The clinical presentation, utilization, and outcome of individuals with sickle cell anaemia presenting to urban emergency department of a tertiary hospital in Tanzania

• Type of Material: Article
• Authors: Hendry R. Sawe, Muhimbili University of Health and Allied Sciences; Teri A. Reynolds, Muhimbili University of Health and Allied Sciences; Juma A. Mfinanga, Muhimbili University of Health and Allied Sciences; Michael S. Runyon, Muhimbili University of Health and Allied Sciences; Brittany Murray, Emory University; Lee A. Wallis, University of Cape Town; Julie Makani, Nuffield Department of Clinical Medicine
• Language: English
• Date: 2018-09-17
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12878-018-0122-3
• Title of Journal or Parent Work: BMC Hematology
• ISSN: 2052-1839
• Volume: 18
• Issue: 1
• Grant/Funding Information: This project was supported by a National Institutes of Health (NIH) Research Training Grant #R25 TW009343 funded by the Fogarty International Center and the National Heart, Lung, and Blood Institute, as well as the University of California Global Health Institute (UCGHI).; The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or UCGHI. NIH or UCGH did not have any role in designing, collection, analysis, interpretation or writing of this manuscript.
• Keywords: anaemia; sickle cell anemia; sub-Saharan Africa; emergency department
• Research Categories: Health Sciences, Health Care Management

Abstract

Background: Sickle cell anaemia (SCA) is prevalent in sub-Saharan Africa, with high risk of complications requiring emergency care. There is limited information about presentation of patients with SCA to hospitals for emergency care. We describe the clinical presentation, resource utilization, and outcomes of SCA patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods: This was a prospective cohort study of consecutive patients with SCA presenting to ED between December 2014 and July 2015. Informed consent was obtained from all patients or patients' proxies prior to being enrolled in the study. A standardized case report form was used to record study information, including demographics, relevant clinical characteristics and overall patients outcomes. Categorical variables were compared with chi-square test or Fisher's exact test; continuous variables were compared with two-sample t-test or Mann-Whitney U-test. Results: We enrolled 752 (2.7%) people with SCA from 28,322 patients who presented to the MNH-ED. The median age was 14 years (Interquartile range [IQR]: 6-23 years), and 395 (52.8%) were female. Pain 614 (81.6%), fever 289 (38.4%) were the most frequent presenting complaint. Patients with fever, hypoxia, altered mental status and bradycardia had statistically significant relative risk of mortality of 10.4, 153, 50 and 12.1 (p < 0.0001) respectively, compared to patients with normal vitals. Overall, 656 (87.2%) patients received Complete Blood Cell counts test, of these 342 (52.1%) had severe anaemia (haemoglobin < 7 g/dl), and a 30.3 (p = 0.02) relative risk of relative risk of mortality compare to patients with higher haemoglobin. Patients who had malaria, elevated renal function test and hypoglycemia, had relative risk of mortality of 22.9, 10.4 and 45.2 (p < 0.0001) respectively, compared to patient with normal values. Most 534 (71.0%) patients were hospitalized for in patients care, and the overall morality rate was 16 (2.1%). Conclusions: We described the clinical presentation, management, and outcomes of patients with SCA presenting to the largest public ED in Tanzania, as well as information on resource utilization. This information can inform development of treatment guidelines, clinical staff education, and clinical research aimed at optimizing care for SCA patients.