Emergency admissions in sub Saharan Africa: example of the surgical emergency admissions unit at the Sylvanus Olympio Teaching Hospital of Lome, Togo

Introduction: The management of patients in emergency departments is an important indicator of the quality of a healthcare system. In sub-Saharan Africa, emergency care is characterized by human and material difficulties. The purpose of this work was to assess the difficulties in managing emergencies at the surgical emergency admissions unit of Sylvanus Olympio teaching hospital of Lome. Patients and method: This descriptive prospective study took place during the last 6 months of 2013. Epidemiological, clinical, and therapeutic data were collected. All admissions for acute conditions requiring urgent care were included. The study excluded patients who died at admission and patients receiving care in the medical emergency department. Results: The study included 2880 patients, 60.3% men; the mean age was 46 years (range: 4 days to 92 years). Traffic accidents accounted for 519 cases (18%). Among patients with trauma, 23.7% had limb injuries and 17.2% head injury. Appendicitis accounted for 32.9% of the non-trauma emergencies, followed by peritonitis (27.3%), burns represented 1%. Laboratory tests were performed for 49.4% of patients, ultrasound for 14.2%, and computed tomography scans for 0.8%. Overall, 44.1% received venous catheterization, 40% volume replacement, 20% oxygen therapy, 16% blood products, 2% pressor amines, and 0.1% intubation. Analgesia was administered to 82%, antibiotic treatment (37%), and sedation to 1%. In all, 34.8% of patients underwent laparotomy, 26.6% trimming with sutures, 21.4% dressing of wounds, and 14.5% immobilization. Time to discharge was less than 24 hours for 82%, and 6.2% were transferred to intensive care. Eighteen patients died (0.6%). Conclusion: Management of surgical emergencies remains a major health problem in developing countries. Prevention measures and accessibility of the population to emergency care will reduce morbidity and mortality for these conditions.