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Background Due to the high burden of mortality from acute communicable and non-communicable diseases,emergency departmentâs mortality has become one of the major health indices in Ethiopia that should be evaluatedregularly in every health institution. However, there are inconsistencies between studies, and there is no systematicreview or meta-analysis study about the prevalence of mortality in the emergency department. Therefore, this studyaimed to determine the pooled prevalence of mortality and identify its determinants in the emergency departmentsof Ethiopian hospitals.Methods This systematic review was conducted according to the guidelines of Preferred Reporting Items forSystematic Reviews and Meta-Analyses (PRISMA) and has been registered with PROSPERO. A structured search ofdatabases (Medline/PubMed, Google Scholar, CINAHL, EMBASE, HINARI, and Web of Science) was undertaken. Allobservational studies reporting the prevalence of mortality of patients in emergency departments of Ethiopianhospitals, and published in English up to December 16, 2023, were considered for this review. Two reviewersindependently assess the quality of the studies using the Joanna Briggs Institute (JBI) critical appraisal tool. A meta-analysis using a random-effects model was performed to estimate the pooled prevalence. The heterogeneity ofstudies was assessed using I2 statistics, and to identify the possible causes of heterogeneity, subgroup analysis andmeta-regression were used. Eggerâs test and funnel plots were used to assess publication bias. STATA version 17.0software was used for all the statistical analyses. A p-value less than 0.05 was used to declare statistical significance.Results A total of 1363 articles were retrieved through electronic search databases. Subsequently, eighteen studiescomprised 21,582 study participants were included for analysis. The pooled prevalence of mortality among patients inthe Emergency Department (ED) was 7.71% (95% CI: 3.62, 11.80). Regional subgroup analysis showed that the pooledprevalence of mortality was 16.7%, 12.89%, 10.28%, and 4.35% in Dire Dawa, Amhara, Oromia, and Addis Ababa,respectively. Moreover, subgroup analysis based on patientsâ age revealed that the pooled prevalence of mortalityamong adults and children was 8.23% (95% CI: 3.51, 12.94) and 4.48% (95% CI: 2.88, 6.08), respectively. Being a ruralresident (OR; 2.30, 95% CI: 1.48, 3.58), unconsciousness (OR; 3.86, 95% CI: 1.35, 11.04), comorbidity (OR; 2.82, 95% CI:1.56, 5.09), and time to reach a nearby health facility (OR; 4.73, 95% CI: 2.19, 10.21) were determinants of mortality forpatients in the emergency departments.
Conclusion and recommendations This study found that the overall prevalence of mortality among patients inemergency departments of Ethiopian hospitals was high, which requires collaboration between all stakeholdersto improve outcomes. Being a rural resident, unconsciousness, comorbidity, and time elapsed to reach healthfacilities were determinants of mortality. Improving pre-hospital care, training healthcare providers, early referral, andimproving first-line management at referral hospitals will help to reduce the high mortality in our country.Keywords Associated factors, Emergency department, Ethiopia, Meta-analysis, Mortality
Full Abstract:
Background Due to the high burden of mortality from acute communicable and non-communicable diseases,emergency departmentâs mortality has become one of the major health indices in Ethiopia that should be evaluatedregularly in every health institution. However, there are inconsistencies between studies, and there is no systematicreview or meta-analysis study about the prevalence of mortality in the emergency department. Therefore, this studyaimed to determine the pooled prevalence of mortality and identify its determinants in the emergency departmentsof Ethiopian hospitals.Methods This systematic review was conducted according to the guidelines of Preferred Reporting Items forSystematic Reviews and Meta-Analyses (PRISMA) and has been registered with PROSPERO. A structured search ofdatabases (Medline/PubMed, Google Scholar, CINAHL, EMBASE, HINARI, and Web of Science) was undertaken. Allobservational studies reporting the prevalence of mortality of patients in emergency departments of Ethiopianhospitals, and published in English up to December 16, 2023, were considered for this review. Two reviewersindependently assess the quality of the studies using the Joanna Briggs Institute (JBI) critical appraisal tool. A meta-analysis using a random-effects model was performed to estimate the pooled prevalence. The heterogeneity ofstudies was assessed using I2 statistics, and to identify the possible causes of heterogeneity, subgroup analysis andmeta-regression were used. Eggerâs test and funnel plots were used to assess publication bias. STATA version 17.0software was used for all the statistical analyses. A p-value less than 0.05 was used to declare statistical significance.Results A total of 1363 articles were retrieved through electronic search databases. Subsequently, eighteen studiescomprised 21,582 study participants were included for analysis. The pooled prevalence of mortality among patients inthe Emergency Department (ED) was 7.71% (95% CI: 3.62, 11.80). Regional subgroup analysis showed that the pooledprevalence of mortality was 16.7%, 12.89%, 10.28%, and 4.35% in Dire Dawa, Amhara, Oromia, and Addis Ababa,respectively. Moreover, subgroup analysis based on patientsâ age revealed that the pooled prevalence of mortalityamong adults and children was 8.23% (95% CI: 3.51, 12.94) and 4.48% (95% CI: 2.88, 6.08), respectively. Being a ruralresident (OR; 2.30, 95% CI: 1.48, 3.58), unconsciousness (OR; 3.86, 95% CI: 1.35, 11.04), comorbidity (OR; 2.82, 95% CI:1.56, 5.09), and time to reach a nearby health facility (OR; 4.73, 95% CI: 2.19, 10.21) were determinants of mortality forpatients in the emergency departments.
Conclusion and recommendations This study found that the overall prevalence of mortality among patients inemergency departments of Ethiopian hospitals was high, which requires collaboration between all stakeholdersto improve outcomes. Being a rural resident, unconsciousness, comorbidity, and time elapsed to reach healthfacilities were determinants of mortality. Improving pre-hospital care, training healthcare providers, early referral, andimproving first-line management at referral hospitals will help to reduce the high mortality in our country.Keywords Associated factors, Emergency department, Ethiopia, Meta-analysis, Mortality