Kiran Ejaz

Insights on the effects of patient perceptions and awareness on ambulance usage in Karachi, Pakistan

Background Prehospital care is a vital part of emergency medical care. Countries with decentralised ambulance systems, such as Pakistan, require patient knowledge as to when to call an ambulance and which service to call. Little is known about how patient perceptions of ambulance services affect ambulance usage in most low- and middle-income countries (LMIC). The purpose of our study was to analyse patient perspectives of the ambulance system in Karachi to understand how to improve ambulance use. Methods Indepth interviews were conducted with 30 individuals selected by convenience sampling representing patients who came to the emergency department by private transport versus one of two of the main ambulance service providers in Karachi. Results Similar to what has been shown in some LMIC contexts, two of the major themes that emerged which affect patient decision making with regard to ambulance use were a mistrust of the ambulance system or providers and a sense of inadequacy of the local system as compared with international standards. In addition, which has not been shown in previous studies, there was a fundamental misunderstanding of the role of ambulance services in the healthcare infrastructure. Conclusions Insight into the main issues affecting patient decisions to use an ambulance service offers possible targets for patient education that could result in an increase in the proper usage of ambulances and thus optimise outcomes from serious injury and illness in an LMIC context.

Severity of Plasmodium vivax Malaria in Karachi: a cross-sectional study

INTRODUCTION Plasmodium vivax malaria affects billions of people annually. This study aimed to note the presentations and complications and subsequently to identify the determinants of in-patient hospital care of P. vivax malaria patients presenting to a tertiary care hospital in Karachi, Pakistan. Severity of the shock was also assessed using a shock index. METHODOLOGY This study descriptive cross-sectional study was conducted at the Emergency Department of Aga Khan University Hospital, Karachi. All adult patients with a positive P. vivax peripheral film and/or immunochromatography admitted through the department were studied during 2009. Data was entered and analyzed using SPSS version 16. Keeping the length of stay at a cut-off of 48 hours after admission, the independent Student-t test was applied. Level of significance was taken at 0.05. RESULTS A total of 97 patients were included in the study. Fever was the most common presentation. A significant number of patients had nonspecific complaints, but tachycardia, altered mental status, and adult respiratory distress syndrome were important findings. Mean shock index was 1 (SD 0.26). Common reasons for admission were thrombocytopenia and dehydration. Some patients were admitted for more than 48 hours. Complications included pneumonia and bleeding requiring platelet transfusion. CONCLUSION This study highlights that the debilitating impact of P. vivax malaria remains high. Although the effects of severe vivax malaria can be contained through aggressive resuscitation and specific therapy, sensitivity and awareness of this complicated course must be highlighted among caregivers.

Pretest of a locally developed trauma registry

Introduction Electronic trauma registries (ETR) play a critical role in the collection of pre-hospital and hospital based trauma data, required for trauma care improvement. The crucial step is to have a functionally active and reliable trauma registry which is customised according to the local needs. This prompted for development of a low cost local registry with the help of software programmers. Objectives To pretest locally developed ETR at a single university hospital, to assess the functionality, efficiency and reliability in data storage retrieval and analysis. Methods We tested the registry with records of poly-trauma patients treated during 2008 at Aga Khan University Hospital. This data was entered into the ETR, by trained staff, its functionality and reliability was assessed through analysis of the data. Results There were 119 patients, with mean age of 32.7 years, mean RTS was 7.48650, ISS score was 12.039 and mean TRISS was 95.7511. The most common mechanism of injury was MVC (73.1%) followed by gunshot wounds (16.8%). There were 5 (4.2%) patients who expired. In the analysis of injuries, head and neck (42%) and extremities (52.1%) were the most commonly involved regions. We found that there were four unexpected deaths (TRISS > 50%) and we also found two unexpected survivors (TRISS <50%). Conclusion The ETR is found to be a reliable data storage system which is also capable of generating standard reports consisting of patient demographics, injury severity scores and probability of survival and outcome.

Locally developed electronic trauma registry: a novel solution for low-income settings

Introduction A functionally active and well organised electronic trauma registry (ETR) can assist in addressing important issues about the prevention and treatment of injuries at hospital and regional level. The ideal process of development of such a registry includes its customisation according to the local needs and enabling the end users to give their feedback to the software programmers who can improvise it accordingly. Examples of ETRs in low and middle income countries are rare, mainly due to cost of obtaining and maintaining such registries. This prompted us for development of a local registry with the help of software programmers at a low cost with a user friendly interface. Attributes The ETR uses both hardware and software to collect, verify, store and analyse the data. Effective coding systems for example, International Classification of Diseases (ICD-9-CM) and Abbreviated Injury Scaling (AIS) aid in standardisation of the terms, whereas backend spreadsheets and calculators help in storage, collation and analysis of the data. Scope Information about patient demographics, injury location, injury date and time, external causes of injury, injury modifiers, mode of transport, ED/hospital assessment and treatment, final diagnosis, disposition and outcome can be recorded. The registry is capable of generating different trauma scores (GCS, RTS, ISS) and probability of survival (TRISS) score. Advantages The registry could be used for hospital based injury surveillance, trauma outcome research and public policy interventions. When applied in multiple hospitals, it will serve as a city-wide trauma data bank.