Emergency department deaths despite active management: Experience from a tertiary care centre in a low-income country

Objective: To determine the frequency and causes of ED deaths despite active management, in a tertiary care centre of a low-income country. Methods: We conducted a retrospective chart review over a 2 year period (January 2001-December 2002) for all patients who died despite active management in an ED in Karachi, Pakistan. Results: Of the 78 418 patient visits, 601 patients (0.7%) were pronounced dead. Of these, 577 patients had complete records. Seventy per cent of these were dead-on-arrival, 1% had do-not-resuscitate orders and 29% (n = 166; 95% confidence interval [CI] 25-32%) died despite active management. Initial vital signs were found to be abnormal in almost all cases (98%). The leading causes of death were sepsis (23%; 95% CI 19-26%), myocardial infarction (19.7%; 95% CI 16-22%), cerebrovascular accident (10.7%; 95% CI 8-13%) and pneumonia (8.2%; 95% CI 6-10%) among adults and sepsis (36.4%; 95% CI 32-40%), myocarditis (15.9%; 95% CI 13-18%) and pneumonia (9.1%; 95% CI 6-11%) among children. Conclusion: Sepsis is the leading cause of death in patients of all age groups in the ED of this hospital.