Mortality pattern in Emergency Department of a Tertiary Care Center in Western Nepal

Background There is abundance of evidence regarding various aspects of mortality in emergency department from different parts of world but there is limited number of studies on mortality in context of western Nepal. The objectives of this analysis were to review the demographical pattern of mortalities and define the cause and frequency of death in the Emergency Department (ED) of our institute within 24 hours of treatment process. Material and Methods A retrospective study was carried out evaluating all patients who died during the treatment process in the Emergency Department of Lumbini Medical College in a three and half year of period from January 2014 to June 2017. Results A total of 33,472 patients attended to ED with mortality rate of 36.4%, 33.6% and 28.2% on consecutive three years in which 110 deaths occurred. There were 66 (60%) male and 44 (40%) female. The highest mortality was seen after age of 60 years (range 2 month to 90 year). Non-communicable causes & stroke deaths were found to be higher in number. Most of our patient n=52 (47.3%) death occurred within 6-12 hours of admission in ED. Conclusion Mortality within 24 hours of presentation at ED remains high. Well organized emergency setup, transport, development of protocol as well as new guideline will definitely help in reducing hospital mortalities.


Introduction
Emergency Department (ED) is the first point of call for all critically ill in any hospital all over the world.In the ED, severity of various illness and injuries are seen and managed.Due to unplanned nature of patient attendance in emergency, the management of these patients is often challenging, so manpower requires immediate attention.The mortality and morbidity in the ED is directly related to the pre-hospital factors, adequate trained manpower and infrastructures [1-3].There are many factors for deaths occurring in ED.These include poor prehospital care for ill and injured patients, distance between the patients place of abode and the hospital and the types of illness or injury.Also, the paucity of skilled manpower in many clinical fields and poorly equipped ED affect the mortality pattern [3,4].It has been reported that 15-16 % of all the mortalities in a hospital occur in ED [5].World Health Organization (WHO) claims that statistics on mortality pattern in ED should be available for evaluation of existing health care services which is a kind of managerial process in any health institute [6].There are very limited numbers of studies on mortality pattern in context of Western Nepal.This study aims to seek the demographic mortality pattern and its causes in the ED of a tertiary center of Palpa within 24 hours of arrival.

Material and Methods
A retrospective review of the death records during admission at the ED of Lumbini Medical College Teaching Hospital was carried out over three and half year period from January 2014 to June 2017.Information was retrieved from patient case files and death certificates.Variables included were patient demographic data, clinical diagnosis, and duration of admission and time duration before death.All brought dead patients were excluded.The variables were analyzed in number and percentage by using SPSS 20.

Results
In a three and half year's period from January 2014 to June 2017, a total of 33,472 patients attended the ED.One hundred ten patients died giving a crude mortality rate of 0.33%.There were 66 (60%) male deaths and 44 (40%) female deaths, giving a mortality male: female ratio of 3:2.(Table 2)

Conclusion
Stroke was found to be the major noncommunicable disease related death presenting in ED.Most of the deaths were recorded after 60 years of age, which occurred within 6-12 hours of admission.Such high mortality in ED may be multifactorial such as lack of pre-hospital care, late in presentation, delayed referral system, high poverty level causing poor access to quality health care.So, promotion of an adequate and competent manpower in ED, efficient prehospital care, well organized ambulance service, vital infrastructures such as diagnostic and therapeutic facilities would help in reducing the emergency mortality.

Table 1 :
Mortality in various age group

Table 3 :
Clinical causes of patient death in Emergency Department

Table 4 :
Time Duration before death