Browsing by Author "Hunter, Luke D."

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    The burden of intentional self-poisoning on a district-level public hospital in Cape Town, South Africa
    (Elsevier, 2018) Van Hoving, Daniel J.; Hunter, Luke D.; Gerber, Rachel (Elre) J.; Lategan, Hendrick J.; Marks, Carine J.
    Introduction: Intentional self-poisoning is a significant part of the toxicological burden experienced by emergency centres. The aim of this study was to describe all adults presenting with intentional self-poisoning over a six-month period to the resuscitation unit of Khayelitsha Hospital, Cape Town. Methods: Adult patients with a diagnosis of intentional self-poisoning between 1 November 2014 and 30 April 2015 were retrospectively analysed after eligible patients were obtained from the Khayelitsha Hospital Emergency Centre database. Missing data and variables not initially captured in the database were retrospectively collected by means of a chart review. Summary statistics were used to describe all variables. Results: A total of 192 patients were included in the analysis. The mean age was 27.3 years with the majority being female (n=132, 68.8%). HIV-infection was a comorbidity in 39 (20.3%) patients, while 13 (6.8%) previously attempted suicide. Presentations per day of the week were almost equally distributed while most patients presented after conventional office hours (n=152, 79.2%), were transported from home (n=124, 64.6%) and arrived by ambulance (n=126, 65.6%). Patients spend a median time of 3h37m in the resuscitation unit (interquartile range 1 h 45m–7 h 00 m; maximum 65 h 49 m). Patient acuity on admission was mostly low according to both the Triage Early Warning Score (non-urgent n=100, 52.1%) and the Poison Severity Score (minor severity n=107, 55.7%). Pharmaceuticals were the most common type of toxin ingested (261/343, 76.1%), with paracetamol the most frequently ingested toxin (n=48, 25.0%). Eleven patients (5.7%) were intubated, 27 (14.1%) received N-acetylcysteine, and 18 (9.4%) received benzodiazepines. Fourteen (7.3%) patients were transferred to a higher level of care and four deaths (2%) were reported. Discussion: Intentional self-poisoning patients place a significant burden on emergency centres. The high percentage of low-grade acuity patients managed in a high-acuity area is of concern and should be investigated further.
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    Estimated injury-associated blood loss versus availability of emergency blood products at a district-level public hospital in Cape Town, South Africa
    (Elsevier, 2018) Weeber, Heinrich; Hunter, Luke D.; Van Hoving, Daniel J.; Lategan, Hendrick; Bruijns, Stevan R.
    Introduction: International guidance suggests that injury-associated haemorrhagic shock should be resuscitated using blood products. However, in low- and middle-income countries resuscitation emphasises the use of crystalloids – mainly due to poor access to blood products. This study aimed to estimate the amount of blood loss from serious injury in relation to available emergency blood products at a secondary-level, public Cape Town hospital. Methods: This retrospective, cross-sectional study included all injured patients cared for in the resuscitation area of Khayelitsha Hospital’s emergency centre over a fourteen-week period. Injuries were coded using the Abbreviated Injury Scale, which was then used to estimate blood loss for each patient using an algorithm from the Trauma Audit Research Network. Descriptive statistics were used to describe blood volume lost and blood units required to replace losses greater than 15% circulating blood volume. Four units of emergency blood are stored in a dedicated blood fridge in the emergency centre. Platelets and fresh plasma are not available. Results: A total of 389 injury events were enrolled of which 93 were excluded due to absent clinic data. The mean age was 29 (±10) years. We estimated a median of one unit of blood requirement per week or weekend, up to a maximum of eight or six units, respectively. Most patients (n=275, 94%) did not have sufficient injury to warrant transfusion. Overall, one person would require a transfusion for every 15 persons with a moderate to serious injury. Conclusion: The volume of available emergency blood appears inadequate for injury care, and doesn’t consider the need for other causes of acute haemorrhage (e.g. gastric, gynaecological, etc.). Furthermore, lack of other blood components (i.e. plasma and platelets) presents a challenge in this low-resourced setting. Further research is required to determine the appropriate management of injury-associated haemorrhage from a resource and budget perspective.