Emergency department deaths in a Nigerian University Hospital: Deaths too many

Objectives: We reviewed the demographic pattern and distribution of deaths in the emergency department (ED) of the University College Hospital (UCH) in order to identify gaps in the standard of care, thereby providing evidence for intervention and enhanced research in acute care. Methods: After obtaining institutional ethics approval, we retrospectively studied all deaths in the ED of UCH from January 1 to December 31, 2011. Data were retrieved from the ED's electronic register. Results: During the 12-month period, a total of 10 728 patients attended the emergency centre and 647 deaths occurred, giving a mortality rate of 6.0%. Male deaths constituted 62% of all deaths. The mean age at death was 44.5 ± 19.1 (range 5 months-92 years). The age group with the highest proportional mortality was 60-69 years (11.4%). Out of all deaths, 295 (45.6%) had alterations of consciousness. Medicine was the specialty with the most deaths (56%), followed by surgery (40%) and lastly, obstetrics and gynaecology (4%). Of the 190 patients that died from trauma, 153 (80.5%) had injury severity score ≥ 15. Most deaths (75.4%) occurred within 24 hours of arrival and the 12-hour night shift had 322 (50%) of the mortalities. Autopsies were carried out in 36 (5.6%) of the 647 deaths. Of the 36 autopsies, 24 (66.7%) were deaths due to medical causes. Conclusion: Mortalities within 24 hours of presentation at the ED of UCH remain high. This calls for an efficient pre-hospital care, well-organized emergency transport system, new guidelines, establishment of protocols and regular audit.