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- Aspelund, Amalia Liljequist, et al.
(författare)
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Evaluating trauma scoring systems for patients presenting with gunshot injuries to a district-level urban public hospital in Cape Town, South Africa
- 2019
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Ingår i: African journal of emergency medicine. - : Elsevier. - 2211-419X .- 2211-4203. ; 9:4, s. 193-196
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Trauma scoring systems are widely used in emergency settings to guide clinical decisions and to predict mortality. It remains unclear which system is most suitable to use for patients with gunshot injuries at district-level hospitals. This study compares the Triage Early Warning Score (TEWS), Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), Kampala Trauma Score (KTS) and Revised Trauma Score (RTS) as predictors of mortality among patients with gunshot injuries at a district-level urban public hospital in Cape Town, South Africa.Methods: Gunshot-related patients admitted to the resuscitation area of Khayelitsha Hospital between 1 January 2016 and 31 December 2017 were retrospectively analysed. Receiver Operating Characteristic (ROC) analysis were used to determine the accuracy of each score to predict all-cause in-hospital mortality. The odds ratio (with 95% confidence intervals) was used as a measure of association.Results: In total, 331 patients were included in analysing the different scores (abstracted from database n = 431, excluded: missing files n = 16, non gunshot injury n = 10, <14 years n = 1, information incomplete to calculate scores n = 73). The mortality rate was 6% (n = 20). The TRISS and KTS had the highest area under the ROC curve (AUC), 0.90 (95% CI 0.83-0.96) and 0.86 (95% CI 0.79-0.94), respectively. The KTS had the highest sensitivity (90%, 95% CI 68-99%), while the TEWS and RTS had the highest specificity (91%, 95% CI 87-94% each).Conclusions: None of the different scoring systems performed better in predicting mortality in this high-trauma burden area. The results are limited by the low number of recorded deaths and further studies are needed.
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| 4. |
- Möller, Anders, et al.
(författare)
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The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town
- 2018
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Ingår i: African Journal of Emergency Medicine. - : Elsevier. - 2211-419X. ; 8:3, s. 89-94
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Trauma is a leading cause of unnatural death and disability in South Africa. The aim of the study was to determine whether method of transport, hospital arrival time or prehospital transport time intervals were associated with in-hospital mortality among trauma patients presenting to Khayelitsha Hospital, a district-level hospital on the outskirts of Cape Town, South Africa.Methods: The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for trauma-related patients presenting to the resuscitation area between 1 November 2014 and 30 April 2015. Missing data and additional variables were collected by means of a chart review. Eligible patients' folders were scrutinised for hospital arrival time, transport time intervals, transport method and in-hospital mortality. Descriptive statistics were presented for all variables. Categorical data were analysed using the Fisher's Exact test and Chi-square, continuous data by logistic regression and the Mann Whitney test. A confidence interval of 95% was used to describe variance and a p-value of < 0.05 was deemed significant.Results: The majority of patients were 19-44 year old males (n=427, 80.3%) and penetrating trauma the most frequent mechanism of injury (n=343, 64.5%). In total, 258 (48.5%) patients arrived with their own transport, 254 (47.7%) by ambulance and 20 (3.8%) by the police service. The arrival of trauma patients peaked during the weekend, and was especially noticeable between midnight and six a. m. In-hospital mortality (n=18, 3.4%) was not significantly affected by transport method (p=0.26), hospital arrival time (p=0.22) or prehospital transport time intervals (all p-values > 0.09).Discussion: Method of transport, hospital arrival time and prehospital transport time intervals did not have a substantially measurable effect on in-hospital mortality. More studies with larger samples are suggested due to the small event rate.
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| 5. |
- Stassen, Willem, et al.
(författare)
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A Prehospital Randomised Controlled Trial in South Africa : Challenges and Lessons Learnt
- 2019
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Ingår i: African Journal of Emergency Medicine. - : Elsevier. - 2211-419X. ; 9:3, s. 145-149
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of cardiovascular disease and STEMI is on the rise in sub-Saharan Africa. Timely treatment is essential to reduce mortality. Internationally, prehospital 12 lead ECG telemetry has been proposed to reduce time to reperfusion. Its value in South Africa has not been established. The aim of this study was to determine the effect of prehospital 12 lead ECG telemetry on the PCI-times of STEMI patients in South Africa. A multicentre randomised controlled trial was attempted among adult patients with prehospital 12 lead ECG evidence of STEMI. Due to poor enrolment and small sample sizes, meaningful analyses could not be made. The challenges and lessons learnt from this attempt at Africa's first prehospital RCT are discussed. Challenges associated with conducting this RCT related to the healthcare landscape, resources, training of paramedics, rollout and randomisation, technology, consent and research culture. High quality evidence to guide prehospital emergency care practice is lacking both in Africa and the rest of the world. This is likely due to the difficulties with performing prehospital clinical trials. Every trial will be unique to the test intervention and setting of each study, but by considering some of the challenges and lessons learnt in the attempt at this trial, future studies might experience less difficulty. This may lead to a stronger evidence-base for prehospital emergency care.
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| 6. |
- Stassen, Willem, et al.
(författare)
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The application of optimisation modelling and geospatial analysis to propose a coronary care network model for patients with ST-elevation myocardial infarction
- 2020
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Ingår i: African Journal of Emergency Medicine. - : Elsevier BV. - 2211-419X. ; 10:Suppl 1, s. S18-S22
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe incidence of myocardial infarction is increasing in South Africa. Prompt treatment is indicated to reduce mortality. One way of expediting treatment is to set up regional referral recommendations that can guide prehospital providers on the best reperfusion strategy for a particular patient. A coronary care network model for patients who present with ST-elevation myocardial infarction is proposed, using the North West province, of South Africa as a case study.MethodsGeospatial analysis with network optimisation modelling was applied, to determine which strategy (prehospital thrombolysis, in-hospital thrombolysis or percutaneous coronary intervention) was most appropriate for patients presenting within each of the municipal wards of the North West province.ResultsAn efficient and swift recommendation for the optimal reperfusion strategy is obtained using the current model, even in the instance of a large amount of ward data with additional constraints. For most municipal wards (204, 53%) percutaneous coronary intervention is the preferred reperfusion strategy based on proximity. For the remainder of the wards prehospital (138, 36%) or in-hospital (44, 11%) thrombolysis is recommended.ConclusionA scalable and efficient method of determining the optimal reperfusion strategy for a patient presenting with ST-elevation myocardial infarction in the North West province, is presented. This approach can serve as a model which can be applied to other settings and can form the basis of regional coronary care network development priorities and resource allocations.
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| 7. |
- Erlingsson, Christen, 1956-, et al.
(författare)
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A hands-on guide to doing content analysis
- 2017
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Ingår i: African Journal of Emergency Medicine. - : Elsevier. - 2211-419X. ; 7:3, s. 93-99
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- There is a growing recognition for the important role played by qualitative research and its usefulness in many fields, including the emergency care context in Africa. Novice qualitative researchers are often daunted by the prospect of qualitative data analysis and thus may experience much difficulty in the data analysis process. Our objective with this manuscript is to provide a practical hands-on example of qualitative content analysis to aid novice qualitative researchers in their task. (C) 2017 African Federation for Emergency Medicine. Publishing services provided by Elsevier B.V.
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| 8. |
- Erlingsson, Christen, 1956-, et al.
(författare)
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Orientation among multiple truths : An introduction to qualitative research
- 2013
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Ingår i: African Journal of Emergency Medicine. - : Elsevier BV. - 2211-419X. ; 3:2, s. 92-99
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Tidskriftsartikel (refereegranskat)abstract
- In order to provide some guidance for the researcher unfamiliar with qualitative research, this article compares quantitative and qualitative research, and introduces a number of qualitative methods. Aspects of methodological rigor are also presented as well as an example of qualitative data analysis using content analysis. Qualitative research methods explore, in a holistic fashion, the complex reality constructed by individuals in the context of their everyday worlds. Qualitative research is based on the subjective, looking at human realities instead of concrete realities of objects. When conducting a qualitative study the researcher is part of the study and is, in fact, the research instrument. The qualitative researcher embraces the ontological assumption of multiple truths, multiple realities, i.e., persons understand reality in different ways that reflect individual perspectives.
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| 10. |
- Moses, J. Fallah, et al.
(författare)
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Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia
- 2015
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Ingår i: African Journal of Emergency Medicine. - : Elsevier BV. - 2211-419X. ; 5:2, s. 60-65
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes. Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia, Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality. Results Median age was 33 years and 85% were males. A majority of the patients (70%) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5 days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35%. Median length of stay among survivors was 16 days, and death occurred at median 1 day after admission. Long symptom duration and age >30 years of age were significantly associated with in-hospital mortality on univariate (β = 2.60 [0.18–5.03], p = 0.035) and multivariate testing (β = 2.95 [0.02–5.88], p = 0.049). Conclusion Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series, surgical treatment for perforated peptic ulcer disease carried a high mortality, and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries.
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