Dead on arrival in a low-income country: results from a multicenter study in Pakistan

Abstract

BackgroundThis study assessed the characteristics of dead on arrival (DOA) patients in Pakistan.MethodsData 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.ResultsA 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).ConclusionThis 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.

Standing at the edge of mortality; Five-year audit of an emergency department of a tertiary care hospital in a low resource setup

“…Our study identified most of the mortalities in 55+ years with a male predominance; consistent with local 13 , 14 and published literature out of Nepal. 15 All trauma mortalities were documented in males, in conformity with African literature.…”

“… 9 This delayed presentation may be compounded by low health literacy, lack of pre hospital care, belief in traditional healers and quality medical facilities inaccessible to the less privileged. 13 , 21 Over half the mortalities in low-resource settings may be addressed by improved emergency care systems. 22 Our study has identified that encouraging timely presentation to healthcare, availability of pre hospital care and swift transfer to tertiary care may mitigate some deaths.…”

“… 22 Our study has identified that encouraging timely presentation to healthcare, availability of pre hospital care and swift transfer to tertiary care may mitigate some deaths. 13 , 21 This would require involvement of all stakeholders and collective change in mindset along with development and implementation of legislature.…”

Analysis of causes of death among brought-in-dead cases in a third-level Hospital in Lusaka, Republic of Zambia, using the tariff method 2.0 for verbal autopsy: a cross-sectional study

“…The background information of the BiD cases is one of the key factors for understanding the bottlenecks in the health system that obstruct the diseased from accessing the facilities before death. However, only a few publications have analyzed BiD cases in LMIC [9], including the African nations [10,11].…”

Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research

“…In addition, little data are available on patients’ motivations for pursuing emergency care in LMICs or their perception of the quality and acceptability of the care they receive. Furthermore, in some LMICs, patients that die in the first 24–48 hours are classified as ‘Brought in Dead’ 10. Such an approach negates the very raison d’etre of emergency medicine as it is these very patients —those that survived to presentation—that represent potentially avertable deaths most in need of emergency care.…”