Prevalence and Antimicrobial Sensitivity Patterns of Uropathogens, in Tikur Anbessa Specialized Hospital Emergency Medicine Department Addis Ababa, Ethiopia.

Background: Empirical treatment of infections remains a major contributing factor to the emergence of pathogens that are resistant to antibiotics. The study aimed to assess the prevalence and anti-microbial sensitivity patterns of uropathogens in the Emergency Medicine Department of Tikur Anbessa Hospital, Ethiopia. Methods: Urine sample data collected over two years from January 2015 to January 2016 at Tikur Anbessa Hospital's laboratory were retrospectively analyzed for bacterial pathogens, and their antimicrobial susceptibility. Antimicrobial sensitivity tests were done using the disc diffusion technique as per the standard of the Kirby-Bauer method. Results: Of the total 220 samples that were collected, 50 (22.7%) were culture-positive. Male to female data ratio was 1:1.1. Escherichia coli was the dominant isolate (50%) followed by Enterococcus species (12%), Enterobacter species (12%), and Klebsiella species (8%). Overall resistance rates to Cotrimoxazole, Ampicillin, Augmentin, and Ceftriaxone were 90.4%, 88.8%, 82.5%, and 79.3%, respectively. The sensitivity rates for Chloramphenicol, Amikacin, Vancomycin, Meropenem, Cefoxitin, and Nitrofurantoin ranged from 72% to 100%. The antibiogram of isolates showed that 43 (86%) isolates were resistant to two or more antimicrobials, and 49 (98%) were resistant to at least one antibiotic. Conclusion and Recommendation: Urinary tract infections are mostly caused by Gram-negative bacteria predominantly in females and Escherichia coli are the most common isolates. Resistance rates to Cotrimoxazole, Ampicillin, Augmentin, and Ceftriaxone were high. Chloramphenicol, Amikacin, Vancomycin, Meropenem, Cefoxitin, and Nitrofurantoin are considered appropriate antimicrobials for the empirical treatment of complicated urinary tract infections in the emergency department. Yet, using antibiotics indiscriminately for patients with complicated UTIs may increase the resistance rate and also lead to treatment failure, hence the prescriptions should be revised following the culture and sensitivity results.

Predictors of ICU Mortality among Mechanically Ventilated Patients: An Inception Cohort Study from a Tertiary Care Center in Addis Ababa, Ethiopia.

Background: Mechanical ventilation is a life-saving intervention for patients with critical illnesses, yet it is associated with higher mortality in resource-constrained settings. This study intended to determine factors associated with the mortality of mechanically ventilated adult intensive care unit (ICU) patients. Methods: A one-year retrospective inception cohort study was conducted using manual chart review in ICU patients (age >13) admitted to Tikur Anbessa Specialized Hospital (Addis Ababa, Ethiopia) from September 2019 to September 2020; mechanically ventilated patients were followed to hospital discharge. Demographic, clinical, and outcome data were collected; logistic regression was used to determine mortality predictors in the ICU. Result: A total of 160 patients were included; 85/160 (53.1%) were females and the mean (SD) age was 38.9 (16.2) years. The commonest indication for ICU admission was a respiratory problem (n = 97/160, 60.7%). ICU and hospital mortality were 60.7% (n = 97/160) and 63.1% (n = 101/160), respectively. Coma (Glasgow Coma Score <8 or 7 with an endotracheal tube (7T)) (adjusted odds ratio [AOR] 6.3, 95% confidence interval 1.19-33.00), cardiovascular diagnosis (AOR 5.05 [1.80-14.15]), and a very low serum albumin level (<2 g/dl) (AOR 4.9 [1.73-13.93]) were independent predictors of mortality (P < 0.05). The most commonly observed complication was ICU acquired infection (n = 48, 30%). Conclusions: ICU mortality in ventilated patients is high. Coma, a very low serum albumin level (<2 g/dl), and cardiovascular diagnosis were independent predictors of mortality. A multifaceted approach focused on developing and implementing context appropriate guidelines and improving skilled healthcare worker availability may prove effective in reducing mortality.

Effect of a tailored sepsis treatment protocol on patient outcomes in the Tikur Anbessa Specialized Hospital, Ethiopia: results of an interrupted time series analysis.

BACKGROUND: Despite improvement, sepsis mortality rates remain high, with an estimated 11 million sepsis-related deaths globally in 2017 (Rudd et. al, Lancet 395:200-211, 2020). Low- and middle-income countries (LMICs) are estimated to account for 85% of global sepsis mortality; however, evidence for improved sepsis mortality in LMICs is lacking. We aimed to improve sepsis care and outcomes through development and evaluation of a sepsis treatment protocol tailored to the Tikur Anbessa Specialized Hospital Emergency Department, Ethiopia, context. METHODS: We employed a mixed methods design, including an interrupted times series study, pre-post knowledge testing, and process evaluation. The primary outcome was the proportion of patients receiving appropriate sepsis care (blood culture collection before antibiotics and initiation of appropriate antibiotics within 1 h of assessment). Secondary outcomes included time to antibiotic administration, 72-h sepsis mortality, and 90-day all-cause mortality. Due to poor documentation, we were unable to assess our primary outcome and time to antibiotic administration. We used segmented regression with outcomes as binomial proportions to assess the impact of the intervention on mortality. Pre-post knowledge test scores were analyzed using the Student's t-test to compare group means for percentage of scenarios with correct diagnosis. RESULTS: A total of 113 and 300 patients were enrolled in the pre-implementation and post-implementation phases respectively. While age and gender were similar across the phases, a higher proportion (31 vs. 57%) of patients had malignancies in the post-implementation phase. We found a significant change in trend between the phases, with a trend for increasing odds of survival in the pre-implementation phase (OR 1.24, 95% CI 0.98-1.56), and a shift down, with odds of survival virtually flat (OR 0.95, 95% CI. 0.88-1.03) in the post-implementation phases for 72-h mortality, and trends for survival pre- and post-implementation are virtually flat for 90-day mortality. We found no significant difference in pre-post knowledge test scores, with interpretation limited by response rate. Implementation quality was negatively impacted by resource challenges. CONCLUSION: We found no improvement in sepsis outcomes, with a trend for increasing odds of survival lost post-implementation and no significant change in knowledge pre- and post-implementation. Variable availability of resources was the principal barrier to implementation. TRIAL REGISTRATION: Open Science Framework osf.io/ju4ga . Registered June 28, 2017.

Assessment of Knowledge, Practice, and Associated Factors Towards Airway and Breathing Management Among Nurses Working in the Emergency Departments of Selected Public Hospitals in Addis Ababa, Ethiopia: A Cross-Sectional Study.

Background: As airway issues or respiratory failures are the leading causes of death in the first hours after an injury, nurses' understanding and practice of fundamental airway and breathing therapies remain "cornerstones" of competent emergency care. As a result, the goal of this study was to evaluate nurses' airway and breathing management knowledge, practice, and associated factors in the emergency departments of selected governmental hospitals in Addis Ababa, Ethiopia. Methods: During the study period of April 12 to April 30, 2021, a cross-sectional survey was conducted with a thorough enumeration of all respondents using the census method. The data were collected from the respondents using a self-administered and structured questionnaire. Data quality was ensured by pre-testing the tools and giving data collectors training. The data were analyzed using the SPSS version 25 program. The researchers used mean, frequency, bivariable, and multiple logistic regression analyses. Only P-values less than 0.05 were considered statistically significant. Results: A total of 102 people took part in this study, with a 96.2% response rate. Females made up slightly more than half of the respondents 52.9%, and their ages ranged from 24 to 48 years old, with a mean age of 29.50 (SD ± 4.96). Only 45.1% of those polled were well versed in the emergency airway and breathing management. About 90.2% of the respondents had a BSc degree. At p< 0.05, having previously received airway and breathing management training was statistically correlated with knowledge. Conclusion: Although many of the practice problems were correctly answered, the respondents in this study had insufficient knowledge of airway and breathing management. As a result, it is critical to give nursing training because it is strongly linked to the knowledge and practice of nurses.

Distal Tracheal Obstructive Mass Leading to Bilateral Pneumothorax and Respiratory Failure.

Tracheal masses are rare in occurrence, but could lead to complications depending on the speed of growth, duration and degree of obstruction. Some of the complications are recurrent pneumonia and air trapping resulting in increased intrathoracic pressure. The latter phenomenon can result in obstruction of the venous return and pneumothorax. We are reporting a rare presentation of bilateral pneumothorax (presumed tensioned) in a young patient with a distal obstructive tracheal tumor. In the emergency department (ED) the patient was in respiratory distress and was found to have extensive subcutaneous emphysema of the neck, chest, and abdominal wall with hypotension. Respiratory failure from bilateral tension pneumothorax was suspected and the patient was intubated with simultaneous bilateral thoracostomy. These measures did not improve the patient's ventilation and oxygenation status. Further fiberoptic investigation revealed a distal tracheal obstructive mass. An emergency surgical intervention was required to remove the tumor. We recommend considering alternative pathologies, such as an obstructive tracheal tumor, in a patient with respiratory distress. They should especially be considered when oxygenation and ventilation are difficult, particularly when endotracheal intubation and/or tube thoracostomy fail to improve the symptoms. A high index of suspicion and a timely multidisciplinary team approach are essential when managing the life-threatening presentation of a patient with a distal tracheal tumor.

Ultrasound-guided regional anesthesia: feasibility and effectiveness of teaching via telesimulation in Ethiopia.

BACKGROUND: Acute pain management in resource-poor countries remains a challenge. Ultrasound-guided regional anesthesia is a cost-effective way of delivering analgesia in these settings. However, for financial and logistical reasons, educational workshops are inaccessible to many physicians in these environments. Telesimulation provides a way of teaching across distance by using simulators and video-conferencing software to connect instructors and students worldwide. We conducted a prospective study to determine the feasibility of ultrasound-guided regional anesthesia teaching via telesimulation in Ethiopia. METHODS: Eighteen Ethiopian orthopedic and emergency medicine house staff participated in telesimulation teaching of ultrasound-guided femoral nerve block. This consisted of four 90-min sessions, once per week. Week 1 consisted of a precourse test and a presentation on aspects of performing a femoral nerve block, weeks 2 and 3 were live teaching sessions on scanning and needling techniques, and in week 4, the house staff undertook a postcourse test. All participants were assessed using a validated Global Rating Scale and Checklist. RESULTS: Participants were provided with a validated checklist and global rating scale as a pretest and post-test. The participants showed significant improvement in their test scores, from a total mean of 51% in the pretest to 84% in their post-test. CONCLUSIONS: Teaching ultrasound-guided regional anesthesia of the femoral nerve remotely via telesimulation is feasible. Telesimulation can greatly improve the accessibility of ultrasound-guided regional anesthesia teaching to physicians in remote areas.

Critical care capacity in Addis Ababa, Ethiopia: A citywide survey of public hospitals.

PURPOSE: We evaluated critical care capacity in the 15 intensive care units (ICUs) in public hospitals in Addis Ababa, Ethiopia to determine the current state of critical care in the city and inform capacity-building efforts. METHODS: We conducted a cross-sectional survey of ICU medical and nursing directors or their delegates using a standardized questionnaire based on World Federation of Society of Intensive and Critical Care Medicine (WFSICCM) criteria. RESULTS: ICU size ranged from 3 to 15 beds. All ICUs had capacity for mechanical ventilation and vasopressor support, and 53% had intensivists on staff. Ultrasound was available in 93%, while 40% had capacity for invasive blood pressure monitoring. Identified barriers to care included a lack of essential equipment, supplies, medications and specially trained providers. Respondents considered increasing available beds and coordinating between hospitals crucial for capacity building. CONCLUSIONS: There is burgeoning critical care capacity in Addis Ababa, Ethiopia with 103 ICU beds in public hospitals, and the WFSICCM criteria provide a useful framework for evaluating critical care capacity and identifying priorities for capacity building. All ICUs in public hospitals in Addis Ababa were able to provide basic support for patients with life-threatening organ failure but demonstrated marked heterogeneity in critical care capacity.

Behcet's Disease with Upper GI Bleeding.

Introduction. Behcet's disease is a multisystem disease. In sub-Saharan Africa, the prevalence of this disease is not known, with only one case report from Ethiopia. Case Presentation. We describe a case of a 29-year-old Ethiopian male who presented to the emergency room of Tikur Anbessa specialized hospital with 4 days history of back pain, recurrent history of oral and genital ulcers, right eye blindness, chronic cerebral vein thrombosis, gastrointestinal bleeding, aortic aneurysm with dissection, and positive pathergy test. He is retrospectively diagnosed with Behcet's disease according to both the International Criteria for Behcet's Disease (ICBD) and the International Study Group (ISG) consensus. Conclusion. Even if Behcet's disease is rare in sub-Saharan Africa, it is important to know the clinical presentation for timely diagnosis and urgent management.

Mixed methods process evaluation of pilot implementation of the African Federation for Emergency Medicine trauma data project protocol in Ethiopia.

INTRODUCTION: The African Federation for Emergency Medicine Trauma Data Project (AFEM-TDP) has created a protocol for trauma data collection in resource-limited settings using a clinical chart with embedded standardized data points that facilitates a systematic approach to injured patients. We performed a process evaluation of the protocol's implementation at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia to provide insights for adapting the protocol to our setting. METHODS: During the pilot implementation period, the quality of collected data was assessed. Structured key informant interviews about participant experiences and perceptions of the protocol implementation were then conducted. Interviews were analysed using a SWOT model. RESULTS: During pilot data collection, the overall capture rate was 21%. Variables collected with high frequency included demographics, vital signs and ED diagnosis, while mechanism of injury and ED disposition were often missed. Key informant interviews identified Strengths, Weaknesses, Opportunities and Threats to the protocol. Strengths included improved patient care, enhanced training for junior providers and facilitated data collection. Weaknesses included inadequate supervision and challenges relating to the physical size of the form, which resulted in missing data. Opportunities included retrospective research and quality improvement work. Threats included perceived lack of a local champion, poor buy-in from other hospital departments and need for ongoing financial support. CONCLUSION: A mixed methods process evaluation is an invaluable tool when implementing novel data collection protocols, especially in resource-limited settings. We determined early successes and challenges of the implementation of the AFEM-TDP protocol and generated strategies to adapt the protocol to better suit our setting. Lessons from this process evaluation may be informative for other researchers designing and implementing similar data collection protocols.

Barriers to and facilitators of the development and utilization of context appropriate evidence based clinical algorithms to optimize clinical care and patient outcomes in the Tikur Anbessa emergency department: a multi-component qualitative study.

BACKGROUND: Evidence-based clinical algorithms (EBCA) are knowledge tools to promote evidence use by codifying evidence into action plans to facilitate appropriate care. However, their impact on process and outcomes of care varies considerably across practice settings and providers, highlighting the need for tailoring of both these knowledge tools and their implementation strategies to target end users and the setting in which EBCAs are to be employed. Leadership at the Tikur Anbessa Specialized Hospital emergency department (TASH-ED) in Addis Ababa, Ethiopia identified a need for context-appropriate EBCAs to improve evidence uptake to mitigate care gaps in this high volume, high acuity setting. We aimed to identify barriers and facilitators to utilization of EBCAs in the TASH-ED, to identify priority targets for development of EBCAs tailored for the TASH-ED context and to understand the process of care in the TASH-ED to inform implementation planning. METHODS: We employed a multi-component qualitative design including: semi-structured interviews with TASH-ED clinical, administrative and support services staff, and Toronto EM physicians who had worked in the TASH-ED; direct observation of the process of care in TASH-ED; document review. RESULTS: Although most TASH-ED participants reported an awareness of EBCAs, they noted little or no experience using them, primarily due to the poor fit of many EBCAs to their practice setting. All participants felt that context-appropriate EBCAs were needed to ensure standardized and evidence-based care and improve patient outcomes for common ED presentations. Trauma, sepsis, acute cardiac conditions, hypertensive emergencies, and diabetic keto-acidosis were most commonly identified as priorities for EBCA development. Lack of medication, equipment and human resources were identified as the primary barriers to use of EBCAs in the TASH-ED. Support from leadership and engagement of stakeholders outside the ED where EBCAs were believed to be less well accepted were identified as essential facilitators to implementation of EBCAs in the TASH-ED. CONCLUSIONS: This study found a perceived need for EBCAs tailored to the TASH-ED setting to support uptake of evidence-based care into routine practice for common clinical presentations. Barriers and facilitators provide information essential to development of both context-appropriate EBCAs and plans for their implementation in the TASH-ED.

Profile of Head Injuries: Prehospital Care, Diagnosis, and Severity in an Ethiopian Tertiary Hospital.

BACKGROUND: Consistent data on head injury is lacking especially in the low- and middle-income countries. Our study tries to characterize patients with head injury at the emergency department of one of the few tertiary public hospitals giving neurosurgical care in the country. METHODS: A retrospective cross-sectional study was performed from May 2015 to October 2015 in one of the neurosurgical teaching hospitals, Black Lion Specialized Hospital. All adult patients with head injury who visited the emergency department during the study period were included. Data on patients' sociodemographic, mechanism of trauma, clinical presentation, imaging findings, and presence of polytrauma were collected by a pretested questionnaire. The source of data was emergency department logbooks and patient charts. RESULTS: A total of 390 patients with head injury who visited the emergency department were included during the study period. There were 335 males (85.9%) and 55 females (14.1%) with the mean age (standard deviation) of 35.4 (15.6) years. Majority of patients came by taxi constituting 149 (38.2%) of all patients, whereas 147 patients (37.7%) used ambulance. Of 147 patients brought by ambulances, 133 (90.4%) were referred from other hospitals. The majority, 26 (45.6%), of patients who came directly to the emergency department used taxis. It is shown that the mode of arrival and origin of arrival are significantly related, P = 0.000. Mortality of severe head injury at the emergency department was 50.8%. CONCLUSIONS: Prehospital care coverage was low and ambulances were used mainly for interhospital transfers. Mortality of severe head injury at the emergency department is high and significantly associated with preventable causes like vital sign derangement.

The burden on emergency centres to provide care for critically ill patients in Addis Ababa, Ethiopia.

INTRODUCTION: Given the scarcity of critical care hospital beds in Africa, emergency centres (ECs) are increasingly charged with caring for critically ill patients for extended periods of time. The objective of this study was to improve the understanding of the nature and outcomes of critically ill patients with prolonged treatment times of more than six hours in two ECs in Addis Ababa, Ethiopia. METHODS: This study was conducted over three months in two ECs of urban tertiary care hospitals in Addis Ababa. Structured questionnaires were completed by six emergency and critical care nurses. EC patients were included if they met the Society for Critical Care Medicine (SCCM) intensive care unit (ICU) admission criteria and stayed in the EC for more than 6 h. We collected initial demographic and clinical information, data about the patients' clinical course in the EC, and data regarding the patients' disposition. We used descriptive statistics for analysis. RESULTS: A total of 291 patients, over the course of three months, had an EC stay that exceeded six hours. The median length of stay for these patients was 48 h (interquartile range: 25-72 h). The most common categories of illness were neurological disease in 87 patients (30%) and cardiovascular disease in 61 patients (21%). The most frequent aetiologies of critical illness were severe head trauma and severe sepsis with multi-organ failure (26 patients, 9% each). A total of 94 patients (32%) died in the EC, while 86 (30%) were discharged directly from the EC without hospital admission. DISCUSSION: ECs in Addis Ababa face a heavy burden in caring for a large number of critically ill patients over a long period of time, with relatively high mortality rates. These findings should promote supporting emergency centres to strengthen and expand ICU capacity to provide appropriate critical care services.

Prospective assessment of patients with stroke in Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia.

INTRODUCTION: The burden of stroke is increasing in many low- and middle-income countries. In Ethiopia, stroke has become a major cause of morbidity, long-term disability, and mortality. Time from stroke onset to hospital presentation is a critical factor in acute stroke care. This study aimed to describe risk factors for stroke and clinical presentation of patients presenting to the emergency centre with stroke. METHODS: We conducted a cross sectional study conducted from August 2015 to January 2016 in an urban tertiary care centre in Addis Ababa, Ethiopia. Descriptive statistics and multivariable logistic regression models were used to evaluate associations between stroke types and stroke risk factors, and delayed presentation and clinical indicators. P-values less than .05 were considered statistically significant. RESULTS: A total of 104 patients were included. The mean age was 53 years, and 56% were male. Only 30% of patients arrived using an ambulance service. The most common presenting symptoms were altered mental status (48%), hemiparesis (47%), facial palsy (45%), hemiplegia (29%), and aphasia (25%). Hypertension was the most common risk factor (49%), followed by cardiovascular disease (20.2%) and diabetes mellitus (11%). The majority of strokes were haemorrhagic in aetiology (56%). The median arrival time to the emergency centre was 24 h after symptoms onset; only 15% presented within three hours. Patients with hypertension, or presented with loss of consciousness were significantly more likely to have haemorrhagic stroke (p < .001 and p = .01 respectively). The only risk factor robustly associated with ischaemic stroke was cardiac illness (odds ratio 3.99, p = .01). DISCUSSION: Our study identified hypertension to be the most common risk factor for stroke. The predominant aetiology type in this cohort is haemorrhagic stroke. Lastly, the median arrival time to an emergency centre was 24 h after symptom onset.

A survey of emergency medicine and orthopaedic physicians' knowledge, attitude, and practice towards the use of peripheral nerve blocks.

INTRODUCTION: Peripheral nerve blocks (also known as regional anaesthesia) are currently used by many anaesthesiologists and emergency physicians for perioperative and procedural pain management. METHODS: This is a cross sectional descriptive study conducted to evaluate knowledge, attitudes, and current practice towards use of peripheral nerve blocks for lower extremity injuries at Black Lion Hospital, a tertiary trauma centre in Addis Ababa. RESULTS: A standardised survey was conducted with 64 participants working in emergency medicine [30/64 (46.9%)] and orthopaedics [34/64 (53.1%)]. Twenty-three of 64 (35.9%) respondents had received formal training. Knowledge was acquired from didactic/workshop format for 15/23 (65.2%), followed by peer training 6/23 (39.1%). The majority, 62/64 (96.9%), believed that knowledge of general anatomy and nerve blocks are very important. Thirty-one of 64 (48%) of the respondents did not routinely perform peripheral nerve blocks. A majority, 27/31 (87.1%) stated they lacked the required skills. Ultrasound guidance of the femoral nerve 16/33 (48.5%) was the most commonly performed peripheral nerve block, followed by ankle block using anatomic landmarks 15/33 (45.5%). Almost all (15/16) ultrasound-guided nerve blocks were done by emergency medicine providers, while all anatomic land mark guided blocks were done by orthopaedic teams. A majority of the respondents (93.8%) (n = 60) were optimistic that their practice on peripheral nerve blocks would increase in future. A highly significant association was found between previous training on peripheral nerve blocks and the number of peripheral nerve blocks performed in a month; p value - 0.006. DISCUSSION: This study indicates peripheral nerve blocks are likely underutilised due to lack of training. There was a positive attitude towards peripheral nerve blocks but gaps on knowledge and practice.

INTRODUCTION: Les blocs nerveux périphériques (également connus sous le nom d'anesthésies locorégionales) sont actuellement utilisées par de nombreux anesthésistes et urgentistes à des fins de gestion de la douleur. MÉTHODES: Cette étude est une étude descriptive cross sectional menée afin d'évaluer les connaissances, attitudes et pratiques actuelles en matière d'utilisation des blocs nerveux périphériques pour les blessures aux extrémités inférieures au Black Lion Hospital, un centre de traumatologie tertiaire à Addis-Abeba. RÉSULTATS: Une étude standardisée a été menée auprès de 64 participants travaillant en médecine d'urgence [30/64 (46,9%)] et en orthopédie [34/64 (53,1%)]. Vingt-trois sur les 64 (35.9%) personnes interrogées ot bénéficié d'une formation formelle. Les connaissances ont été acquises sous forme didactique/d'atelier pour 15/23 (65,2%) d'entre eux, suivies d'une formation par les pairs pour 6/23 (39,1%) d'entre eux. La majorité, 62/64 (96,9 %) d'entre eux, considérait que les connaissances en anatomie générale et les blocs nerveux comme très importantes. Trente et un sur 64 (48%) personnes interrogées ne réalisaient pas régulièrement des blocs nerveux périphériques. Une majorité 27/31 (87,1%) de participants a indiqué ne pas disposer des compétences requises. Ultrasound guidance of the femoral nerve 16/33 (48,5%) était le bloc nerveux périphérique réalisé le plus fréquemment, suivi du ankle block using anatomic landmarks 15/33 (45,5%). La quasi-totalité (15/16) des blocs nerveux ultrasound-guided étaient réalisés par des emergency medicine providers, while all anatomic land mark guided blocks étaient réalisés par des équipes d'orthopédistes. Une majorité de personnes interrogées (93,8%) (n = 60) indiquaient être optimistes quant au fait que leur pratique sur les blocs nerveux périphériques augmenterait à l'avenir. Une association hautement significative a été trouvée entre la formation antérieure sur les blocs nerveux périphériques et le nombre de blocs nerveux périphériques réalisés au cours d'un mois; p value ­ 0,006. DISCUSSION: Cette étude indique que les blocs nerveux périphériques sont probablement sous-utilisés en raison d'un manque de formation. On a pu observer une attitude positive à l'égard des blocs nerveux périphériques, mais des lacunes en matière de connaissances et de pratique.

The clinical profile and acute care of patients with traumatic spinal cord injury at a tertiary care emergency centre in Addis Ababa, Ethiopia.

INTRODUCTION: Traumatic spinal cord injuries can have catastrophic physical, psychological, and social consequences, particularly in low resource settings. Since many of these injuries result in irreversible damages, it is essential to understand risk factors for them and focus on primary prevention strategies. The objectives of this study are to describe the demographics, injury characteristics, and management of traumatic spinal cord injury victims presenting to the Adult Emergency Centre of Tikur Anbessa Specialised Hospital in Addis Ababa, the tertiary referral centre for emergency care in Ethiopia. METHODS: A prospective cross sectional survey was conducted from October 2013 to March 2014 in the Adult Emergency Centre of Tikur Anbessa Specialised Hospital. Patients were identified at triage and followed through admission to discharge from the emergency centre. RESULTS: Eighty-four patients with traumatic spinal cord injuries were identified. The mean age was 33 years and 86% were male. The most common mechanisms of injury were motor vehicle collisions (37%), falls (31%), and farming injuries (11%). The cervical spine (48%) was the most commonly injured region and 41% were complete spinal cord injuries. Most patients (77%) did not receive any prehospital care or medical care at other facilities prior to arrival in the Emergency Centre. CONCLUSION: In our context, traumatic spinal cord injuries predominantly affect young men, and the majority of victims suffer severe injuries with little chance of recovery. Attention to occupational and road traffic safety is essential to mitigate the personal and societal burdens of traumatic spinal cord injuries. It is also imperative to focus on improving prehospital care and rehabilitation services for traumatic spinal cord injury victims.

INTRODUCTION: Les lésions traumatiques de la moelle épinière peuvent avoir des conséquences physiques, psychologiques et sociales catastrophiques, notamment dans un contexte caractérisé par de faibles ressources. La majorité de ces blessures résultant sur des dommages irréversibles, il est essentiel de comprendre les facteurs de risque qui y sont associés et de se concentrer sur les stratégies de prévention de base. Les objectifs de cette étude sont de décrire les caractéristiques démographiques et de la blessure, et la prise en charge des victimes de lésions traumatiques de la moelle épinière se présentant au Centre d'urgences pour adultes de l'hôpital spécialisé de Tikur Anbessa à Addis-Abeba, le centre de référence tertiaire pour la prise en charge d'urgence en Éthiopie. MÉTHODES: Une étude prospective transversale a été menée entre octobre 2013 et mars 2014 au Centre d'urgences pour adultes de l'hôpital spécialisé de Tikur Anbessa. Les patients ont été identifiés au triage et suivis de leur admission à leur sortie du centre d'urgences. RÉSULTATS: Quatre-vingt-quatre patients présentant des lésions traumatiques de la moelle épinière ont été identifiés. L'âge moyen était de 33 ans et 86% des patients étaient des hommes. Les mécanismes de blessure les plus courants étaient les collisions de véhicules motorisés (37%), les chutes (31%) et les blessures liées à une activité agricole (11%). La colonne cervicale était la région la plus fréquemment touchée (48%) et 41% étaient des lésions entraînant une interruption totale de la moelle épinière. La plupart des patients (77%) n'avaient pas reçu de soins avant d'arriver à l'hôpital ni de soins médicaux dans d'autres structures avant d'arriver aux Urgences. CONCLUSION: Dans notre contexte, les lésions traumatiques de la moelle épinière affectent essentiellement les hommes jeunes, et la majorité des victimes souffrent de blessures graves, et ont peu de chances de guérir. Une attention à la sécurité au travail et à la sécurité routière est essentielle afin de diminuer le fardeau personnel et sociétal des lésions traumatiques de la moelle épinière. Il est également impératif de se concentrer sur l'amélioration de la prise en charge pré-hospitalière et des services de rééducation pour les victimes de blessures traumatiques de la moelle épinière.