Emergency department crowding and its impact on the clinical care and mortality outcomes of stroke patients at the Tema General Hospital in Ghana

Lartey, Lawrence

Abstract

Stroke is a cardiovascular related disease that commonly presents at the emergency department
(ED) with high mortality rates and lifelong disability. At the ED, overcrowding is a reported
challenge that has impact on the outcome of patient care. The overall aim of the study was to
evaluate the levels of overcrowding and predictors of mortality outcomes among stroke patients
at the ED of Tema General Hospital (TGH) in the Greater Accra Region of Ghana, a lowermiddle income country (LMIC) in sub-Saharan Africa (SSA). The study aimed to evaluate the
crowding status of the ED, stroke specific case fatality, stroke specific mortality by stroke
subtype, association between CT scan use and stroke mortality, association between admission
BP levels and mortality, and to evaluate ED overcrowding and other predictors of stroke
specific mortality.
This was a facility-based retrospective study of prospectively collected secondary data already
documented in the patients’ clinical records between October 2019 and March 2020.
Participants were all patients aged 18 years and above who presented at the ED with any focal
neurologic deficit suggestive of acute stroke (ischaemic, haemorrhagic, and transient ischaemic
attack). The National Emergency Department Overcrowding Scale (NEDOCS) was the
standard metric used to assess the levels of crowding. The analysis was evaluated at the 95%
confidence interval and a p-value of <0.05 was considered significant. The outcome variable
of interest was stroke mortality.
A total of 175 (89 males and 86 females) stroke patients visited the ED during the period of
data collection. Only 70 (40.0%) stroke patients had a computer tomography (CT) scan done
during admission at the ED. The ED was always overcrowded with the NEDOCS greater than
100. There were 139 deaths representing a stroke specific mortality rate of 79.4%. Overall,
there were 104 (59.4%) ischaemic strokes of which 78 (75.0%) died, and there were 71 (40.6%)
haemorrhagic strokes of which 61 (85.7%) died at the ED. There were three statistically
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significant stroke predictors; average NEDOCS (AOR = 1.033; 95% C1: 1.003 – 1.064; p =
0.033), type of stroke (haemorrhagic stroke) (AOR = 3.834; 95% CI: 1.184 – 12.416; p = 0.025)
and a medical history of diabetes mellitus (AOR = 3.001; 95% CI: 1.006 – 8.951; p = 0.049).
In conclusion, in-patient stroke case fatality was extremely high and stroke mortality were
higher among younger patients and patients with haemorrhagic stroke. There is an urgent need
to establish comprehensive stroke care systems at the ED to reduce stroke mortality, and
practical measures to improve the crowding situation at the ED are required.

Citation

Lartey, L. (2024). Emergency department crowding and its impact on the clinical care and mortality outcomes of stroke patients at the Tema General Hospital in Ghana. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Feb 21, 2024
• Publicly Available Date: Apr 27, 2024
• Keywords: Emergency Department, Overcrowding, Stroke and Impact
• Award Date: Mar 26, 2024