Aetiologies and outcomes of patients with abdominal pain presenting to an emergency department of a tertiary hospital in Tanzania: a prospective cohort study

Abstract

Background: Abdominal pain in adults represents a wide range of illnesses, often warranting immediate intervention. This study is to fill the gap in the knowledge about incidence, presentation, causes and mortality from abdominal pain in an established emergency department of a tertiary hospital in Tanzania. Methods: This was a prospective cohort study of adult (age ≥ 18 years) patients presenting to the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH) in Dar Es Salaam, Tanzania with non-traumatic abdominal pain from September 2017 to October 2017. A case report form was used to record data on demographics, clinical presentation, management, diagnosis, outcomes and patient follow-up. The primary outcome of mortality was summarized using descriptive statistics; secondary outcome was, risks for mortality.Results: Among 3381 adult patients present during the study period, 288 (8.5%) presented with abdominal pain, and of these 199 (69%) patients were enrolled in our study. Median age was 47 years (IQR 35-60 years), 126 (63%) were female, and 118 (59%) were referred from another hospital. Most common final diagnoses were malignancies 71 (36%), intestinal obstruction 11 (6%) and peptic ulcer disease 9 (5%). Most common EMD interventions given were intravenous fluids 57 (21%), analgesia 49 (25%) and antibiotics 40 (20%). 160 (80%) were admitted of which 15 (8%) underwent surgery directly from EMD. 24-h and 7-day mortality were 4 (2%) and 7 (4%) respectively, while overall in hospital-mortality was 16 (8%). Among the risk factors for mortality were male sex Relative Risk (RR) 2.88 (p = 0.03), hypoglycemia (RR) 5.7 (p = 0.004), ICU admission (RR) 14 (p < 0.0001), receipt of IV fluids (RR) 3.2 (p = 0.0151) and need for surgery (RR) 6.6 (p = 0.0001).

Emergency medicine matters: epidemiology of medical pathology and changes in patient outcomes after implementation of a post-graduate training program at a Tertiary Teaching Hospital in Kigali, Rwanda

“…However, similar to cardiovascular rates seen in the present data, hypertensive emergency was noted as the leading diagnosis in those > 50 years of age [18]. Disease-specific studies in Tanzania have noted similarly high rates of cardiovascular and neurologic pathology [19] as well as renal disease [20] and gastrointestinal pathology [21] as seen in this study. Thus, this study helps to establish a foundation of the epidemiology of medical pathology amongst adult patients in LMICs and more specifically, Africa which will facilitate better understanding of care and resource needs in those settings.…”

“…In sub-analyses, EC mortality decreased in the top 5 diagnosis categories. Similar findings of overall decreased mortality rates were seen after institution of an emergency medicine residency program in Tanzania although specific changes in EC management were not described [ 21 ].…”

Emergency Medicine Matters: Epidemiology of Medical Pathology and Changes in Patient Outcomes after Implementation of a Post-graduate Training Program at a Tertiary Teaching Hospital in Kigali, Rwanda

“…However, similar to cardiovascular rates seen in the present data, hypertensive emergency was noted as the leading diagnosis in those > 50 years of age. 16 Disease-speci c studies in Tanzania have noted similarly high rates of cardiovascular and neurologic pathology 17 as well as renal disease 18 and gastrointestinal pathology 19 as seen in this study. Thus, this study helps to establish a foundation of the epidemiology of medical pathology amongst adult patients in LMICs and more speci cally, Africa which will facilitate better understanding of care and resource needs in those settings.…”

Factors associated with an unfavorable outcome in patients visiting the emergency department with acute abdominal pain

“…The overall mortality rates of ED patients who presented with abdominal pain at 24 hours and 7 days were 2% and 4%, respectively, while the overall in-hospital mortality rate was 8%. The risk factors for mortality were male sex, hypoglycemia, ICU admission, receipt of IV uids, and need for surgery [10].…”

“…In the present study we de ned acute abdominal pain as an abrupt onset of pain or soreness that appeared within 7 days before presenting to the ED and necessitated prompt diagnosis and aggressive treatment, typically surgical intervention [10,12]. Unfavorable outcome was de ned as the occurrence of one or more of the following: i) shock that required an invasive procedure during the ED stay (e.g., CVC insertion and mechanical ventilation), ii) emergency surgery, iii) presence of post-operative complications, and iv) occurrence of IHCA in the ED or after admission [3,13].…”