Mortality and its determinants among patients attending in emergency departments.

BACKGROUND: Due to the high burden of mortality from acute communicable and non-communicable diseases, emergency department's mortality has become one of the major health indices in Ethiopia that should be evaluated regularly in every health institution. However, there are inconsistencies between studies, and there is no systematic review or meta-analysis study about the prevalence of mortality in the emergency department. Therefore, this study aimed to determine the pooled prevalence of mortality and identify its determinants in the emergency departments of Ethiopian hospitals. METHODS: This systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and has been registered with PROSPERO. A structured search of databases (Medline/PubMed, Google Scholar, CINAHL, EMBASE, HINARI, and Web of Science) was undertaken. All observational studies reporting the prevalence of mortality of patients in emergency departments of Ethiopian hospitals, and published in English up to December 16, 2023, were considered for this review. Two reviewers independently assess the quality of the studies using the Joanna Briggs Institute (JBI) critical appraisal tool. A meta-analysis using a random-effects model was performed to estimate the pooled prevalence. The heterogeneity of studies was assessed using I2 statistics, and to identify the possible causes of heterogeneity, subgroup analysis and meta-regression were used. Egger's test and funnel plots were used to assess publication bias. STATA version 17.0 software was used for all the statistical analyses. A p-value less than 0.05 was used to declare statistical significance. RESULTS: A total of 1363 articles were retrieved through electronic search databases. Subsequently, eighteen studies comprised 21,582 study participants were included for analysis. The pooled prevalence of mortality among patients in the Emergency Department (ED) was 7.71% (95% CI: 3.62, 11.80). Regional subgroup analysis showed that the pooled prevalence of mortality was 16.7%, 12.89%, 10.28%, and 4.35% in Dire Dawa, Amhara, Oromia, and Addis Ababa, respectively. Moreover, subgroup analysis based on patients' age revealed that the pooled prevalence of mortality among adults and children was 8.23% (95% CI: 3.51, 12.94) and 4.48% (95% CI: 2.88, 6.08), respectively. Being a rural resident (OR; 2.30, 95% CI: 1.48, 3.58), unconsciousness (OR; 3.86, 95% CI: 1.35, 11.04), comorbidity (OR; 2.82, 95% CI: 1.56, 5.09), and time to reach a nearby health facility (OR; 4.73, 95% CI: 2.19, 10.21) were determinants of mortality for patients in the emergency departments. CONCLUSION AND RECOMMENDATIONS: This study found that the overall prevalence of mortality among patients in emergency departments of Ethiopian hospitals was high, which requires collaboration between all stakeholders to improve outcomes. Being a rural resident, unconsciousness, comorbidity, and time elapsed to reach health facilities were determinants of mortality. Improving pre-hospital care, training healthcare providers, early referral, and improving first-line management at referral hospitals will help to reduce the high mortality in our country.

Prolonged time to recovery and its predictors among trauma patients admitted to the intensive care units in comprehensive specialized hospitals in Northwest Ethiopia: a multicenter retrospective follow-up study, 2022.

Introduction: A prolonged time to recovery in the intensive care units has adverse effects on both the patients and the healthcare providers. However, there is limited evidence in African countries, including Ethiopia. Therefore, this study aimed to assess the time to recovery and its predictors among trauma patients admitted to intensive care units. Methods: An institutional-based retrospective follow-up study was conducted on trauma patients hospitalized in intensive care units between 9 January 2019 and 8 January 2022. The charts of 450 patients were chosen using a simple random sampling technique. Data collection was conducted using smartphones and tablets. The data were then exported into STATA version 16 for analysis. The log-rank test and the Kaplan-Meier survival curve were fitted for analysis. An adjusted hazard ratio with 95% confidence intervals was reported to declare the strength of association between time to recovery and predictors in the multivariable Weibull regression analysis. Results: The overall incidence density rate of recovery was 6.53 per 100 person-day observations, with a median time to recovery of 10 days. Significant predictors of time to recovery included being on mechanical ventilation (AHR = 0.47, 95% CI: 0.34, 0.64), having a Glasgow Coma Scale (GCS) score between 9-12 and 13-15 (AHR = 1.58, 95% CI: 1.01, 2.47, and AHR = 1.66, 95% CI: 1.09, 2.53, respectively), experiencing polytrauma (AHR = 0.55, 95% CI: 0.39, 0.78), and having complications (AHR = 0.43, 95% CI: 0.31, 0.59). Conclusion and recommendations: The incidence rate of recovery for trauma patients is lower than the national standard, and the median time to recovery is longer. Being on mechanical ventilation, mild and moderate GCS scores, polytrauma, and the presence of complications were significantly associated with prolonged time to recovery. Therefore, special attention has to be given to trauma patients who had polytrauma, complications, received mechanical ventilation, and had a lower GCS score.

Magnitude and associated factors of postoperative mortality among patients who underwent surgery in Ethiopia: systematic review and meta-analysis.

Background: Postoperative mortality is one of the six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. This study aimed to assess the magnitude and associated factors of postoperative mortality among patients who underwent surgery in Ethiopia. Methods: This systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Ten studies were included in this Systematic review and meta-analysis. The risk of bias for each study was assessed using the Joanna Briggs Institute quality appraisal scale. Publication bias was checked using a funnel plot and Egger's regression test. Heterogeneity across studies was assessed by I2 statistics. STATA version 17 software was used for analysis. A random effect model and the DerSimonian-Laird method of estimation was used to estimate the pooled magnitude of postoperative mortality. Odds ratios with 95% CIs were calculated to determine the associations of the identified factors with postoperative mortality. Results: The results revealed that the pooled magnitude of postoperative mortality among patients who underwent surgery in Ethiopia was 4.53% (95% CI :3.70-5.37). An American Society of Anesthesiologists score greater than or equal to III [adjusted odds ratio (AOR): 2.45, 95% CI: 2.02, 2.96], age older than or equal to 65 years (AOR: 3.03, 95% CI: 2.78, 3.31), and comorbidity (AOR: 3.28, 95% CI: 1.91, 5.63) were significantly associated with postoperative mortality. Conclusion and recommendations: The pooled magnitude of postoperative mortality among patients who underwent surgery in Ethiopia was high. The presence of comorbidities, age older than 65 years, and ASA physical status greater than III were significantly associated with postoperative mortality. Therefore, the Ministry of Health and other concerned bodies should consider quality improvement processes.