Emergency care in 59 low- and middle-income countries: a systematic review.
Emergency care in 59 low- and middle-income countries: a systematic review.
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DOI：
10.2471/blt.14.148338
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发表时间：
2015-08-01
影响因子：
11.1
通讯作者：
Acute Care Development Consortium
中科院分区：
文献类型：
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作者：
Obermeyer Z;Abujaber S;Makar M;Stoll S;Kayden SR;Wallis LA;Reynolds TA;Acute Care Development Consortium
对低收入和中等收入国家（LMIC）的紧急护理进行系统性审查。我们检索了PubMed、CINAHL和世界卫生组织（WHO）数据库中描述基于设施的紧急护理的报告，并从临床医生和研究人员网络中获得了未发表的数据。我们根据标题和英文或法文摘要筛选纳入的文章。我们提取了有关患者结局和人口统计学以及设施和提供者特征的数据。分析仅限于1990年以后发表的报告。我们确定了195份报告，涉及59个国家的192个设施。大多数是城市地区的学术附属医院。急诊科的中位死亡率为1.8%（四分位距，IQR：0.2-5.1%）。儿科机构（中位数：4.8%; IQR：2.3-8.4%）和撒哈拉以南非洲（中位数：3.4%; IQR：0.5-6.3%）的死亡率相对较高。中位患者数量为每年30 000例（IQR：10 296-60 000），其中大多数为年轻人（中位年龄：35岁; IQR：6.9-41.0）和男性（中位年龄：55.7%; IQR：50.0-59.2%）。大多数设施的工作人员要么是受训医生，要么是培训程度不详的医生。这些提供者中很少有人受过紧急护理方面的专门培训。关于中低收入国家急诊护理的现有数据表明，病人负担和死亡率很高，特别是在撒哈拉以南非洲，那里的所有死亡中有很大一部分可能发生在急诊室。高容量和治疗的紧迫性相结合，使急诊护理成为旨在降低这些环境中死亡率的干预措施的一个重要重点领域。
To conduct a systematic review of emergency care in low- and middle-income countries (LMICs). We searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards. We identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2–5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3–8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5–6.3%). The median number of patients was 30 000 per year (IQR: 10 296–60 000), most of whom were young (median age: 35 years; IQR: 6.9–41.0) and male (median: 55.7%; IQR: 50.0–59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care. Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings.