Clinical and Autopsy Parameters of Acute Medical Deaths in an Emergency Facility in South-West Nigeria
Date
2013
Authors
Ajuluchukwu, JNA
Abdulkareem, FB
Achusi, IB
Mbakwem, AC
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of clinical sciences
Abstract
Background: Acute medical deaths are usually consequences of acute critical diseases, or acute exacerbations of chronic diseases. Thus, autopsy – confirmed characteristics would provide support for future management strategies. Objectives: To examine clinical and autopsy parameters including causes of death (COD) and mechanisms of death (MOD) among acute medical deaths. Methods: A 5-year (2005–2009) retrospective analysis was undertaken of Emergency Department (ED) related medical deaths occurring <24 hours after presentation. Case-notes provided clinical details while autopsy records supplied the COD and MOD respectively. Results: Decedents were 250 males (58.5%) and 177 females (41.5%), (male: female ratio=1.4: 1), predominantly (78%) young; with mean age of 43.7±16.6 years. In 22.8%, symptom duration was <1 day but >4 days in 42.8%. Coma –36%, and dyspnoea –10% prompted early presentation; but late presentation (>4days) characterised cough (4%), fever (10%), and body swelling (19%). Of the total, 23% presented after 10 pm, 16% were “dead on arrival” (DOA), and 40% died within six hours of arrival. Three commonest CODs were circulatory-cardiovascular disease [CVD](36%), infections/ septicaemia (18%), and malignancies (8.4%). CVD subset was older (52 years), with significant male preponderance (62.5% vs 37.5%; p<0.05); but comparable mean age in both sexes. Common MODs were cerebral dysfunction (29%) – including sub-types of intra-cerebral haemorrhage (51.8%) and tonsillar herniation (33.3%), heart failure (19%), and septicaemia (15%). Conclusion: The highlights were late presentation, early demise from communicable and noncommunicable diseases; and common “exit” mechanisms of septicaemia, heart failure and cerebral dysfunction. These data will guide management and preventive strategies.
Description
Keywords
Acute medical mortality, late presentation, cause of death, mechanism of death; cardiovascular disease, emergency department.
Citation
Year : 2013 | Volume : 10 | Issue : 1 | Page : 21-26