Abstract:
Background: Critical care practice in Emergency Department of resource limited setting is neglected and mortality is enormous. ED overcrowding, decreased ICU bed availability and increased patient acuity compromised critical care service and posed heavy burden on ED stuff. There is need to know type of patients admitted to EICU, common diagnoses and outcome
Objectives: To assess pattern of admission and outcome of patients in Emergency-ICU of ED at Jimma medical center.
Methods: Institutional based retrospective cross sectional study was conducted from September 1, 2022 to June 7, 2023. 227 study subjects were included in the study. Data was collected using structured questionnaires by reviewing patient medical review and the collected data was daily checked for completeness and consistency. Data was entered on Epi info version 7.2.5 and analyzed using SPSS version 24 for Windows software. Statistical test and association between variable was interpreted accordingly. P-value < 0.05 was considered significant.
Results: Patients admitted to EICU were young adults (mean 42 years SD +/- 18.1) and male (M: F= 1.27:1). Medical category admissions accounts for 217(95.6%) cases with acute decompensated heart failure 35(16.1%) being the commonest diagnosis. Cardiogenic shock 26(11.9%), Septic shock 24(11%), acute respiratory distress syndrome 22(10.1%) and severe community acquired pneumonia 19(8.7%) were among the top five EICU diagnosis. Ten (4.4%) EICU admissions were Surgical diagnosis out of which four (40%) were due to traumatic brain injury. Sixty two (27.3%) patients received vasopressor and 25 (11%) patients received ventilator support. The mean length of ICU stay was 50.4 hours (SD+/-2.69). The overall in-ICU mortality rate was 41.8%. Seven days Hospital mortality was 48.4%. Length of ICU stay for 48 hours, the need for vasopressor and the need for mechanical ventilator were identified to be independent predictors of EICU and 7-days mortality in patients admitted to EICU of Jimma University Medical Center at p<0.05.
Conclusion: Overall, medical diagnoses were the most common cause for EICU admissions. The study showed nearly half of in-ICU mortality are young adults (age <40) and having no comorbidities. EICU and 7-days Hospital mortality is high in patients who stayed for 48 hours, in those who require vasopressor and mechanical ventilator support. In spite of challenges of poor healthcare access resulting delayed presentation, provision of quality critical care delivery could significantly lower mortality of ICU patients.
