Clinical epidemiology, management and predictors of outcomes of adult patients with non-traumatic acute abdomen presenting to the emergency medicine department of Muhimbili National Hospital

Abstract

ABSTRACT Background: Abdominal pain in adults represents a wide range of illnesses, from benign to life threatening conditions warranting immediate interventions. Emergency medicine as a new specialty provides an opportunity for early recognition and provision of appropriate treatment. However, the range of possibilities poses a unique challenge to emergency care providers particularly in low-income countries where there is general paucity of data on aetiology and outcomes for patients presenting to acute intake areas. Aim: To describe the clinical profiles, management and outcomes of adult patients presenting with non-traumatic abdominal pain to the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH). Methodology: This was a prospective cohort study of adult patients presenting to the EMD MNH with non-traumatic abdominal pain. A case report form with inbuilt online data capture software was used to record data on demographics, clinical presentation, management, diagnosis and outcomes of patients. Data was summarized using descriptive statistics. Relative risks (RR) were ascertained to determine factors associated with mortality. Results: A total 3381 adult patients presented at the EMD during the study period, 288 (8.5%) presented with abdominal pain, and of these 199 (69.1%) patients consented and were enrolled to our study. The median age was 47 years with IQR (35-60 years), 126 (63.3%) were female, and 118 (59.3%) were referral cases. Top EMD diagnoses were malignancies 67 (33.7%), intestinal obstruction 15 (7.5%) and UGIB 10 (5%) while final diagnosis were malignancies 71 (35.7%), intestinal obstruction 11 (5.5%) and PUD 9 (4.5%). Most common interventions given were intravenous fluids 57 (20.8%), analgesia 49 (24.6%) and antibiotics 40 (20.1%). There were 39 (19.6%) patients discharged, 160 (80.4%) admitted of which 15 (7.5%) underwent surgery directly from EMD. 24-hour and 7-day mortality were 4 (2.0%) and 7 (3.5%) respectively while overall in hospital-mortality was 16 (8.0%). Significant risk factors for mortality seen in this study included male patients Relative Risk (RR) 2.88 (p = 0.03), and ICU admission RR= 14 (p <0.0001). Conclusion & Recommendations: Abdominal pain is a common complain amongst adult patients presenting to the EMD-MNH. This presentation was associated with significant morbidity and mortality as evidenced by very high admission rate, need for surgical intervention and an in hospital-mortality rate of 8%. Future studies and quality improvement efforts should focus in identifying aetiologies, risks and appropriate interventions to optimize outcomes