, Canada. chunchak@gmail.com.
Cheryl
C
Hunchak
Department of Obstetrics and Gynecology and Emergency Medicine, Addis Ababa University School of Medicine, Zambia Street, Addis Ababa, Ethiopia. siteet@yahoo.com.
Sisay
S
Teklu
Department of Medicine, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. nmeshkat@gmail.com.
Nazanin
N
Meshkat
Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada. Christopher.Meaney@utoronto.ca.
Christopher
C
Meaney
Department of Medicine, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. lisa.puchalskiritchie@utoronto.ca.
Lisa
L
Puchalski Ritchie
D000328:Adult; D002423:Cause of Death; D004636:Emergency Service, Hospital; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012307:Risk Factors