title: Emergency Department of a Rural Hospital in Ecuador.
abstract: BACKGROUND
  There is a paucity of data studying patients and complaints presenting to emergency departments (EDs) in low- and middle-income countries. The town of Pedro Vicente Maldonado (PVM) is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM) is a rural teaching hospital providing family medicine residency training. These physicians provide around-the-clock acute medical care in HPVM's ED. This study provides a first look at a functioning ED in rural Latin America by reviewing one year of ED visits to HPVM.
  
  
  METHODS
  All ED visits between April 14, 2013, and April 13, 2014, were included and analyzed, totaling 1,239 patient visits. Data were collected from their electronic medical record and exported into a de-identified Excel® database where it was sorted and categorized. Variables included age, gender, mode of arrival, insurance type, month and day of the week of the service, chief complaint, laboratory and imaging requests, and disposition. We performed descriptive statistics, and where possible, comparisons using Student's T or chi-square, as appropriate.
  
  
  RESULTS
  Of the 1239 total ED visits, 48% were males and 52% females; 93% of the visits were ambulatory, and 7% came by ambulance. Sixty-three percent of the patients had social security insurance. The top three chief complaints were abdominal pain (25.5%), fever (15.1%) and trauma (10.8%). Healthcare providers requested labs on 71.3% of patients and imaging on 43.2%. The most frequently requested imaging studies were chest radiograph (14.9%), upper extremity radiograph (9.4%), and electrocardiogram (9.0%). There was no seasonal or day-of-week variability to number of ED patients. The chief complaint of human or animal bite made it more likely the patient would be admitted, and the chief complaint of traumatic injury made it more likely the patient would be transferred.
  
  
  CONCLUSIONS
  Analysis of patients presenting to a rural ED in Ecuador contributes to the global study of acute care in the developing world and also provides a self-analysis identifying disease patterns of the area, training topics for residents, areas for introducing protocols, and information to help planning for rural EDs in low- and middle-income countries.
authors.affiliation: Maricopa Medical Center, Department of Emergency Medicine, Phoenix, Arizona.
authors.forename: Tara
authors.initials: T
authors.lastname: Johnson
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, Madison, Wisconsin.
authors.forename: David
authors.initials: D
authors.lastname: Gaus
authors.affiliation: Central University of Ecuador, Catholic University of Ecuador, Department of Family Medicine, Santo Domingo, Ecuador.
authors.forename: Diego
authors.initials: D
authors.lastname: Herrera
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology*; D002985:Clinical Protocols; D004484:Ecuador / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005334:Fever / Q000453:epidemiology*; D019538:Health Care Surveys; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency; D017410:Practice Guidelines as Topic; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D014947:Wounds and Injuries / Q000453:epidemiology*
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