Clinical profile and outcomes of adult patients presenting with non-traumatic respiratory distress to the emergency department of Muhimbili National Hospital

Abstract

ABSTRACT Background: Respiratory Distress (RD) is a life-threatening condition among adults at the emergency department that presents with an abnormal respiratory rate or respiratory effort (increased or inadequate) and is usually associated with high mortality. Objectives: Aimed to determine the clinical profile and outcome of adult patients who present to the emergency department with non-traumatic RD in a low resource setting. Methodology: This was a prospective observational cohort study in a public tertiary hospital of adult patients who presented with respiratory distress at ED September 2019 to January 2020. Adult patients that presented with non-traumatic RD and consented were included in the study using a structured case report form we documented patient demography, clinical presentation, and ED management provided. ED and in-hospital LOS were recorded as well. Modified early warning signs (MEWS) score was calculated. Patients were followed-up until death or discharge. We determined the proportion of patients with RD and their mortality using proportions and identified the risk factors for mortality using logistic regression analysis. Results: We enrolled 345 (2.8%) adults with respiratory distress from 12,184 adult patients that presented to the ED during the study period. The median age was 54 years (IQR 38 to 66 years) and 190(55.1%) were men. 742 patients (16.8%) had difficulty breathing and the most common associated complaints were cough 109(31.6%), chest pain 101(29.3%), and lower limb swelling 100(29%). Cardiovascular diseases were the most frequently reported comorbidity 218(63.2%). The median MEWS score was 4 (IQR 1-7). The most frequent imaging done was bedside ultrasound 281(81.4%.). Oxygen therapy during transport from referring health facilities was provided to a few 98(28.4%) while more patients were given oxygen treatment in ED 223(64.6%). Median LOS in ED was 4 hours (IQR 3-6hours). Most patients were admitted 292(84.6%), median LOS in-hospital was 6 days(IQR 2-10days) and in-hospital mortality was 126(43.2%). MEWS score of 5 or more (OR=4.39(95%CI1.70-11.32), p=0.002) was independently associated with mortality.

Conclusion: In this descriptive study we found that RD has a high in-hospital mortality of 43.2%. Abnormal airway sounds and elevated urea levelarelevel are ominous indicators in patients with respiratory distress. The MEWS score 5 and above was independently associated with increased mortality and future studies should consider linking its use in low-resource setting.