Emergency Medicine

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Assessment of Prevalence, Risk Factors, and Outcomes of Acute Kidney Injury Patients Admitted to Adult Intensive Care Unit at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, 2019
(Addis Abeba University, 2019-12) Getahun Edmialem; Abebe Asmamaw ; Zewdu Tigist
Introduction: Acute kidney injury is a syndrome characterized by the rapid loss of the kidney'sexcretory function and is typically diagnosed by -the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output, or both. In critically ill patients Acute Kidney Injury (AKI)occurs frequently and it allied with great rates of morbidity and mortality. Objective: This study aims to assess the prevalence, risk factors and outcome of acute kidneyinjury in patients admitted in the intensive care unit of Saint Paul's Hospital Millennium Medical College from January 2017 to December 2019. Methods: The study design was a facility-based retrospective; the cross-sectional study was conducted. Medical records of 108 were revised. Data collection checklist was developed and the data were extracted from the patients' medical records. Data entry and analysis were conduct by using the Epi-Data-4.2 and Statistical Package for the Social Sciences (SPSS) software version25.0 respectively. The logistic regression model was used for analysis. Result: AKI in critically ill patients covered 16.1% with a mean age of 34 ± 15 age distribution and female predominance (66.7%). Being female and Anemia were the leading risk factors to develop AKI, 72 (66.7%)and 56 (51.9%) respectively. Sepsis was more likely associated to kill the patients with AKI. Most 81 (75%) AKI critically ill patients were initiated renal replacement therapy. Stage three AKI were account for 66(61.1%). Length of hospital stay ranged from 1 day to 52 days with a mean stay of 10.7 days. Critically ill patients with AKI(48.1%) had died in the study period. Conclusion: AKI is the most common cause for critically ill patient's morbidity I too observed the higher prevalence of AKI in critically ill patients with younger age groups and female predominance. The mortality rate of AKI in critically ill patients was near to half of all respondents during the study period.
Assessment of Emergency Medical Services Response Time and Associated Factors in Emergency Patient Transportation at Addis Ababa, Ethiopia 2019
(Addis Abeba University, 2019-06) Bafa Muluken; Woldetsadik Assefu ; Abebe Asmamaw
Background: Emergency Response Time is an interval between call receipt and arrival of the first Emergency vehicle to the scene which should be less than 8 minute. As a result of the emerging significance of time-sensitive medical emergencies such as cardiac arrest, stroke, and acute myocardial infarction and nonmedical emergency like trauma, it has been the leading measure of Emergency Medical System performance quality in many countries. Despite its importance, little was studied about the ERT and associated factors. Therefore, this study aims to determine the Emergency Response Time (ERT) and identify associated factors in Addis Ababa, Ethiopia 2019. Method: Facility based cross-sectional study design was conducted in Addis Ababa City Fire and Emergency Prevention and Control Authority and Red Cross Association ambulance service, from April 2019 to May 2019. Data was collected by observation and interview using structured checklist. Then it was cleaned, coded, entered in to EPI data v.3.1 and exported to SPSS version 25 statistical package for analysis. Descriptive statistics used in order to describe data and both bivariate and multivariable logistic regression used to examine associated factors. A factor with pvalue<0.05 wasconsidered as statistically significant.Mean ERT, COR,AOR and 95%CIwere used to report the finding. Result: Among 345 study subjects three-forth were females with the mean age of 28.8 (SD+ 13). Labor was main reason 206 (59.7%) for seeking of ambulance. Only 47 (13.6 %) case had life threatening critical emergency. This study determined mean ERT 11.40 (SD + 6.5) and among study participants only 39.7 % participants had ERT < 8 minute. Distance to the scene > 6 km AOR 17.34 (7.16, 41.98), dispatch time interval >2 min AOR 15.79 (5.95, 41.93) and heavy traffic conditions AOR 16.33 (4.49, 59.43)are found to be the major determent factors of ERT. Age, level of consciousness, severity of the illness and weather condition were also shown significant association. Conclusion and recommendation: The mean emergency response time interval was above the standard and the majority of the patients were transported under delayed ERT. Scene distance,dispatch time interval, heavy traffic condition, time of call, and has shown associations. Action like pre-allocation of ambulance, installing emergency communication device, drivers and public awareness creation and training to ambulance nurse should be done to decrease ERT.
Assessment of Knowledge Attitude and Practice of Residents About Pre Hospital Care in Addis Ababa
(Addis Ababa University, 2014-06) Abebe Asmamaw; Enquselassie Fikirie
Background: In Ethiopia pre hospital care is not well developed. Apart from some governmental and non-governmental institutions, the pre hospital care is not well known by thecommunity Objective to assess the knowledge, attitude and practice of residents about pre hospital care In Addis Ababa Methodology: household based cross sectional study was conducted using multi stage random sampling technique from March to April, 2014. The data was collected through structured self-administered questionnaire and interviewing technique among 422 participants. Data was entered, analyzed, and interpreted by using SPSS Software version20. Result: The findings of this study shows that majority of the respondents 364 (86.3%) knew the presence of pre hospital care, most respondents 405(96%) believed that pre hospital care is important and 160 (37.9%) individuals had encountered in different levels of pre hospital care provision. 411(97.4%) respondents believed that pre hospital care should be strengthened by increasing number of ambulances (23.7%), by training health professionals (18.7%), by teaching the community about pre hospital care (26.1%) and a combination of the above methods(31.5%). Regarding the assessment of their practice the common care givers during mass casualty were bystanders 102(24.2%) and the least care givers were paramedics being18(4.2%).The common emergent problems that occurred in Addis Ababa fall down accident72(29.2%) and followed by road traffic accident 59(24.1%). Conclusion: Knowledge, Attitude and Practice investigations provide helpful insight into the level of understanding and utilization of services within the community .The findings show that high proportions of respondents have good knowledge (76.5%) and, positive attitude (69.9%) of pre hospital care, however, less than half of them have practiced pre hospital care in mass casualty.Unfortunately 58.8% and 65.2% of the respondents did not know the phone number of Red Cross and fire & emergency dispatch center respectively. Recommendation: The city administration should teach the community to improve awareness about the advantages of pre hospital care, ambulance transportation and early visit to a hospital so as to decrease morbidity and mortality of trauma patients. The Red Cross and fire and emergency dispatch center should advertise their phone number to the public and respond immediately to community call and formulate a decision with policy makers about safe and rapid transportation despite the barriers Concerned authorities should be concerned about increasing the number of paramedics and the available Paramedics should actively participate in mass casualty incidents. Based on this study no identified barriers about pre hospital care so that there should be another study by taking othervariables
Assessment of Knowledge of Alarm Fatigue, Practice towards Alarms and Associated Factors among Nurses Working in Adult Intensive Care units of Federal Government Hospitals in Addis Ababa city, Ethiopia.
(Addis Abeba University, 2020-06) Kebede Hana; Abebe Asmamaw
Background: Audible clinical alarms have been an essential part of patient monitoring since the 1950s.Alarm fatigue is the desensitization of a clinician to an alarm stimulus that occurs when caregivers areexposed to a great number of repeated alarms. Due to a number of clinical alarms from medical machines within the ICU, there is a high risk of nurses becoming desensitized to the sound of patientalarms. Moreover, physiologic alarms may be disabled, silenced, or ignored. These practices canpotentially affect the patient care negatively. Objectives: To assess the nurses' level of knowledge of alarm fatigue, practices towards alarms andassociated factors among nurses working in adult ICUs of federal government hospitals in Addis Ababacity, Ethiopia, Jan-Jun 2020 G.C. Methods: A descriptive cross-sectional quantitative study design was conducted to determine theknowledge of alarm fatigue, practices towards alarms and associated factors among nurses working inAdult ICUs of federal governmental hospitals in Addis Ababa, Ethiopia from Jan -Jun 2020 GC. A totalof 162 nurses was recruited by the convienience sampling method. The data were collected by usingsemi structured, self-administer questioner. SPSS version 25 for Windows was used for data entry andanalysis, descriptive statistics and bivariate and multivariate logistic regression were used to analyze thedata. Result: In this study, 42% of participants had poor practice towards alarms and 57.8% have goodpractice. The majority of, 107 (66%) respondents had good knowledge on alarm fatigue. The majority ofnurses 140 (86.4%)answered correctly that Non actionable/nuisance alarms disrupt patient care. Nurseswho don’t have in service training on alarm management are 2 times, having a poor practice than thosewho took in service training (AOR=1.974, 95% CI (1.296, 4.024)). Conclusion and Recommendation: Although the improvement of nurses' knowledge and practicesregarding alarm management will directly or indirectly reduce the harms related to poor alarm management, Nurses have remarkable gaps and alarming skill performance related to alarms. Therefore,periodic on-job and pre-service training regarding alarm management, guidelines as well as protocolsshould be provided to all ICU nurses. There is also a need for further research to include more settings would be valuable. In addition, there are gaps identified for further research to strengthen findings.
Assessment of Magnitude, Clinical Presentation and Outcome of Pediatrics Burninjury at Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia.
(Addis Abeba University, 2020-06) Tamre Sosina; Bacha Tigis; Abebe Asmamaw
Background: Pediatrics burn injury continues to be a major public health concern globally.Majority of cases has occurred in low resource countries. Due to children’s higher susceptibility risk, burn is more prevalent among this age group and is commonly associated with a higher morbidity and mortality rate. Objective: This study aims to assess the magnitude, clinical presentation and outcomes of pediatrics burn at AaBET hospital, Addis Ababa, Ethiopia. Method: Institutional based retrospective cross sectional study design was conducted in AaBET hospital from July 2016-January 2020. Convenience sampling was used to review two hundred and seventy one medical records of pediatric burn victims by using a checklist. The collected data wasentered into EPI info version 3.1 and was exported to SPSS version 25. Descriptive statistics and logistic regression was done for data analysis. Result: A total of 256 patients were participated in this study with a response rate of 94.5%. Male patients accounted 130 (50.8%). The most common cause of burn are scald, flame, electric burn accounting 130 (50.8%) ,104 (40.6%) 12 (4.7%) respectively. Second degree burns were thecommonest presentation 214 (83.6%) and 8.2% of the patients had co-morbidities; 93.8% of the incidents occurred in private residencies. only 2.3% of the victims had received pre hospital treatment. Total Body Surface Area burned ranged from 1% to 92% with a median TBSA of 14.Intentional burn accounted 1.2%. Length of hospital stay ranged from (1-164) days with a mean of24.73 days. One quarter, 64(25%) of patients had developed hospital acquired infection. Eight patients were (3.1%) died. Presence of burn associated injuries [p= 0.006 AOR=0.012(0.001,0.277)] showed significant association with the outcome death. Conclusion and recommendation: Scald burn and flame burn are the common causes of burninjury, Majority of the incidents took in indoor settings and most of them had not received prehospital care. Burn patients with associated injuries need more attention as they are more likely todie. For all governmental and non-governmental bodies, it is highly recommended to give priorityon preventive measures and improve pre-hospital care service.
Assessment of Patients‟ Readiness for Hospital Discharge and Associated Factors among Medical Emergency Patients in Black Lion Specialized Teaching Hospital Adult Emergency Department, Addis Ababa, Ethiopia ,January 2020G.C.
(Addis Abeba University, 2020-01) Getachew Migbaru; Abebe Asmamaw
Introduction: Improving health institution discharge processes, decreasing readmissions and emergency department visits after discharge is on the countrywide issue for health care reform and health facility-based improvement tasks, which are unplanned, adverse,potentially avoidable, and costly outcomes of hospitalization caused by low patient readinessfor hospital discharge. A patient's readiness for Hospital Discharge is defined as a patient‟sassessment of their own preparedness for discharge and their ability to cope with their illness at home. However, a little is known about whether emergency medical patients sufficiently prepared for discharge to home after acute care at intermediate phase of recovery. Objective: To assess patients‟ readiness for discharge and associated factors in the emergency department of black lion specialized teaching hospital Addis Ababa Ethiopia from February 17 to July 2020G.C Method: An institutional-based cross-sectional prospective study was conducted and all patients with a diagnosis of medical conditions, and ready for discharge during the study period were included and the collected data was evaluated with SPSS version 25 software. Results; the total number of respondents was 159; the mean age of the study subjects is 49with a standard deviation of ± 16.7 the majority of the patients 106 (66.7%) reported low RHD scores (<7.0), although 53 (33.3%) reported RHD scores (≥7.0). The overall patientRHDscore was 6.89 ± 0.92. Increased age AOR 16.34 (CI 5.4, 49.02) and high Charlsoncomorbidity index AOR 24.1, (CI 4.1, 44.2) are contributing factors for low patient RHDscores. On the other hand, having a spouse as a primary caregiver was predictive of greaterRHD (AOR 0.31, CI 0.002, 0.56). Conclusions and recommendations; the finding indicate most patients are being discharged without being ready and most are not getting any discharge education. Paying attention to adequate discharge planning, providing appropriate discharge education is essential to improve patient outcome.
Clinical Features and Treatment Outcomes of Preeclampsia and Eclampsia at Gondar University Specialized Teaching Hospital Amhara Ethiopia, 2020/2021.
(Addis Abeba University, 2021-07) Alemie Tamalew; Azazh Aklilu; Abebe Asmamaw
Background: - Preeclampsia is a disorder of pregnancy characterized by high blood pressure and proteinuria after 20 weeks of gestation, and a common direct obstetric cause for perinatal and maternal morbidity and mortality in developing countries. Objective: To assess the clinical features, and treatment outcome of women with preeclampsia and Eclampsia admitted in Gondar University specialized hospital, Northern Ethiopia 2020/2021. Methods: A retrospective cross-sectional chart review study was conducted at Gondar university specialized hospital from April 9-May/30/2021. Among women hospitalized for preeclampsia and eclampsia 311 mothers selected using systematic sampling. A pretested check list was used to collect data from medical records. The collected data was coded, entered into Epi-data version 4.6, and exported to SPSS 26 for descriptive and inferential analysis. Chi-square and fishers exact test were done to determine a statistically significant factors and a p-value of ≤0.05 was considered to set a statically significant association. Results; Out of 311 study population, almost half of cases (49.8%) were preeclampsia with severity features. While, Eclampsia accounted for 18.6% of women. Above 50% of mothers required immediate interventions to terminate the pregnancy by cesarean section for various indications. Unfavorable maternal outcome was present in more than 25% of cases; the observed unfavorable maternal outcomes were aspiration pneumonia 10.6%, HELLP syndrome 8.7% and maternal death 2(0.6%).While 12.2% of cases had unfavorable perinatal outcome. The unfavorable perinatal outcomes were still birth 31(10%) and early neonatal death 7(2.3%).Disease severity, mode of delivery, aspartate transaminase, gravidity, gestational age and antenatal care were statistically significant factors with outcome of pregnancy. Conclusion; Prevalence of unfavorable maternal and perinatal outcomes of preeclampsia and eclampsia are considerable in the study area. To deter these effects both on perinatal and the maternal outcomes of pregnancy, antenatal care services and emergency obstetrics and new born care should be expanded and strengthen.
Clinical Pattern and Management outcomes among Road Traffic Accident Victims Attending Emergency Department of Jimma University Medical Center, Jimma,Southwest Ethiopia
(Addis Abeba University, 2021-05) Endale Dereje; Beyene Temesgen; Abebe Asmamaw
Background: Road Traffic Accident is an incident on a way or street open to public traffic that becomes one of the most significant public health problems in the world especially in developing countries. In Ethiopia, RTA is the major public health problem even though studies indicate clinical pattern and management outcomes among these victims are limited. The aim of this study is to assess clinical pattern and management outcomes among road traffic accident victims who attended emergency department of Jimma University Medical Center, Jimma Ethiopia, 2021. Methods: Hospital based retrospective cross sectional study design was implemented based on patients' record review for one year. Records of patients were revieweduntil the calculated minimum sample size (357) attained. Systematic random sampling technique was applied to recruit the records. Pretested checklist was used to collect data. Descriptive statistics were used to show the distribution of variables under the study.Independent factors associated with management outcomes were assessed using binarylogistic regression using SPSS version 26 at p<0.05. Results:Among 357 cases reviewed, the median age was 27 ± 13.71 years and male victims accounted for 75.6%. The largest proportion was pedestrians (49.6%) injured by motorcycle (42.9%)and sustained fracture (60.5%). More than half of victims (58%) never got any type of prehospital care. On triage paper, majority were classified as Red needing urgent/immediate intervention (38.7%)of which 71.4% of themwere managed surgically. Regarding management outcomes, 84.9% were discharged with improvement, referred (1.7%) and died (12.6%). Using multivariate logistic regression analysis,anatomical sites (head injury)(AOR=16.61: 95% CI;3.85,71.71),mechanism of injury (AOR= 0.23; 95% CI: 0.08, 0.68), time elapsed to reach nearby health facility (AOR= 3.30; 95 CI (1.13, 9.60), time of the day (AOR= 2.79; 95% CI; 1.06, 7.34),condition of patient at ED (AOR= 7.78; 95% CI: 2.33, 26.06), GCS at admission(AOR= 20.12;95% CI: 7.23,55.96)and days spent in hospital (AOR= 6.85; 95% CI 5.81, 8.06)were independent predictors of unfavorable outcome. Conclusion:This study finding can help reducethe mortality and disability from RTA by appropriately identifying the priority patient and giving appropriate intervention promptly.In general, anatomical sites, mechanism of injury, GCS on admission, disposition outcome, time to health facility, condition of the patient, and days spent in hospital were independent predictors for unfavorable outcome.
Clinical Profile and Outcome of Trauma among Adult Patient Treated at Alert Hospital Trauma Center Emergency Department Addis Ababa, Ethiopia, 2021.
(Addis Abeba University, 2021-06) Abebe Tesfaye; Kefyalew Merahi; Abebe Asmamaw
Introduction: A traumatic injury can be caused by a wide range of blunt, penetrating, and other mechanisms. As a result, after a patient has sustained this injury, he/she may require immediate care. So, all aspects of trauma care systems, such as a powerful prehospital care system, skilled human power, facilities, equipment, and continuous supplies, must be in place for asuccessfu outcome. Objective: This study is aimed to assess the clinical profile and outcome of trauma among adultpatient treated at ALERT hospital trauma center emergen department Addis Ababa, Ethiopia,from January 1/2019 to December 1/2020. Methods: A retrospective chart review study was performed during the time period of January2019 to December 2020 on trauma patients treated to the trauma and emergency department ofALERT hospital. For statistical analysis, Epi-data version 4.6 and SPSS version 25 were employed, and Fisher's exact test was performed to determine the statistical association. Results: Male to female ratio was 259:103, with the 24–33 age group predominantly affected by trauma. The most common time of injury was 8–6 a.m., and the taxi was the predominant mode of arrival to the hospital (59.7%). Inter personal violence (IPV) is the most common accident, accounting for 31.8 %. Road traffic injury (R.T.I.) is the second most common cause of injury accounted for 30.7% of victims, three wheelers or Bajaj (45%) dominated over others vehicles. Mostly pedestrian was affected 62.1%. The Kampala severity score II (KTS II) were show milled trauma (82.3%), moderate trauma (11%), and severe trauma account (6.6%). Open wound/ Soft tissue injury (44.2%) and Extremity fracture (24%) were the frontrunners injury, with 11.3% of the victims were polytrauma. The mortality rate was 3.6%. Conclusions and recommendation: The injury was prominently IPV and RTA, the trauma victims were young. The focus should be directed to injury prevention and safety measures. Future studies can be directed to long term outcomes and follow up of injury victims to account for exact mortality and morbidity due to such unfortunate events.
Disease Pattern, outcome and Associated Factors of Patient Admitted in Pediatric Intensive Care unit at Tikur Anbessa Specialized Teaching Hospital, Addis Abeba,Ethiopia,2019.
(Addis Abeba University, 2019-06) Noah Yafet; Abebe Asmamaw; Engda Hywet
Background: Advances in pediatrics especially in the field of intensive care have dramaticallyimproved the prognosis for the critically ill children. Numerous conditions that were previouslyfatal are now treatable, and many children who previously would have sustained a permanentdisability now recover completely. The current evidence suggests that the sickest subgroups of critically ill children are less likely to die if treated in the PICU in a tertiary care hospital. Objectives: To assess the disease pattern, outcome and associated factor of admitted patients atPICU Tikur Anbessa Specialized Hospital, Addis Ababa Ethiopia from January 2017 To January 2019. Methods: Institutional based cross-sectional study was conducted. All patients who were admitted at pediatrics ICU from January 2017 to January 2019 and met the criteria were included. Data was collected using adapted questionnaire from chart review and registration book. SPSS version 20 software was used for data entry and analysis. The ethical clearance was obtained from AAU College of health sciences department of emergency medicine. Result: Most of the study subjects were in the age range of less than 1 year 97(30.6%).50.5%was female. The mean age was 4.5 ± 3 years. A majority 124(39.1%) were admitted from EOPD.The mean PICU length of stay was 7.18 ± 9.12 days. The majority of patients admitted to PICU71(22.4%) were due to respiratory problem and gastrointestinal disease is least admission diagnosis 10 (3.2%). the mortality rate is, 125(39.3%) and main cause of death is cardiovasculardisease (25.6%) Conclusion & Recommendation: Respiratory and Neurology diseases were the predominant conditions leading to PICU admissions in our setting. 56.8% of patients used mechanical ventilator. Mortality rate was significantly associated with cardiovascular disease compered to other system classification and patient who use mechanical ventilator.This can be due to limited infrastructure, few trained professional and resource, make it difficult to provide optimum care.Tikur Anbessa Teaching Specialized Hospital should work more on PICU providing a high quality intensive care to critically ill patients focusing on increase PICU capacity.00
Knowledge,Practice and Associated Factors of Nurses Working in intensive Care Unit Towards Open-Endotracheal Suctioning for Mechanically Ventilated Patients in Public Hospital of Addis Ababa,Ethiopia,2023.
(Addis Ababa University, 2023-06) Merchaw Abebe; Beyene Temesgen ; Abebe Asmamaw
Introduction: Endotracheal suctioning is one of the commonly performed invasive procedures in intensive care unit so as to keep airway patent in intubated patients. Knowledge and practice of nurses working in intensive care unit towards endotracheal suctioning is directly related to minimize complications, to improve standard of care, to promote effective/safe suctioning and to reduce length of stay in intensive care unit. Objective: To assess knowledge, practice and associated factors of nurses working in intensive care unit towards open endotracheal suctioning for mechanically ventilated patient in public hospitals of Addis Ababa, Ethiopia, 2023. Methods: Institutional based cross-sectional study was conducted on nurses working in six public hospitals. Simple random sampling method was used and data were collected using structured self-administered questionnaire and observational checklist. Data were entered into epi data version 4.6 and analysis was done using SPSS version 27. Frequency and percentage were done for categorical data. In addition, mean and standard deviation were done for continuous data. Besides, binary logistic regression was used to determine association between dependent and independent variables. Result: A total of 136 were included with response rate of 97% (132). From this, 78 (59.1%) with 95% CI (50.67, 67.53) and 51 (38.6% with 95% CI (30.30, 46.91) of nurses had good knowledge and practice respectively. Qualification [AOR = 6.01; CI: 1.24–29.05] and training [AOR= 3.69; CI: 1.40-9.67] were significantly associated with knowledge with P-value <0.05.equipment supplies [AOR= 5.0; CI: 1.71-14.38],and experience => 6years [AOR= 6.8; CI: 2.21-20.86] were associated of practice. Conclusion: In this study, more than half of the nurses who were working in intensive care units had good knowledge, but majority had poor practice on endotracheal suctioning. Training, qualification, experience and availability of adequate equipment were major factors associated with knowledge and practice.

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