AFEM consensus conference 2013 summary: Emergency care in Africa – Where are we now?

Reynolds, Teri; Calvello, Emilie J.B.; Broccoli, Morgan C.; Sawe, Hendry R.; Mould‐Millman, Nee‐Kofi; Teklu, Sisay; Wallis, Lee

doi:10.1016/j.afjem.2014.07.004

Cited by 37 publications

(48 citation statements)

References 11 publications

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“…In a recent study, physicians in Gaborone, Botswana, were successfully taught how to insert intraosseous (IO) needles via tele-simulation with a simulator based in Toronto, Canada. 16 Pediatric trauma care should be an integrated part of the undergraduate medical curriculum as well as a key rotation within postgraduate training programs in surgery, pediatrics, general practice, and emergency medicine. Development of trauma teams should be adapted to the local context in each LMIC and requires investments in education, training, and equipment.…”

Section: Emergency Department Evaluation and Managementmentioning

confidence: 99%

Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward

Kiragu

Dunlop

Wachira

et al. 2016

J Pediatr Intensive Care

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Traumatic injuries are a significant cause of death and disability worldwide. The vast majority of these injuries occur in low- and middle-income countries (LMICs). Attention to protocolized care and adaptations to treatments based on availability of resources, regionalization of care, and the development of centers of excellence within each LMIC are crucial to improving outcomes and lowering trauma-related morbidity and mortality worldwide. Given limitations in the availability of the resources necessary to provide the levels of care found in high-income countries, strategies to prevent trauma and make the best use of available resources when prevention fails, and thus achieve the best possible outcomes for injured and critically ill children, are vital. Overall, a commitment on the part of governments in LMICs to the provision of adequate health care services to their populations will improve the outcomes of injured children. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.

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Section: Emergency Department Evaluation and Managementmentioning

confidence: 99%

Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward

Kiragu

Dunlop

Wachira

et al. 2016

J Pediatr Intensive Care

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“…Elucidating the epidemiology of acute conditions, including trauma, was deemed a research priority by the World Health Organization (WHO) and the African Federation for Emergency Medicine [24] . While several studies have researched the epidemiology of trauma presenting to EC at South African tertiary hospitals, limited data are available regarding trauma care at frontline district level hospitals [9] , [10] , [25] , [26] , [27] .…”

Section: Introductionmentioning

confidence: 99%

The burden of trauma at a district hospital in the Western Cape Province of South Africa

Zaidi

Dixon

Lupez

et al. 2019

African Journal of Emergency Medicine

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Background Sub-Saharan Africa bears a disproportionate burden of mortality from trauma. District hospitals, although not trauma centres, play a critical role in the trauma care system by serving as frontline hospitals. However, the clinical characteristics of patients receiving trauma care in African district hospitals remains under-described and is a barrier to trauma care system development. We aim to describe the burden of trauma at district hospitals by analysing trauma patients at a prototypical district hospital emergency centre. Methods An observational study was conducted in August, 2014 at Wesfleur Hospital, a district facility in the Western Cape Province of South Africa. Data were manually collected from a paper registry for all patients visiting the emergency centre. Patients with trauma were selected for further analysis. Results Of 3299 total cases, 565 (17.1%) presented with trauma, of which 348 (61.6%) were male. Of the trauma patients, 256 (47.6%) were ages 18–34 and 298 (52.7%) presented on the weekend. Intentional injuries (assault, stab wounds, and gunshot wounds) represented 251 (44.4%) cases of trauma. There were 314 (55.6%) cases of injuries that were unintentional, including road traffic injuries. There were 144 (60%) intentionally injured patients that arrived overnight (7pm–7am). Patients with intentional injuries were three times more likely to be transferred (to higher levels of care) or admitted than patients with unintentional injuries. Conclusion This district hospital emergency centre, with a small complement of non-EM trained physicians and no trauma surgical services, cared for a high volume of trauma with over half presenting on weekends and overnight when personnel are limited. The high volume and rate of admission/ transfer of intentional injuries suggests the need for improving prehospital trauma triage and trauma referrals. The results suggest strengthening trauma care systems at and around this resource-limited district hospital in South Africa may help alleviate the high burden of post-trauma morbidity and mortality.

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“…[4–6] There is increasing recognition that emergency care delivery is an essential part of health systems, [7–9] and this has been reflected in the dramatic rise in emergency department (ED) patient volumes over the last few decades in many parts of the world. [10] However, outside of a handful of high-income countries (HICs) with well-established emergency care systems, there is a dearth of information about the burden of emergency conditions, or how frequently patients seek emergency care.…”

Section: Introductionmentioning

confidence: 99%

“…These constraints are particularly heightened in low- and middle- income countries (LMICs). [9, 11] Even where data are collected, systematic analysis is difficult because emergency care is frequently delivered across a variety of settings, including clinics and outpatient departments,[2, 7, 12] and formal EDs may not exist, even in some HICs. [12] This lack of basic information about emergency care delivery and the burden of emergency conditions has stalled attempts to understand and improve emergency care, particularly in LMICs.…”

Section: Introductionmentioning

confidence: 99%

Burden of emergency conditions and emergency care usage: new estimates from 40 countries

et al. 2016

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Objective To estimate the global and national burden of emergency conditions, and compare them to emergency care utilization rates. Methods We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care utilization rates were obtained from a systematic literature review on emergency care facilities in low- and middle-income countries (LMICs), supplemented by national health system reports. Findings All 15 leading causes of death and DALYs globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency utilization. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47,728 per 100,000 population (IQR 45,253-50,085) in low-income, 25,186 (IQR 21,982-40,480) in middle-income, and 15,691 (IQR 14,649-16,382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency utilization rates were the lowest in low-income countries, with median 8 visits per 1,000 population (IQR 6-10), 78 (IQR 25-197) in middle-income, and 264 (IQR 177-341) in high-income countries. Conclusion Despite higher burden of emergency conditions, emergency utilization rates are substantially lower in LMICs, likely due to limited access to emergency care.

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AFEM consensus conference 2013 summary: Emergency care in Africa – Where are we now?

Cited by 37 publications

References 11 publications

Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward

Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward

The burden of trauma at a district hospital in the Western Cape Province of South Africa

Burden of emergency conditions and emergency care usage: new estimates from 40 countries

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