An observational study of adults seeking emergency care in Cambodia

• Published in: Bulletin of the World Health Organization Vol. 93; no. 2; pp. 84 - 92
• Main Authors: Yan, Lily D, Mahadevan, Swaminatha V, Yore, Mackensie, Pirrotta, Elizabeth A, Woods, Joan, Somontha, Koy, Sovannra, Yim, Raman, Maya, Cornell, Erika, Grundmann, Christophe, Strehlow, Matthew C
• Format: Journal Article
• Language: English
• Published: Switzerland World Health Organization 01.02.2015; The World Health Organization
• Subjects: Adolescent; Adult; Adults; Aged; Cambodia; Clinical outcomes; Complaints; Data collection; Demographics; Diagnostic systems; Electrocardiography; Emergencies; Emergency medical care; Emergency Medical Services - statistics & numerical data; Emergency services; Female; Fever; Health care; Health Policy & Services; Hospitalization; Hospitals; Hospitals, Public - statistics & numerical data; Humans; Low income groups; Male; Medicine; Middle Aged; Multivariate analysis; Observational studies; Obstetrics; Patient Acceptance of Health Care - statistics & numerical data; Patients; Socioeconomic Factors; Studies; Surgery; Vital signs; Young Adult; Cambodia
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.14.143917

To describe the characteristics and chief complaints of adults seeking emergency care at two Cambodian provincial referral hospitals. Adults aged 18 years or older who presented without an appointment at two public referral hospitals were enrolled in an observational study. Clinical and demographic data were collected and factors associated with hospital admission were identified. Patients were followed up 48 hours and 14 days after presentation. In total, 1295 hospital presentations were documented. We were able to follow up 85% (1098) of patients at 48 hours and 77% (993) at 14 days. The patients' mean age was 42 years and 64% (823) were females. Most arrived by motorbike (722) or taxi or tuk-tuk (312). Most common chief complaints were abdominal pain (36%; 468), respiratory problems (15%; 196) and headache (13%; 174). Of the 1050 patients with recorded vital signs, 280 had abnormal values, excluding temperature, on arrival. Performed diagnostic tests were recorded for 539 patients: 1.2% (15) of patients had electrocardiography and 14% (175) had diagnostic imaging. Subsequently, 783 (60%) patients were admitted and 166 of these underwent surgery. Significant predictors of admission included symptom onset within 3 days before presentation, abnormal vital signs and fever. By 14-day follow-up, 3.9% (39/993) of patients had died and 19% (192/993) remained functionally impaired. In emergency admissions in two public hospitals in Cambodia, there is high admission-to-death ratio and limited application of diagnostic techniques. We identified ways to improve procedures, including better documentation of vital signs and increased use of diagnostic techniques.