Incidence of Mortality and Predictors Among Patients with Shock Managed in the Emergency Room of a Large Tertiary Referral Hospital in Ethiopia

Abstract

Background: Shock is a common emergency condition which can lead to organ failure and death if not diagnosed and managed timely. Despite its huge global impact, data is scarce in resource-limited settings, such as Ethiopia, which hinders the provision of quality care for improved patient outcomes. Hence, the aim of the study was to determine the incidence of death and predictors among adult patients with shock managed at the Emergency Department of St. Paul's Hospital Millennium Medical College in Ethiopia. Methods: A retrospective chart review study was conducted between July to September 2022 among 178 eligible adult patients who were managed at hospital between October 2021 and May 2022. The characteristics of the participants were summarized using frequency and median with interquartile range. The incidence of mortality was estimated using incidence density using person hour (PH) of observation. To identify predictors of mortality, a generalized linear model using poisson regression model with robust standard errors was run at 5% level of significance, where adjusted relative risk (ARR) with its 95% CI was used to interpret significant results Result: The incidence of death was 6.87 deaths per 1000 PH (95% CI= 5.44 to 8.69). Significant predictors of death were being triaged orange (ARR=0.46, 95% CI=0.24-0.88, p=0.020), having a high shock index (ARR=1.59, 95% CI=1.07-2.36, p=0.021), being diagnosed with septic shock (ARR=3.66, 95% CI=1.20-11.17, p=0.023), taking vasopressors (ARR=3.18, 95% CI=1.09, 9.27, p=0.034), and developing organ failure (ARR=1.79, 95% CI=1.04-3.07, p=0.035). Conclusion: The incidence of mortality among shock patients was found to be considerable but relatively lower than previous studies. To optimize patient care and improve outcomes, it is important to remain vigilant in the proper triage and early diagnosis of shock using more sensitive tools for prompt identification of high-risk cases, as well as to provide timely, prioritized and effective interventions.