ABSTRACT
Background: Antibiotic resistance is a major public health concern. The Emergency department (ED) is the community gate for healthcare where antibiotics are often prescribed. However, there is a paucity of data regarding antibiotic prescription practices in Africa. Objectives: To describe the use of antibiotics in an ED and level of prescribing adherence to national guidelines. Methods: Retrospective observational study of antibiotic practice in ED. All patients who presented to ED during the study period and were prescribed an anti-microbial agent were included. Data on demographics, working diagnosis, anti-microbial prescribed, dose, route and prescriber level were used to provide descriptive statistics of these parameters. Results: We identified 195 (13.4%) patients who received anti-microbial therapy among 1454 charts reviewed. The mean age was 34.8 with male predominance. The most common indication identified was abscess in 37 (30.8%) patients and in general surgical conditions had the highest rate of antimicrobials prescribed at 54.3%. In addition, co-amoxiclav was the most commonly prescribed anti-microbial (72.15%). We found that combination therapy was not common practice in ED, with majority of the patients having received single anti-microbial therapy (87.18%). The appropriateness of antimicrobial prescriptions was (46.2%) and not statistically significant (P = 0.654). Conclusion: The most commonly prescribed anti-microbial was co amoxiclav and the most common indication was abscess. It was found that antibiotic prescription appropriateness was acceptable when compared to studies conducted in developed countries. However, further research within other hospital departments will add to the study to determine the adherence as an institution rather than the Emergency department alone, as antimicrobial resistance is a major global healthcare problem and impacts patient care throughout the care pathway.
Subject(s)
Anti-Bacterial Agents , Emergency Service, Hospital , Adult , Anti-Bacterial Agents/therapeutic use , Drug Prescriptions , Hospitals , Humans , Male , South AfricaABSTRACT
BACKGROUND: Clearing the cervical spine in an unconscious blunt trauma patient is an elusive concept. The aim of this study was to describe the incidence of cervical spine injury (CSI) in patients with a traumatic brain injury (TBI). The study was conducted on patients who underwent imaging of both the cervical spine and the brain in one sitting at a busy government healthcare facility in Pietermaritzburg. METHODS: This was a retrospective, cross sectional study of all the trauma patients presenting to a regional hospital emergency department (ED) in the KwaZulu-Natal (KZN) Province, who underwent computed tomography (CT) imaging of the brain and the cervical spine in one sitting during the period January 2016 to June 2016. RESULTS: Adult males formed the majority (78.9%) of the study population and had the highest incidence of TBI, the most common identified pathology in CT being parenchymal injuries (41%). The mechanisms that resulted in the majority of injuries sustained were assault (38.7%) and motor vehicle collisions (MVCs) (25%), while seven patients (4.76%) had a combined diagnosis of TBI and CSI. The average Glasgow Coma Scale (GCS) was 12. CONCLUSION: Young adult males are at the greatest risk of sustaining TBI, with assault being the most common mechanism of injury. Combined diagnoses of TBI and CSI are rare and were mostly noted in patients involved in MVCs and pedestrian vehicle collisions. While the chance of an abnormal CT scan increased with a decreasing GCS score, 33% of patients with a mild TBI did not have abnormal CT findings, and 25% patients with severe TBI had no abnormal CT findings.
Subject(s)
Brain Injuries, Traumatic , Cervical Vertebrae , Brain Injuries, Traumatic/diagnostic imaging , Cervical Vertebrae/diagnostic imaging , Cross-Sectional Studies , Hospitals , Humans , Male , Retrospective Studies , South Africa , Young AdultABSTRACT
Background. Babies born before arrival (BBAs) at hospital constitute a special group at risk of high morbidity and mortality.Objective. We conducted a 12-month retrospective review to describe maternal and neonatal characteristics of BBAs; and their outcomes compared with babies born in the state health sector.Methods. Using case-control sampling; all babies born outside a health facility and who presented to hospital within 24 hours of life were included and compared to the next in-hospital delivery occurring immediately after each BBA presented. Results. During the period reviewed; 135 BBAs (prevalence 1.8) presented; 71 after hours with most deliveries occurring at home (73.8). There was no birth attendant present at 70.5 of deliveries. Average birth weights were similar (2.86 kg in the BBA group; 95 confidence interval (CI) 2.73 - 2.95; 2.94 kg in the control group; 95 CI 2.78 - 3.02); but significantly more preterm babies were found in the BBA group (23 v. 9; respectively; p0.0001). Admitted BBAs had significantly lower average weights than those who were not admitted (2.19 kg v. 2.96 kg; respectively; p0.0001). No significant differences were found when maternal age; parity; co-morbidities and distance from the hospital were compared. There were significantly more unbooked mothers in the BBA group (23.0 v. 6.7; respectively;p0.0001). Only 54.40 of the admitted BBAs' mothers had booked antenatally; compared with 78.89 of mothers whose babies were discharged. Admission and complication rates were similar between the groups; but average length of stay was longer in admitted BBAs compared with controls. Conclusion. The prevalence of BBAs in this study is comparable to that in other developing countries; and is associated with poor antenatal attendance; prematurity; delay in presentation to hospital and lengthier hospital stays. These factors have implications for prehospital care of newborns and access to maternal and child healthcare in general
