Table 4.
Assessment and management of seriously injured patients presenting to emergency units (ER) of select Ghanaian district and regional hospitals
| District hospital (N=168) | Regional hospital (N=140) | ||||
|---|---|---|---|---|---|
| N | (%) | N | (%) | p-valueh | |
| Background information | |||||
| Date of patient arrival at ER recorded | 163 | (97) | 140 | (100) | 0.04 |
| Time of patient arrival at ER recorded | 163 | (97) | 139 | (99) | 0.15 |
| Date of injury recorded | 161 | (96) | 135 | (96) | 0.79 |
| Time of injury recorded | 162 | (96) | 129 | (92) | 0.10 |
| Initial clinical impression of injury recorded | 163 | (97) | 138 | (99) | 0.36 |
| Triage and monitoring | |||||
| Mobility at ER arrival assessed | 148 | (88) | 140 | (100) | <0.001 |
| Respiratory rate at ER arrival assessed | 95 | (57) | 137 | (98) | <0.001 |
| Temperature at ER arrival assessed | 136 | (81) | 140 | (100) | <0.001 |
| Oxygen saturation level at ER assessed | 112 | (67) | 123 | (88) | <0.001 |
| Time of any repeat triage assessment recorded for patients who stayed ≥0.5 hr at the ER (n=152)a | 51 | (34) | 46 | (35) | 0.85 |
| Mobility re-assessed for patients who stayed ≥0.5 hr at the ER (n=152)a | 50 | (33) | 29 | (22) | 0.04 |
| Respiratory rate re-assessed for patients who stayed ≥0.5 hr at the ER (n=152)a | 38 | (25) | 32 | (24) | 0.85 |
| Heart rate re-assessed for patients who stayed ≥0.5 hr at the ER (n=152)a | 47 | (31) | 34 | (26) | 0.32 |
| Blood pressure re-assessed for patients who stayed ≥0.5 hr at the ER (n=152)a | 39 | (26) | 47 | (35) | 0.08 |
| Consciousness level re-assessed for patients who stayed ≥0.5 hr at the ER (n=152)a | 60 | (39) | 34 | (26) | 0.01 |
| Temperature re-assessed for patients who stayed ≥0.5 hr at the ER (n=152)a | 40 | (26) | 48 | (36) | 0.08 |
| Oxygen saturation level re-assessed for patients who stayed ≥0.5 hr at the ER (n=152)a | 35 | (23) | 42 | (32) | 0.11 |
| Primary assessment and actions | |||||
| Airway assessed | 154 | (92) | 110 | (79) | 0.001 |
| Chest examined | 122 | (73) | 110 | (79) | 0.23 |
| intravenous line placed | 136 | (81) | 135 | (96) | <0.001 |
| External bleeding checked for and controlled | 108 | (64) | 119 | (85) | <0.001 |
| Internal abdominal bleeding ruled outb | 65 | (39) | 117 | (84) | <0.001 |
| Pelvic fracture ruled out | 51 | (30) | 101 | (72) | <0.001 |
| All distal pulses checked | 75 | (45) | 100 | (71) | <0.001 |
| Fluid and/or blood requirement considered | 124 | (74) | 123 | (88) | 0.002 |
| Spine immobilized for RTI or fall victims (n=128)c | 16 | (13) | 42 | (37) | <0.001 |
| Splinting of fractures considered (n=76)d | 52 | (68) | 29 | (50) | 0.03 |
| Physical examination findings recorded | 161 | (96) | 140 | (100) | <0.001 |
| Alcohol on breath assessed | 59 | (35) | 40 | (29) | 0.22 |
| Total burn surface area recorded (n=8)e | 7 | (88) | 3 | (75) | 1.00 |
| Tetanus considered for bites, burns, lacerations, and abrasions (n=96)f | 66 | (69) | 76 | (84) | 0.01 |
| Antibiotic considered | 127 | (76) | 132 | (94) | <0.001 |
| Analgesics considered | 149 | (89) | 131 | (94) | 0.138 |
| Documented information and actions | |||||
| Patient sex | 166 | (99) | 140 | (100) | 0.20 |
| Patient age | 157 | (93) | 136 | (97) | 0.13 |
| Mechanism of injury | 166 | (99) | 140 | (100) | 0.20 |
| Intent of injury | 166 | (99) | 139 | (99) | 0.67 |
| Heart rate at ER arrival | 118 | (70) | 138 | (99) | <0.001 |
| Blood pressure at ER arrival | 93 | (55) | 135 | (96) | <0.001 |
| Consciousness level at ER arrival | 157 | (93) | 140 | (100) | 0.002 |
| Injury type | 160 | (95) | 140 | (100) | 0.009 |
| Patient encounter signed by EHSP | 102 | (61) | 136 | (97) | <0.001 |
| Date of ER disposition recorded | 127 | (76) | 136 | (97) | <0.001 |
| Time of ER disposition recorded | 125 | (74) | 131 | (94) | <0.001 |
| Important clinical data documented g | 75 | (45) | 130 | (93) | <0.001 |
Seriously injured – Referred, died, or length of overall hospital stay ≥24 hours; ER – Emergency Unit; RTI – Road Traffic Injury; EHSP – Emergency Unit Health Service Provider
For seriously injured patients, n=133;
Internal abdominal bleeding ruled out by any one of: abdominal exam, ultrasound, x-ray, computerized tomography;
For seriously injured patients, n=114; spine immobilization implies use of either cervical collar or backboard;
For seriously injured patients, n=58;
For seriously injured patients, n=4;
For seriously injured patients, n=90;
Important clinical data documented - all of the following: patient sex, patient age, mechanism of injury, intent of injury, heart rate at ER arrival, Systolic blood pressure at ER arrival, Diastolic blood pressure at ER arrival, Consciousness level at ER arrival, and Injury type.
Comparison by chi-square test and Fisher’s exact test where appropriate