Epidemiology of patients presenting to a pediatric emergency department in Karachi, Pakistan
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RESEARCH ARTICLE
Open Access
Epidemiology of patients presenting to a pediatric emergency department in Karachi, Pakistan Nadir Ijaz1, Matthew Strehlow1* , N. Ewen Wang1, Elizabeth Pirrotta1, Areeba Tariq2, Naseeruddin Mahmood3 and Swaminatha Mahadevan1
Abstract Background: There is little data describing pediatric emergencies in resource-poor countries, such as Pakistan. We studied the demographics, management, and outcomes of patients presenting to the highest-volume, public, pediatric emergency department (ED) in Karachi, Pakistan. Methods: In this prospective, observational study, we approached all patients presenting to the 50-bed ED during 28 12-h study periods over four consecutive weeks (July 2013). Participants’ chief complaints and medical care were documented. Patients were followed-up at 48-h and 14-days via telephone. Results: Of 3115 participants, 1846 were triaged to the outpatient department and 1269 to the ED. Patients triaged to the ED had a median age of 2.0 years (IQR 0.5–4.0); 30% were neonates (< 28 days). Top chief complaints were fever (45.5%), diarrhea/vomiting (32.3%), respiratory (23.1%), abdominal (7.5%), and otolaryngological problems (5.8%). Temperature, pulse and respiratory rate, and blood glucose were documented for 66, 42, and 1.5% of patients, respectively. Interventions included medications (92%), IV fluids (83%), oxygen (35%), and advanced airway management (5%). Forty-five percent of patients were admitted; 11 % left against medical advice. Outcome data was available at time of ED disposition, 48-h, and 14 days for 83, 62, and 54% of patients, respectively. Of participants followed-up, 4.3% died in the ED, 11.5% within 48 h, and 19.6% within 14 days. Conclusions: This first epidemiological study at Pakistan’s largest pediatric ED reveals dramatically high mortality, particularly among neonates. Future research in developing countries should focus on characterizing reasons for high mortality through pre-ED arrival tracking, ED care quality assessment, and post-ED follow-up. Keywords: Global health, Pediatric emergency medicine, Epidemiology, Outcomes, Pakistan
Background Pakistan is a resource-poor country in South Asia that has recently taken significant steps to improve its national healthcare delivery. Despite its efforts, Pakistan continues to perform poorly on many international health indicators, especially with regard to its pediatric population. In 2016, its neonatal, infant, and under-five mortality rates were 46, 64, and 79 per 1000 live births, respectively, giving Pakistan the world’s highest neonatal mortality rate, as * Correspondence: [email protected] 1 Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Rm M121, Alway Building MC 5119, Stanford, CA 94305, USA Full list of author information is available at the end of the article
well as the 11th highest infant and 20th highest under-five mortality rates [1]. One contributor to high pediatric morbidity and mortality in Pakistan is the absence of an organized emergenc
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