Acute care needs in an Indian emergency department: A retrospective analysis

doi:10.5847/wjem.j.1920-8642.2016.03.005

Abstract

Abstract:

BACKGROUND: Emergencies such as road traffic accidents (RTAs), acute myocardial infarction (AMI) and cerebrovascular accident (CVA) are the most common causes of death and disability in India. Robust emergency medicine (EM) services and proper education on acute care are necessary. In order to inform curriculum design for training programs, and to improve the quality of EM care in India, a better understanding of patient epidemiology and case burden presenting to the emergency department (ED) is needed.
METHODS: This study is a retrospective chart review of cases presenting to the ED at Kerala Institute of Medical Sciences (KIMS), a private hospital in Trivandrum, Kerala, India, from November 1, 2011 to April 21, 2012 and from July 1, 2013 to December 21, 2013. De-identified charts were systematically sampled and reviewed.
RESULTS: A total of 1 196 ED patient charts were analyzed. Of these patients, 55.35% (n=662) were male and 44.7% (n=534) were female. The majority (67.14%, n=803) were adults, while only 3.85% (n=46) were infants. The most common chief complaints were fever (21.5%, n=257), renal colic (7.3%, n=87), and dyspnea (6.9%, n=82). The most common ED diagnoses were gastrointestinal (15.5%, n=185), pulmonary (12.3%, n=147), tropical (11.1%, n=133), infectious disease and sepsis (9.9%, n=118), and trauma (8.4%, n=101).
CONCLUSION: The patient demographics, diagnoses, and distribution of resources identified by this study can help guide and shape Indian EM training programs and faculty development to more accurately reflect the burden of acute disease in India.

Key words: Emergency care systems, Emergency department, Education, Acute care, Emergency department utilization

Elizabeth G. Clark, Jessica Watson, Allison Leemann, Alan H. Breaud, Frank G. Feeley III, James Wolff, Tamorish Kole, Gabrielle A. Jacquet. Acute care needs in an Indian emergency department: A retrospective analysis[J]. World Journal of Emergency Medicine, 2016, 7(3): 191-195.

Figures/Tables 4

Table 1

Table 2

Table 3

Table 4

References 18

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Variables	n (%)
Gender
Male	662 (55.4)
Female	534 (44.7)
Age group
Infant	46 (3.9)
Child	213 (17.8)
Adult	803 (67.1)
Geriatric	134 (11.2)

Variables	n (%)^*
Fever	257 (21.5)
Renal colic	87 (7.3)
Dyspnea	82 (6.9)
Chest pain	65 (5.4)
Vomiting	60 (5.0)
RTA	41 (3.4)
Cough	37 (3.1)
Diarrhea	35 (2.9)
Extremity pain	30 (2.5)
Fall	29 (2.4)

Variables	n (%)^*
Most common consultations
Internal medicine	206 (17.3)
Cardiology	82 (6.9)
Surgery	68 (5.7)
Neurology	67 (5.6)
Pediatrics	44 (3.7)
Most common laboratory tests
Complete blood count	643 (53.8)
CRP	509 (42.6)
Creatinine	472 (39.5)
BUN	440 (36.8)
Urinalysis	417 (34.9)
Most common imaging studies
X-Ray	308 (25.8)
Ultrasound	151 (12.6)
CT	96 (8.0)
MRI	10 (0.8)
Most common procedures
IV placement	571 (47.7)
ECG	339 (28.5)
Wound care	17 (1.4)
Suturing	10 (0.8)
Urinary catheterization	9 (0.8)

Variables	n (%)^*
Discharged	519 (43.4)
Admitted	503 (42.0)
AMA	24 (2.0)
Transferred	3 (0.3)
Expired	8 (0.7)

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