title: Dead on arrival in a low-income country: results from a multicenter study in Pakistan.
abstract: BACKGROUND
  This study assessed the characteristics of dead on arrival (DOA) patients in Pakistan.
  
  
  METHODS
  Data about the DOA patients were extracted from Pakistan National Emergency Department Surveillance study (Pak-NEDS). This study recruited all ED patients presenting to seven tertiary care hospitals during a four-month period between November 2010 and March 2011. This study included patients who were declared dead-on-arrival by the ED physician.
  
  
  RESULTS
  A total of 1,557 DOA patients (7 per 1,000 visits) were included in the Pak-NEDS. Men accounted for two-thirds (64%) of DOA patients. Those aged 20-49 years accounted for about 46% of DOA patients. Nine percent (n = 72) of patients were brought by ambulance, and most patients presented at a public hospital (80%). About 11% of DOA patients had an injury. Factors significantly associated (p < 0.05) with ambulance use were men (adjusted odds ratio [aOR] = 2.72), brought to a private hospital (OR = 2.74), and being injured (aOR = 1.89). Cardiopulmonary resuscitation (CPR) was performed on 6% (n = 42) of patients who received treatment. Those brought to a private hospital were more likely to receive CPR (aOR = 2.81).
  
  
  CONCLUSIONS
  This study noted a higher burden of DOA patients in Pakistan compared to other resourceful settings (about 1 to 2 per 1,000 visits). A large proportion of patients belonging to productive age groups, and the low prevalence of ambulance and CPR use, indicate a need for improving the prehospital care and basic life support training in Pakistan.
authors.forename: Munawar
authors.initials: M
authors.lastname: Khursheed
authors.forename: Junaid
authors.initials: J
authors.lastname: Bhatti
authors.forename: Fatima
authors.initials: F
authors.lastname: Parukh
authors.forename: Asher
authors.initials: A
authors.lastname: Feroze
authors.forename: Syed
authors.initials: S
authors.lastname: Naeem
authors.forename: Haseeb
authors.initials: H
authors.lastname: Khawaja
authors.forename: Junaid
authors.initials: J
authors.lastname: Razzak
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010154:Pakistan / Q000453:epidemiology; D011159:Population Surveillance; D017678:Sex Distribution; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult