Management of patients with non traumatic hypotension presenting at emergency department Muhimbili National Hospital.

Abstract

Background: Hypotension is associated with high morbidity and mortality among emergency department patients. The diagnostic workup and management of hypotensive patients may vary greatly based on suspected etiology and regional burden of disease. Unfortunately, little is known about the emergency department (ED) diagnostic evaluation, treatment, and discharge diagnoses of patients with non-traumatic hypotension in sub-Saharan Africa. Objectives: This study aims to characterize the diagnostic test utilization, treatment, and final EMD diagnosis for patients presenting to the MNH ED with non-traumatic hypotension. Methodology: This was a prospective descriptive cohort study carried out from April to November 2012 at the MNH ED. A total of 65 adult patients with non-traumatic hypotension were enrolled. Data collected at presentation included history, physical examination findings, diagnostic testing, and final EMD diagnosis. Follow-up data collected included hospital length of stay, discharge diagnosis, and 24-hour and in-hospital mortality. Descriptive statistics were used to report the type and frequency of laboratory tests used in the evaluation of study patients. Results: Out of 65 patients, 53 (88%) were referred from other hospitals, and 12 (18%) were self-referred. The mean systolic blood pressure at arrival was 84mmHg and diastolic of 50mmHg. At MNH ED, 54 (83%) patients had ECGs done which were abnormal in 32 patients (59%). Bedside USS done to all 65 and 45 (69%) had abnormal findings. Fifteen (23%) of the patients received X rays and 11(73%) had abnormal findings. All patients underwent laboratory work up. Amongst the 53 patients referred from an outside hospital only 20 (38%) patients received fluids prior to arrival. While at the EMD 63 patients x (97%) received fluids. Mean systolic blood pressure after intervention was 91mmHg (median90 mmHg), while diastolic was 60mmHg (median 6).For patients who survived to discharge the mean systolic was 92mmhg and diastolic of 56mmHg. The mean hospital length of stay was 2 days in those who died and 4 days for those who survived till discharge. In 78% patients, the EMD diagnosis matched hospital discharge diagnosis. Overall mortality in this study was 26% (17) patients, with 7 (48%) of these deaths occurring in the first 24hours. Conclusion The most common diagnostic tests performed in the ED were: USS, ECG, plain X RAYS, RBG, RDTFBP, ABG and rapid for HIV. Seventy eight percent of EMD diagnoses were the same as final discharge diagnosis. There was a high overall mortality in patients presenting with hypotension and many of these patients died within the first 24hours of admission.