The Magnitude of Adult Emergency Department Mortality and Associated Determinant Factors at a Tertiary Hospital, Addis Ababa, Ethiopia: A Mixed-Methods Study

The Magnitude of Adult Emergency Department Mortality and Associated Determinant Factors at a Tertiary Hospital, Addis Ababa, Ethiopia: A Mixed-Methods Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Magnitude of Adult Emergency Department Mortality and Associated Determinant Factors at a Tertiary Hospital, Addis Ababa, Ethiopia: A Mixed-Methods Study Dr Endalamaw Wondimagegn Belie, Dr Demelash Gezahegn, Dr Gediyon Dereje Mekonenn, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9469916/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Emergency department (ED) mortality remains disproportionately high in low- and middle-income countries, posing a significant public health concern. In Ethiopia, the Ministry of Health defines ED mortality as death occurring within 24 hours of admission, excluding cases of dead-on-arrival, with a national target set below 0.6%. Despite this benchmark, local evidence on the prevalence and determinants of 24-hour ED mortality remains limited. Methods An explanatory sequential mixed-methods study was conducted at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia, from October 2024 to September 2025. The quantitative phase retrospectively analyzed all adult patients (aged ≥ 14 years) who died within 24 hours of ED admission, yielding a sample of 154 cases after necessary exclusions. Descriptive statistics and multivariable logistic regression were performed using SPSS version 25. A focus group discussion (FGD) involving nine emergency and critical care postgraduate students was subsequently conducted to elaborate on the predominant finding of sepsis as the primary cause of death, with results triangulated with the quantitative data. Results The study revealed a 24-hour ED mortality rate of 1.13%, surpassing the national target, with medical causes accounting for 84.4% of deaths; sepsis contributed to 54.1%. Over a third (37.9%) of these deaths occurred very early, within 6 hours of admission. Multivariable logistic regression identified symptom duration of less than 12 hours, cardiovascular and renal diagnoses, and oxygen saturation above 90% as significant predictors of very early mortality. Factors such as delayed antibiotic initiation, insufficient monitoring, drug shortages, and overcrowding emerged from the FGD as key contributors to sepsis-related mortality. Conclusions The 24-hour ED mortality rate at TASH surpasses the national target, primarily driven by sepsis stemming from pulmonary sources. Urgent interventions are needed, including sepsis training for healthcare practitioners, institution-specific protocols, involvement of infectious disease physicians in daily rounds, and enhanced pre-hospital ambulance utilization. These results carry direct implications for the formulation of national Emergency Medical Services (EMS) policy. emergency department mortality sepsis Ethiopia Tikur Anbessa predictors pre-hospital emergency care mixed methods BACKGROUND The emergency department (ED) serves as the primary entry for individuals with life-threatening conditions, with ED mortality accounting for a significant proportion of in-hospital deaths globally. ED mortality rates in sub-Saharan Africa are up to 5 percentage points higher than in high income regions. All countries are encouraged by World Health Organization (WHO) to develop and monitor emergency care systems. The timely management of ED reduces the negative outcomes. In Ethiopia, the Ministry of Health's 2016 Hospital Services Transformation Guideline defines ED mortality as death occurring within 24 hours of admission, excluding cases of dead-on-arrival. The national target stipulates an ED mortality rate below 0.6%. However, a systematic review of Ethiopian studies in 2023 reported an overall ED mortality rate of 7.71%, with varying rates across different regions. Contributing factors identified nationally include rural residency, altered consciousness, delayed hospital arrival, and comorbid conditions. The largest academic referral hospital of the country, Tikur Anbessa Specialized Hospital (TASH), handles huge numbers of adult ED patients each year. Previous studies at TASH have reported 72-hour ED mortality rates of 1.68–1.9%, in which large number of deaths occurring within the initial 24 hours. Furthermore, TASH is the leading institution for emergency and critical care training and a major national referral center. Thus, understanding the extent and predictors of 24-hour mortality is crucial for enhancing both institutional quality and national healthcare policies. This study aimed to determine the 24-hour ED mortality rate at TASH, identify determinants of very early mortality (occurring within 6 hours), and explore systemic factors contributing to sepsis-related deaths, considering sepsis as the primary cause identified in the quantitative analysis. METHODS Study Setting Established in 1972, TASH serves as Ethiopia's premier academic teaching hospital under Addis Ababa University College of Health Sciences. The adult ED operates within a dedicated facility, encompassing multiple floors with over 80 beds. The department is staffed by a team of emergency and critical care medicine consultants and postgraduate trainees. Study Design and Period An explanatory sequential mixed-methods design was employed for this study. The quantitative phase involved a retrospective cross-sectional analysis of medical records from October 1, 2024, to September 30, 2025. Subsequently, a qualitative phase comprising a focus group discussion (FGD) was conducted. Population and Sampling For the quantitative component, the study included all adult patients aged 14 years and above who died within 24 hours of admission to the ED, except for those classified as dead-on-arrival or with substantially incomplete records. The final analysis included a sample of 154 individuals. The qualitative component involved the purposive selection of nine postgraduate students specializing in emergency and critical care from the first to third year of their program. Selection criteria were based on active involvement in clinical practice, communication skills, and willingness to participate in the FGD; the group comprised six male and three female participants. Data Collection Quantitative data were sourced from inpatient medical records and the ED logbook using a structured questionnaire derived from previous Ethiopian ED mortality studies. The instrument underwent pre-testing on a subset of records, with subsequent adjustments made accordingly. Data extraction was conducted by the principal investigator. The FGD was structured around four open-ended inquiries exploring sepsis recognition, treatment pathways, strengths and weaknesses in current management practices, and potential solutions to mitigate sepsis-related mortality. Discussions took place in a designated venue, utilizing both Amharic and English, and were recorded for transcription and analysis. Ethical approval was granted by the Institutional Review Board of Addis Ababa University College of Health Sciences, and oral consent was obtained from all FGD participants. Definitions ED mortality was defined as death occurring within 24 hours of ED admission, excluding dead-on-arrival cases. Very early mortality was defined as death within 6 hours of ED admission. Adult patients were those aged 14 years and above. Triage categories were classified based on the Triage Early Warning Score (TEWS). Statistical Analysis Descriptive statistics were used for continuous and categorical variables, with binary logistic regression applied to identify factors associated with very early mortality. Multivariable logistic regression was subsequently performed on variables exhibiting significance levels below 0.05 in univariable analysis. Model adequacy was evaluated using the Pearson chi-square test, with adjusted odds ratios (AOR) and 95% confidence intervals (CI) reported. Data analysis was executed using SPSS version 25. FGD audio recordings underwent transcription, translation, and thematic analysis to complement the quantitative findings through an inductive thematic approach and triangulation. RESULTS Magnitude of Mortality The study analyzed mortality rates within a cohort of 14,276 adult ED attendees over a 12-month period. Among the 198 deaths recorded within 24 hours of ED arrival, we excluded 37 dead-on-arrival cases, resulting in 161 confirmed ED deaths, representing a mortality rate of 1.13%. After excluding 7 incomplete records, 154 cases remained for further analysis. Among the 161 confirmed deaths, 61 instances (37.9%) occurred within the initial 6 hours post-admission, denoted as very early mortality. Demographic Profile The demographic profile revealed that males accounted for 51.3% of deaths, with a male-to-female ratio of 1.1:1. The age range spanned from 14 to 90 years, with a mean age of 49.94 ± 17.83 years. Most patients lived in Addis Ababa (64.9%), Despite their critical condition, only 33.8% arrived by ambulance, with the majority using taxis (50.6%). Over half of the patients (53.2%) were self-referral. Socio-demographic details are presented in Table 1 . Table 1 Socio-demographic profile of deaths within 24 hours at TASH adult ED Socio demographics Category Frequency Percent Sex Male 79 51.3 Female 75 48.7 Age 14–24 11 7.1 25–34 20 13 35–44 34 22.1 45–54 25 16.2 55–64 28 18.2 > 64 36 23.4 Address Addis Ababa 100 64.9 Oromia 21 13.6 Amhara 10 6.5 SNNPR 7 4.5 Other* 16 10.4 Mode of Transportation Ambulance 52 33.8 Taxi 78 50.6 Public transport 1 0.6 Other** 23 14.9 Source of Referral Public hospital 23 14.9 Private center 3 1.9 Health center 33 21.4 Self 82 53.2 OPD 12 7.8 Other*** 1 0.6 *Other regions: Afar, Benishangul-Gumuz, Somali, Tigray. **Patients carried by attendants. ***Police station referrals. Clinical Profiles at Presentation Most patients (77.3%) had no recent ED visits within the preceding 30 days. Upon initial triage, the majority were categorized as either Red (64.3%) or Orange (22.7%). Many patients presented with hemodynamic instability, with 51.9% had tachycardia, 33.1% had hypotension, and 47.4% had oxygen saturation below 90%. Moreover, 48.9% manifested altered consciousness, while 26% were unresponsive. Predominant initial complaints included neurological (27.9%) and respiratory (25.3%) issues. Nearly half of the patients (49.4%) reported symptom durations ranging from 25 hours to one week. Further clinical information is presented in Table 2 . Table 2 Baseline clinical characteristics of deaths within 24 hours at TASH adult ED (n = 154) Variable Category Frequency Percent Prior ED visit (30 days) No visit 119 77.3 1 visit 34 22.1 > 1 visit 1 0.6 Triage category Red 99 64.3 Orange 35 22.7 Yellow 10 6.5 Green 10 6.5 Presenting symptom Neurologic 43 27.9 Respiratory 39 25.3 GI symptoms 27 17.5 Respiratory + other 15 9.7 Other 11 7.1 Trauma 10 6.5 Cardiac 9 5.8 Duration of symptoms 25 h – 1 week 76 49.4 1 week 27 17.5 4–12 h 16 10.4 13–24 h 8 5.2 Blood pressure Normal 55 35.7 Hypotensive 51 33.1 Hypertensive 31 20.1 Unrecordable 17 11 SpO2 > 90% 66 42.9 < 90% 73 47.4 Unrecordable 15 9.7 Consciousness (AVPU) Alert 79 51.3 Verbal 24 15.6 To pain 11 7.1 Unresponsive 40 26 Diagnosis, Comorbidities, and Investigations Medical causes constituted 84.4% of the fatalities, with the remaining 15.6% attributed to surgical causes. Non-traumatic incidents comprised the majority at 94.8%. Among medical causes, infections leading to sepsis were the primary contributor to death, accounting for 54.1% of cases, with pulmonary infections being the most prevalent, affecting 69.2% of patients. Neurological causes were responsible for 16% of deaths, followed by oncological causes at 9.1%. Malignancy emerged as the most common comorbidity, affecting half of individuals with chronic conditions, reflecting the institution's status as the nation's sole provider of radiotherapy services. Of the 154 patients examined, 74.4% underwent investigative procedures, revealing high incidence rates of anemia (62.9%), thrombocytopenia (56.2%), leukocytosis (62.9%), renal function abnormalities (53.4%), and electrolyte imbalances, notably hyponatremia affecting 54% of those examined. Further clinical information is presented in Table 3 . Table 3 Diagnosis, comorbidity, and infection focus of deaths within 24 hours at TASH adult ED Variable Category Frequency Percent Main diagnosis Medical 130 84.4 Surgical 24 15.6 Trauma category Non-traumatic 144 94.8 Traumatic 10 5.2 Medical cause Infection/Sepsis 71 54.1 Neurologic (incl. stroke) 21 16 Oncologic 12 9.1 Cardiovascular 12 9 Other* 14 10.8 Chronic comorbidity Malignancy 61 50 (n = 122) HTN and DM 21 17.2 Cardiac disease 17 13.9 Malignancy + other 10 8.2 Other** 7 5.7 Focus of infection/sepsis Chest (alone) 42 53.8 (n = 78) Chest + other systems 12 15.4 Gastrointestinal 15 19.2 Other* 9 11.6 Vasopressor use Yes 51 65.4 No 27 34.6 **Other comorbidities include HIV/AIDS Location, Timing, and Immediate Cause of Death Most deaths occurred within the Red zone (66.9%), followed by the Orange zone, accounting for 20.1%. Approximately two-thirds (64.9%) of the deaths took place during duty hours, specifically overnight or on weekends. The primary immediate cause of death was multi-organ failure (39.0%), followed by herniation (22.1%), respiratory arrest (18.2%), and sudden cardiac arrest (14.3%), as detailed in Table 4 . Table 4 Location, timing, and immediate cause of death within 24 hours at TASH adult ED (n = 154) Variable Category Frequency Percent Location of death Red zone 103 66.9 Orange zone 31 20.1 Green zone 9 5.8 Resuscitation area 7 4.5 Yellow zone 4 2.6 Timing of death Duty hours 100 64.9 Working hours 54 35.1 Immediate cause of death Multi-organ failure 60 39 Herniation 34 22.1 Respiratory arrest 28 18.2 Sudden cardiac arrest 22 14.3 Pulmonary embolism 6 3.9 Other/Unknown 4 2.6 Predictors of Very Early Mortality Four predictors of very early mortality (occurring within 0–6 hours) were identified through multivariable logistic regression analysis. Symptom duration less than 12 hours showed the strongest association with death within 6 hours (AOR 55.44; 95% CI: 3.53–870.44; p = 0.004). Symptom duration between 25 hours and one week also remained significant (AOR 13.52; 95% CI: 1.26–144.87; p = 0.031). Among admission diagnoses, cardiovascular disease (AOR 29.56; 95% CI: 1.33–657.09; p = 0.032 was independently linked to very early mortality. Maintaining oxygen saturation above 90% was found to be independently protective (AOR 0.029; 95% CI: 0.002–0.469; p = 0.013). Table 5 Multivariable logistic regression of predictors of very early mortality (≤ 6 h) vs. late mortality (> 6–24 h) Variable Category 0–6 hrs. (n) > 6 hrs. (n) COR (95% CI) AOR (95% CI) Duration of symptoms 24 h – 1 week 29 47 0.20 (0.06–0.73) * 13.52 (1.26–144.87) * > 1 week (ref) 3 24 — — SpO2 > 90% 15 51 9.35 (2.60–33.66) ** 0.029 (0.002–0.469) * < 90% 35 38 2.99 (0.87–10.25) 0.15 (0.01–2.10) Main diagnosis Cardiovascular 8 5 0.13 (0.02–0.82) * 29.56 (1.33–657.09) * Neurologic 8 15 0.38 (0.07–2.14) 5.14 (0.23–116.92) Infection/Sepsis 17 49 0.58 (0.12–2.90) 5.44 (0.46–64.07) Oncologic 10 4 0.08 (0.01–0.54) * 11.46 (0.40–332.51) Others* 7 5 0.040(0.003–0.555) 19.747(0.533-732.197) COR = crude odds ratio; AOR = adjusted odds ratio; CI = confidence interval. *p < 0.05; **p 1 week. *Others = Renal, Liver QUALITATIVE FINDINGS In the qualitative analysis focused on the management of sepsis at the ED of TASH, identification and screening of sepsis were predominantly based on vital signs such as hypotension, fever, and tachycardia, along with the quick Sequential Organ Failure Assessment (qSOFA) scoring system. Laboratory constraints limited the use of comprehensive scoring tools such as the Sequential Organ Failure Assessment (SOFA), Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and National Early Warning Score (NEWS). Participants recognized challenges posed by the lack of culture diagnostics, clinical similarities with conditions such as malaria and malignancies, and the persistent concern of underdiagnosis, resulting in frequent instances of overdiagnosis of sepsis. Regarding treatment and patient disposition, there were notable delays exceeding one hour in initiating antibiotic therapy, attributed mainly to stock-outs of pharmacy supplies, delays in patient payments, overcrowding, and inadequate nursing staffing levels. Participants highlighted the scarcity of patient monitoring equipment in the designated Red zone, coupled with the absence of a standardized sepsis monitoring checklist. Strengths of the department included heightened clinical suspicion and the utilization of point-of-care ultrasound for fluid resuscitation. However, major weaknesses included delays in administering antibiotics and vasopressors, low adherence to obtaining cultures, insufficient monitoring, and challenges related to patient overcrowding. Proposed solutions included enhancing the availability of drugs and medical equipment, providing regular sepsis training for all clinical personnel, formulating locally tailored institutional sepsis management protocols, conducting daily ward rounds led by infectious disease specialists, and implementing strategies aimed at alleviating patient congestion. DISCUSSION At TASH, 24-hour mortality rate was 1.13%, which was nearly twice the national target of 0.6%. Also, the rate was higher than reported in similar sub-analyses at Saint Paul Hospital Millennium Medical College (SPHMMC; 0.75%) and a previous TASH cohort (0.9%) [ 6 , 12 ]. This increase is likely attributable to TASH's function as the tertiary referral center of last resort, receiving patients who are severely ill patients, many with advanced malignancies or end-stage organ conditions, referred from across Ethiopia. Death from sepsis was responsible for 54.1% deaths, which aligns with findings at SPHMMC and surpasses the 16.8–18.8% rates reported in earlier TASH studies [ 6 , 12 ]. This discrepancy may be due to the current study's exclusive focus on 24-hour mortality, a period during which acute infectious decompensation is prevalent. The substantial predominance of pulmonary-source sepsis (69.2%) emphasizes the critical need for prompt respiratory evaluation and early initiation of antibiotics for suspected pneumonia-related sepsis, in accordance with global guidelines. Qualitative data shed light on why this standard is not consistently met: delayed administration of antibiotics, limited diagnostic capabilities, and overcrowding collectively hinder the sepsis care bundle at TASH. The markedly high incidence of malignancy as a comorbidity (50%) sets this cohort apart from previous Ethiopian ED mortality investigations, where HIV/AIDS was the predominant comorbidity [ 13 , 15 ]. This shift likely reflects TASH's distinctive position as the only operational radiotherapy facility in Ethiopia, attracting a concentrated national population of cancer patients. Two distinct symptom duration profiles independently predicted early mortality: individuals presenting within 12 hours, likely represent hyperacute illnesses such as acute coronary syndrome, hemorrhagic stroke, or rapidly progressive sepsis, and those arriving between 25 hours and one week, typically reflecting delayed healthcare-seeking behavior in advanced disease stages. The former association mirrors findings from a 2015 prospective study at TASH, where symptom duration of less than 4 hours was the sole significant predictor of death within 6 hours, consistent with global data indicating a prevalence of cardiovascular and hemorrhagic emergencies in the very early mortality timeframe [ 13 ]. Cardiovascular conditions, as independent predictors of early mortality (AOR 29.56), contrast with previous Ethiopian studies where these conditions were not significantly linked to early death [ 13 , 14 ]. This disparity may signify a shifting disease burden at TASH or potentially result from delayed presentations with multi-organ complications. We acknowledge that the wide confidence intervals for several predictors in Table 5 (including cardiovascular diagnosis, AOR 29.56; 95% CI: 1.33–657.09, other diagnoses, AOR 19.75; 95% CI: 0.53–732.20) reflect small cell sizes and should be interpreted with considerable caution. The protective effect of maintaining oxygen saturation above 90% (AOR 0.029) highlights the importance of rapid airway management and oxygen delivery at triage. Only 33.8% of critically ill patients were brought in by ambulance, with over half relying on taxis. This is a pattern observed across various Ethiopian ED mortality studies, indicating a persistent gap in pre-hospital care [ 5 , 6 , 14 ]. A key recommendation for the Ministry of Health’s directorate is to enhance EMS utilization through public awareness campaigns. This study presents several limitations that should be acknowledged. The retrospective chart review introduced selection bias and depended on the comprehensiveness of medical records. Variation in mortality cut-off definitions across studies (24, 48, and 72 hours) complicates direct comparisons. The focus group discussion involved solely postgraduate students at a single institution, potentially not fully representing frontline nursing or consultant viewpoints. Moreover, broad confidence intervals in the multivariable model, particularly for the renal diagnosis predictor, reflect small sample sizes and should be cautiously interpreted. CONCLUSION The 24-hour ED mortality rate at TASH significantly exceeds the national standard, primarily due to medical emergencies, mainly pulmonary sepsis. Early mortality, occurring within 6 hours, was associated with short symptom duration, cardiovascular and renal conditions, and decreased oxygen saturation levels. There is significant ambulance underutilization for critically ill patients. Immediate focus areas include implementing comprehensive sepsis training for all ED personnel, establishing sepsis protocols tailored to the local context, ensuring regular involvement of infectious disease specialists, and targeted acquisition of vital medications and monitoring devices. On a broader scale, the Ministry of Health should strengthen pre-hospital EMS systems and enhance public awareness regarding ambulance utilization for medical crises. Abbreviations AOR Adjusted odds ratio AVPU Alert, Voice, Pain, Unresponsive CI Confidence interval COR Crude odds ratio ED Emergency department EMS Emergency medical services ETB Ethiopian birr FGD Focus group discussion LMIC Low–and middle–income countries MOF Multiorgan failure qSOFA Quick Sequential Organ Failure Assessment RTA Road traffic accident SpO2 Peripheral oxygen saturation SPHMMC Saint Paul Hospital Millennium Medical College SPSS Statistical Package for the Social Sciences TASH Tikur Anbessa Specialized Hospital TEWS Triage Early Warning Score WHO World Health Organization Declarations Ethics approval and consent to participate: Ethical clearance was obtained from the Institutional Review Board of Addis Ababa University, College of Health Sciences. Informed oral consent was obtained from all focus group discussion participants. Quantitative data were extracted retrospectively from medical records; patient identifiers were not disclosed. Consent for publication: Not applicable (no individual patient data, images, or videos are included). Competing interests: The authors declare that they have no competing interests. Funding: This study was funded by Addis Ababa University, College of Health Sciences (AAU/CHS). Total study cost: ETB 25,725. The funder had no role in study design, data collection, analysis, interpretation, or manuscript preparation. Author Contribution Endalamaw Wondimagegn conceived the study, collected and analyzed data, conducted the FGD, and drafted the manuscript.Gediyon Dereje contributed to study design, data collection, and critical revision of the manuscript Merahi Kefyalew and Demelash Gezahegn supervised the study design and provided critical revisions to the questionnaire and the manuscript. Endalamaw Wondimagegn is the guarantor of this work. All authors read and gave approval to the final thesis and agree to be accountable for all aspects of the work. Acknowledgement The authors gratefully acknowledge the TASH Emergency Department staff and all focus group discussion participants for their contributions, and the Department of Emergency and Critical Care Medicine, Addis Ababa University, for facilitating this research. The supervisory support of Dr Merahi Kefyalew and Dr Demelash Gezahegn is also gratefully acknowledged. Availability of data and materials: The data sets generated and analyzed during the current study are available from the corresponding author on reasonable request, subject to institutional approval from TASH. References Ethiopian Hospital Services Transformation Guideline, Volume 1. Addis Ababa: Federal Ministry of Health; 2016. Obermeyer Z, Abujaber S, Makar M, Stoll S, Kayden SR, Wallis LA, et al. Emergency care in 59 low- and middle-income countries: a systematic review. Bull World Health Organ. 2015;93(8):577–586G. Burkholder TW, Hill K, Calvello Hynes EJ. Developing emergency care systems: a human rights-based approach. Bull World Health Organ. 2019;97(9):612–9. Hirshon JM, Risko N, Calvello EJ, Stewart De Ramirez S, Narayan M, Theodosis C, et al. Health systems and services: the role of acute care. Bull World Health Organ. 2013;91(5):386–8. Messelu MA, Amlak BT, Mekonnen GB, Belayneh AG, Tamre S, Adal O, et al. Mortality and its determinants among patients attending in emergency departments. BMC Emerg Med. 2024;24(1):125. Yosha HD, Tadele A, Teklu S, Melese KG. A two-year review of adult emergency department mortality at Tikur Anbesa specialized tertiary hospital, Addis Ababa, Ethiopia. BMC Emerg Med. 2021;21(1):33. Stefanovski PH, Radkov VR, Ilkov LT, Tonchev PT, Mladenova YT, Manchev VK, et al. Analysis of mortality in the emergency department at a university hospital in Pleven. J Int Med Res. 2017;45(5):1553–61. Mukhtar S, Saleem SG, Ali S, Khatri SA, Yaffee AQ. Standing at the edge of mortality: five-year audit of an emergency department of a tertiary care hospital in a low resource setup. Pak J Med Sci. 2021;37(3). Valli G, Galati E, De Marco F, Bucci C, Fratini P, Cennamo E, et al. In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission. Clin Exp Emerg Med. 2021;8(4):325–32. Olusegun-Joseph A, Akande O, Otrofanowei E, Nwoye E, Olopade O, Ajuluchukwu J. Medical mortality in an emergency department in Nigeria: the transition is obvious! Afr Health Sci. 2021;21(1):172–9. Rukewe A, Fatiregun A, Okolo C, Ojifinni K, Akinola O, Nweke M. Emergency department deaths in a Nigerian University Hospital: deaths too many. West Indian Med J. 2015. Available from: https://www.mona.uwi.edu/fms/wimj/article/2041 Dode W, Alemayehu G, Tebebe B, Getachew T, Tigistu S, Aklog E, et al. Pattern and predictors of mortality in emergency department of Saint Paul Hospital Millennium Medical College Addis Ababa, Ethiopia: retrospective study. Research Square; 2024;38(2). doi: 10.20372/ejhd.v38i.6367 Hunchak C, Teklu S, Meshkat N, Meaney C, Puchalski Ritchie L. Patterns and predictors of early mortality among emergency department patients in Addis Ababa, Ethiopia. BMC Res Notes. 2015;8(1):605. Abebe F, Habtamu A, Workina A. Risks of early mortality and associated factors at adult emergency department of Jimma University Medical Center. Open Access Emerg Med. 2023;15:293–302. Misganaw A, Mariam DH, Araya T, Ayele K. Patterns of mortality in public and private hospitals of Addis Ababa, Ethiopia. BMC Public Health. 2012;12(1):1007. Misganaw A, Mariam DH, Araya T, Ayele K. Patterns of mortality in public and private hospitals of Addis Ababa, Ethiopia. BMC Public Health. 2012;12(1):1007. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624. Creswell JW, Plano Clark VL. Designing and Conducting Mixed Methods Research. 3rd ed. Thousand Oaks, CA: SAGE Publications; 2018. Calvello EJ, Skog AP, Tenner AG, Wallis LA. Applying the lessons of maternal mortality reduction to global emergency health. Bull World Health Organ. 2015;93(6):417–23. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–77. Baelani I, Jochberger S, Laimer T, et al. Availability of critical care resources to treat patients with severe sepsis or septic shock in Africa: a self-reported, continent-wide survey of anaesthesia providers. Crit Care. 2011;15(1):R10. Schultz MJ, Dunser MW, Dondorp AM, et al. Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future. Intensive Care Med. 2017;43(5):612–24. Bhatt M, Amalakumar L, Patel A, Mehta S. Point-of-care ultrasound in the management of septic shock in resource-limited settings: a systematic review. J Crit Care. 2020;57:212–7. Tran A, Fernando SM, Brodie D, et al. Prognostic factors associated with mortality in patients with COVID-19 and sepsis. J Intensive Care Med. 2022;37(3):399–407. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 14 May, 2026 Reviewers agreed at journal 14 May, 2026 Reviewers agreed at journal 12 May, 2026 Reviewers agreed at journal 09 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers invited by journal 07 May, 2026 Editor invited by journal 28 Apr, 2026 Editor assigned by journal 24 Apr, 2026 Submission checks completed at journal 24 Apr, 2026 First submitted to journal 20 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9469916","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":641526535,"identity":"f0877a28-57bc-4ede-8907-4dd4bd9ee1a2","order_by":0,"name":"Dr Endalamaw Wondimagegn Belie","email":"","orcid":"","institution":"Tikur Anbessa Hospital","correspondingAuthor":false,"prefix":"Dr","firstName":"Endalamaw","middleName":"Wondimagegn","lastName":"Belie","suffix":""},{"id":641526536,"identity":"14869c66-950b-42ca-a868-5758797c09a1","order_by":1,"name":"Dr Demelash Gezahegn","email":"","orcid":"","institution":"Tikur Anbessa Hospital","correspondingAuthor":false,"prefix":"Dr","firstName":"Demelash","middleName":"","lastName":"Gezahegn","suffix":""},{"id":641526537,"identity":"40c7a4fd-acb4-4522-b630-a1350fa34862","order_by":2,"name":"Dr Gediyon Dereje Mekonenn","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBCD+n4QmVBAghbGmQ0gLQakaNlwAEQRo4V/2uGDD39U1DIbn1+d+OGBAYM8v9gB/FokbqclG/OcOc5mduPtZgmgwwxnzk4gYM3tHDNpxrZjPGY3zm4AaUkwuE1Ai/zt/O8/f7YdkzCecXbzD6K0GNzOYWPgbasxMODv3UacLYa304ylec4cSJC4wbvNIsFAgrBf5G4nP/z4o6Iugb//7OabPyps5PmlCWiBgsPAsAOrlCBKOQjUAWPoANGqR8EoGAWjYIQBADrlR1Hz6sEYAAAAAElFTkSuQmCC","orcid":"","institution":"Tikur Anbessa Hospital","correspondingAuthor":true,"prefix":"Dr","firstName":"Gediyon","middleName":"Dereje","lastName":"Mekonenn","suffix":""},{"id":641526538,"identity":"2dfbf6bb-6435-427f-a579-a4c42de242d4","order_by":3,"name":"Dr Merahi Kefyalew Merahi","email":"","orcid":"","institution":"Tikur Anbessa Hospital","correspondingAuthor":false,"prefix":"Dr","firstName":"Merahi","middleName":"Kefyalew","lastName":"Merahi","suffix":""}],"badges":[],"createdAt":"2026-04-20 09:27:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9469916/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9469916/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109435291,"identity":"b7d125ae-39a9-4fb9-acf1-e7049b4933ec","added_by":"auto","created_at":"2026-05-18 06:01:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":351770,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9469916/v1/cb896fa3-b3b0-4504-959a-703a894718f3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Magnitude of Adult Emergency Department Mortality and Associated Determinant Factors at a Tertiary Hospital, Addis Ababa, Ethiopia: A Mixed-Methods Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eThe emergency department (ED) serves as the primary entry for individuals with life-threatening conditions, with ED mortality accounting for a significant proportion of in-hospital deaths globally. ED mortality rates in sub-Saharan Africa are up to 5 percentage points higher than in high income regions. All countries are encouraged by World Health Organization (WHO) to develop and monitor emergency care systems. The timely management of ED reduces the negative outcomes. In Ethiopia, the Ministry of Health's 2016 Hospital Services Transformation Guideline defines ED mortality as death occurring within 24 hours of admission, excluding cases of dead-on-arrival. The national target stipulates an ED mortality rate below 0.6%. However, a systematic review of Ethiopian studies in 2023 reported an overall ED mortality rate of 7.71%, with varying rates across different regions. Contributing factors identified nationally include rural residency, altered consciousness, delayed hospital arrival, and comorbid conditions.\u003c/p\u003e \u003cp\u003eThe largest academic referral hospital of the country, Tikur Anbessa Specialized Hospital (TASH), handles huge numbers of adult ED patients each year. Previous studies at TASH have reported 72-hour ED mortality rates of 1.68\u0026ndash;1.9%, in which large number of deaths occurring within the initial 24 hours. Furthermore, TASH is the leading institution for emergency and critical care training and a major national referral center. Thus, understanding the extent and predictors of 24-hour mortality is crucial for enhancing both institutional quality and national healthcare policies. This study aimed to determine the 24-hour ED mortality rate at TASH, identify determinants of very early mortality (occurring within 6 hours), and explore systemic factors contributing to sepsis-related deaths, considering sepsis as the primary cause identified in the quantitative analysis.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting\u003c/h2\u003e \u003cp\u003eEstablished in 1972, TASH serves as Ethiopia's premier academic teaching hospital under Addis Ababa University College of Health Sciences. The adult ED operates within a dedicated facility, encompassing multiple floors with over 80 beds. The department is staffed by a team of emergency and critical care medicine consultants and postgraduate trainees.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design and Period\u003c/h3\u003e\n\u003cp\u003eAn explanatory sequential mixed-methods design was employed for this study. The quantitative phase involved a retrospective cross-sectional analysis of medical records from October 1, 2024, to September 30, 2025. Subsequently, a qualitative phase comprising a focus group discussion (FGD) was conducted.\u003c/p\u003e\n\u003ch3\u003ePopulation and Sampling\u003c/h3\u003e\n\u003cp\u003eFor the quantitative component, the study included all adult patients aged 14 years and above who died within 24 hours of admission to the ED, except for those classified as dead-on-arrival or with substantially incomplete records. The final analysis included a sample of 154 individuals. The qualitative component involved the purposive selection of nine postgraduate students specializing in emergency and critical care from the first to third year of their program. Selection criteria were based on active involvement in clinical practice, communication skills, and willingness to participate in the FGD; the group comprised six male and three female participants.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eQuantitative data were sourced from inpatient medical records and the ED logbook using a structured questionnaire derived from previous Ethiopian ED mortality studies. The instrument underwent pre-testing on a subset of records, with subsequent adjustments made accordingly. Data extraction was conducted by the principal investigator. The FGD was structured around four open-ended inquiries exploring sepsis recognition, treatment pathways, strengths and weaknesses in current management practices, and potential solutions to mitigate sepsis-related mortality. Discussions took place in a designated venue, utilizing both Amharic and English, and were recorded for transcription and analysis. Ethical approval was granted by the Institutional Review Board of Addis Ababa University College of Health Sciences, and oral consent was obtained from all FGD participants.\u003c/p\u003e\n\u003ch3\u003eDefinitions\u003c/h3\u003e\n\u003cp\u003eED mortality was defined as death occurring within 24 hours of ED admission, excluding dead-on-arrival cases. Very early mortality was defined as death within 6 hours of ED admission. Adult patients were those aged 14 years and above. Triage categories were classified based on the Triage Early Warning Score (TEWS).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used for continuous and categorical variables, with binary logistic regression applied to identify factors associated with very early mortality. Multivariable logistic regression was subsequently performed on variables exhibiting significance levels below 0.05 in univariable analysis. Model adequacy was evaluated using the Pearson chi-square test, with adjusted odds ratios (AOR) and 95% confidence intervals (CI) reported. Data analysis was executed using SPSS version 25. FGD audio recordings underwent transcription, translation, and thematic analysis to complement the quantitative findings through an inductive thematic approach and triangulation.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eMagnitude of Mortality\u003c/h2\u003e \u003cp\u003eThe study analyzed mortality rates within a cohort of 14,276 adult ED attendees over a 12-month period. Among the 198 deaths recorded within 24 hours of ED arrival, we excluded 37 dead-on-arrival cases, resulting in 161 confirmed ED deaths, representing a mortality rate of 1.13%. After excluding 7 incomplete records, 154 cases remained for further analysis. Among the 161 confirmed deaths, 61 instances (37.9%) occurred within the initial 6 hours post-admission, denoted as very early mortality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Profile\u003c/h2\u003e \u003cp\u003eThe demographic profile revealed that males accounted for 51.3% of deaths, with a male-to-female ratio of 1.1:1. The age range spanned from 14 to 90 years, with a mean age of 49.94\u0026thinsp;\u0026plusmn;\u0026thinsp;17.83 years. Most patients lived in Addis Ababa (64.9%), Despite their critical condition, only 33.8% arrived by ambulance, with the majority using taxis (50.6%). Over half of the patients (53.2%) were self-referral. Socio-demographic details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic profile of deaths within 24 hours at TASH adult ED\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocio demographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAddress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAddis Ababa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e 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colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource of Referral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e*Other regions: Afar, Benishangul-Gumuz, Somali, Tigray. **Patients carried by attendants. ***Police station referrals.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eClinical Profiles at Presentation\u003c/h2\u003e \u003cp\u003eMost patients (77.3%) had no recent ED visits within the preceding 30 days. Upon initial triage, the majority were categorized as either Red (64.3%) or Orange (22.7%). Many patients presented with hemodynamic instability, with 51.9% had tachycardia, 33.1% had hypotension, and 47.4% had oxygen saturation below 90%. Moreover, 48.9% manifested altered consciousness, while 26% were unresponsive. Predominant initial complaints included neurological (27.9%) and respiratory (25.3%) issues. Nearly half of the patients (49.4%) reported symptom durations ranging from 25 hours to one week. Further clinical information is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline clinical characteristics of deaths within 24 hours at TASH adult ED (n\u0026thinsp;=\u0026thinsp;154)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior ED visit (30 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1 visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTriage category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrange\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresenting symptom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurologic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespiratory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGI symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespiratory\u0026thinsp;+\u0026thinsp;other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 h \u0026ndash; 1 week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1 week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026ndash;12 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026ndash;24 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypotensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnrecordable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnrecordable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsciousness (AVPU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVerbal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnresponsive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDiagnosis, Comorbidities, and Investigations\u003c/h2\u003e \u003cp\u003eMedical causes constituted 84.4% of the fatalities, with the remaining 15.6% attributed to surgical causes. Non-traumatic incidents comprised the majority at 94.8%. Among medical causes, infections leading to sepsis were the primary contributor to death, accounting for 54.1% of cases, with pulmonary infections being the most prevalent, affecting 69.2% of patients. Neurological causes were responsible for 16% of deaths, followed by oncological causes at 9.1%. Malignancy emerged as the most common comorbidity, affecting half of individuals with chronic conditions, reflecting the institution's status as the nation's sole provider of radiotherapy services. Of the 154 patients examined, 74.4% underwent investigative procedures, revealing high incidence rates of anemia (62.9%), thrombocytopenia (56.2%), leukocytosis (62.9%), renal function abnormalities (53.4%), and electrolyte imbalances, notably hyponatremia affecting 54% of those examined. Further clinical information is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDiagnosis, comorbidity, and infection focus of deaths within 24 hours at TASH adult ED\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-traumatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraumatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical cause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfection/Sepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurologic (incl. stroke)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOncologic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiovascular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic comorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalignancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHTN and DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiac disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalignancy\u0026thinsp;+\u0026thinsp;other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFocus of infection/sepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChest (alone)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChest\u0026thinsp;+\u0026thinsp;other systems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGastrointestinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVasopressor use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e**Other comorbidities include HIV/AIDS\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eLocation, Timing, and Immediate Cause of Death\u003c/h2\u003e \u003cp\u003eMost deaths occurred within the Red zone (66.9%), followed by the Orange zone, accounting for 20.1%. Approximately two-thirds (64.9%) of the deaths took place during duty hours, specifically overnight or on weekends. The primary immediate cause of death was multi-organ failure (39.0%), followed by herniation (22.1%), respiratory arrest (18.2%), and sudden cardiac arrest (14.3%), as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLocation, timing, and immediate cause of death within 24 hours at TASH adult ED (n\u0026thinsp;=\u0026thinsp;154)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRed zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrange zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreen zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResuscitation area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYellow zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTiming of death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuty hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorking hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmediate cause of death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMulti-organ failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHerniation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespiratory arrest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSudden cardiac arrest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulmonary embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther/Unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePredictors of Very Early Mortality\u003c/h2\u003e \u003cp\u003eFour predictors of very early mortality (occurring within 0\u0026ndash;6 hours) were identified through multivariable logistic regression analysis. Symptom duration less than 12 hours showed the strongest association with death within 6 hours (AOR 55.44; 95% CI: 3.53\u0026ndash;870.44; p\u0026thinsp;=\u0026thinsp;0.004). Symptom duration between 25 hours and one week also remained significant (AOR 13.52; 95% CI: 1.26\u0026ndash;144.87; p\u0026thinsp;=\u0026thinsp;0.031). Among admission diagnoses, cardiovascular disease (AOR 29.56; 95% CI: 1.33\u0026ndash;657.09; p\u0026thinsp;=\u0026thinsp;0.032 was independently linked to very early mortality. Maintaining oxygen saturation above 90% was found to be independently protective (AOR 0.029; 95% CI: 0.002\u0026ndash;0.469; p\u0026thinsp;=\u0026thinsp;0.013).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable logistic regression of predictors of very early mortality (\u0026le;\u0026thinsp;6 h) vs. late mortality (\u0026gt;\u0026thinsp;6\u0026ndash;24 h)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;6 hrs. (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6 hrs. (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;12 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.08 (0.02\u0026ndash;0.31) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e55.44 (3.53\u0026ndash;870.44) **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026ndash;24 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.21 (0.03\u0026ndash;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.17 (0.52\u0026ndash;283.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;24 h \u0026ndash; 1 week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.20 (0.06\u0026ndash;0.73) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e13.52 (1.26\u0026ndash;144.87) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1 week (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.35 (2.60\u0026ndash;33.66) **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.029 (0.002\u0026ndash;0.469) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.99 (0.87\u0026ndash;10.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.15 (0.01\u0026ndash;2.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiovascular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.13 (0.02\u0026ndash;0.82) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e29.56 (1.33\u0026ndash;657.09) *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurologic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.38 (0.07\u0026ndash;2.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.14 (0.23\u0026ndash;116.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfection/Sepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.58 (0.12\u0026ndash;2.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.44 (0.46\u0026ndash;64.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOncologic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.08 (0.01\u0026ndash;0.54) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.46 (0.40\u0026ndash;332.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.040(0.003\u0026ndash;0.555)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.747(0.533-732.197)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eCOR\u0026thinsp;=\u0026thinsp;crude odds ratio; AOR\u0026thinsp;=\u0026thinsp;adjusted odds ratio; CI\u0026thinsp;=\u0026thinsp;confidence interval. *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01. Reference category for symptom duration: \u0026gt;1 week. *Others\u0026thinsp;=\u0026thinsp;Renal, Liver\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eQUALITATIVE FINDINGS\u003c/h2\u003e \u003cp\u003eIn the qualitative analysis focused on the management of sepsis at the ED of TASH, identification and screening of sepsis were predominantly based on vital signs such as hypotension, fever, and tachycardia, along with the quick Sequential Organ Failure Assessment (qSOFA) scoring system. Laboratory constraints limited the use of comprehensive scoring tools such as the Sequential Organ Failure Assessment (SOFA), Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and National Early Warning Score (NEWS). Participants recognized challenges posed by the lack of culture diagnostics, clinical similarities with conditions such as malaria and malignancies, and the persistent concern of underdiagnosis, resulting in frequent instances of overdiagnosis of sepsis.\u003c/p\u003e \u003cp\u003eRegarding treatment and patient disposition, there were notable delays exceeding one hour in initiating antibiotic therapy, attributed mainly to stock-outs of pharmacy supplies, delays in patient payments, overcrowding, and inadequate nursing staffing levels. Participants highlighted the scarcity of patient monitoring equipment in the designated Red zone, coupled with the absence of a standardized sepsis monitoring checklist. Strengths of the department included heightened clinical suspicion and the utilization of point-of-care ultrasound for fluid resuscitation. However, major weaknesses included delays in administering antibiotics and vasopressors, low adherence to obtaining cultures, insufficient monitoring, and challenges related to patient overcrowding. Proposed solutions included enhancing the availability of drugs and medical equipment, providing regular sepsis training for all clinical personnel, formulating locally tailored institutional sepsis management protocols, conducting daily ward rounds led by infectious disease specialists, and implementing strategies aimed at alleviating patient congestion.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAt TASH, 24-hour mortality rate was 1.13%, which was nearly twice the national target of 0.6%. Also, the rate was higher than reported in similar sub-analyses at Saint Paul Hospital Millennium Medical College (SPHMMC; 0.75%) and a previous TASH cohort (0.9%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This increase is likely attributable to TASH's function as the tertiary referral center of last resort, receiving patients who are severely ill patients, many with advanced malignancies or end-stage organ conditions, referred from across Ethiopia.\u003c/p\u003e \u003cp\u003eDeath from sepsis was responsible for 54.1% deaths, which aligns with findings at SPHMMC and surpasses the 16.8\u0026ndash;18.8% rates reported in earlier TASH studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This discrepancy may be due to the current study's exclusive focus on 24-hour mortality, a period during which acute infectious decompensation is prevalent. The substantial predominance of pulmonary-source sepsis (69.2%) emphasizes the critical need for prompt respiratory evaluation and early initiation of antibiotics for suspected pneumonia-related sepsis, in accordance with global guidelines. Qualitative data shed light on why this standard is not consistently met: delayed administration of antibiotics, limited diagnostic capabilities, and overcrowding collectively hinder the sepsis care bundle at TASH.\u003c/p\u003e \u003cp\u003eThe markedly high incidence of malignancy as a comorbidity (50%) sets this cohort apart from previous Ethiopian ED mortality investigations, where HIV/AIDS was the predominant comorbidity [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This shift likely reflects TASH's distinctive position as the only operational radiotherapy facility in Ethiopia, attracting a concentrated national population of cancer patients.\u003c/p\u003e \u003cp\u003eTwo distinct symptom duration profiles independently predicted early mortality: individuals presenting within 12 hours, likely represent hyperacute illnesses such as acute coronary syndrome, hemorrhagic stroke, or rapidly progressive sepsis, and those arriving between 25 hours and one week, typically reflecting delayed healthcare-seeking behavior in advanced disease stages. The former association mirrors findings from a 2015 prospective study at TASH, where symptom duration of less than 4 hours was the sole significant predictor of death within 6 hours, consistent with global data indicating a prevalence of cardiovascular and hemorrhagic emergencies in the very early mortality timeframe [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCardiovascular conditions, as independent predictors of early mortality (AOR 29.56), contrast with previous Ethiopian studies where these conditions were not significantly linked to early death [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This disparity may signify a shifting disease burden at TASH or potentially result from delayed presentations with multi-organ complications. We acknowledge that the wide confidence intervals for several predictors in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e (including cardiovascular diagnosis, AOR 29.56; 95% CI: 1.33\u0026ndash;657.09, other diagnoses, AOR 19.75; 95% CI: 0.53\u0026ndash;732.20) reflect small cell sizes and should be interpreted with considerable caution. The protective effect of maintaining oxygen saturation above 90% (AOR 0.029) highlights the importance of rapid airway management and oxygen delivery at triage.\u003c/p\u003e \u003cp\u003eOnly 33.8% of critically ill patients were brought in by ambulance, with over half relying on taxis. This is a pattern observed across various Ethiopian ED mortality studies, indicating a persistent gap in pre-hospital care [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A key recommendation for the Ministry of Health\u0026rsquo;s directorate is to enhance EMS utilization through public awareness campaigns.\u003c/p\u003e \u003cp\u003eThis study presents several limitations that should be acknowledged. The retrospective chart review introduced selection bias and depended on the comprehensiveness of medical records. Variation in mortality cut-off definitions across studies (24, 48, and 72 hours) complicates direct comparisons. The focus group discussion involved solely postgraduate students at a single institution, potentially not fully representing frontline nursing or consultant viewpoints. Moreover, broad confidence intervals in the multivariable model, particularly for the renal diagnosis predictor, reflect small sample sizes and should be cautiously interpreted.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe 24-hour ED mortality rate at TASH significantly exceeds the national standard, primarily due to medical emergencies, mainly pulmonary sepsis. Early mortality, occurring within 6 hours, was associated with short symptom duration, cardiovascular and renal conditions, and decreased oxygen saturation levels. There is significant ambulance underutilization for critically ill patients. Immediate focus areas include implementing comprehensive sepsis training for all ED personnel, establishing sepsis protocols tailored to the local context, ensuring regular involvement of infectious disease specialists, and targeted acquisition of vital medications and monitoring devices. On a broader scale, the Ministry of Health should strengthen pre-hospital EMS systems and enhance public awareness regarding ambulance utilization for medical crises.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted odds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAVPU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlert, Voice, Pain, Unresponsive\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCrude odds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency department\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency medical services\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eETB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEthiopian birr\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFGD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFocus group discussion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow\u0026ndash;and middle\u0026ndash;income countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMOF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMultiorgan failure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eqSOFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQuick Sequential Organ Failure Assessment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRoad traffic accident\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSpO2\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeripheral oxygen saturation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPHMMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSaint Paul Hospital Millennium Medical College\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTASH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTikur Anbessa Specialized Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTEWS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTriage Early Warning Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e Ethical clearance was obtained from the Institutional Review Board of Addis Ababa University, College of Health Sciences. Informed oral consent was obtained from all focus group discussion participants. Quantitative data were extracted retrospectively from medical records; patient identifiers were not disclosed.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eNot applicable (no individual patient data, images, or videos are included).\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study was funded by Addis Ababa University, College of Health Sciences (AAU/CHS). Total study cost: ETB 25,725. The funder had no role in study design, data collection, analysis, interpretation, or manuscript preparation.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEndalamaw Wondimagegn conceived the study, collected and analyzed data, conducted the FGD, and drafted the manuscript.Gediyon Dereje contributed to study design, data collection, and critical revision of the manuscript Merahi Kefyalew and Demelash Gezahegn supervised the study design and provided critical revisions to the questionnaire and the manuscript. Endalamaw Wondimagegn is the guarantor of this work. All authors read and gave approval to the final thesis and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e The authors gratefully acknowledge the TASH Emergency Department staff and all focus group discussion participants for their contributions, and the Department of Emergency and Critical Care Medicine, Addis Ababa University, for facilitating this research. The supervisory support of Dr Merahi Kefyalew and Dr Demelash Gezahegn is also gratefully acknowledged.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials:\u003c/h2\u003e \u003cp\u003eThe data sets generated and analyzed during the current study are available from the corresponding author on reasonable request, subject to institutional approval from TASH.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEthiopian Hospital Services Transformation Guideline, Volume 1. Addis Ababa: Federal Ministry of Health; 2016.\u003c/li\u003e\n\u003cli\u003eObermeyer Z, Abujaber S, Makar M, Stoll S, Kayden SR, Wallis LA, et al. Emergency care in 59 low- and middle-income countries: a systematic review. Bull World Health Organ. 2015;93(8):577\u0026ndash;586G.\u003c/li\u003e\n\u003cli\u003eBurkholder TW, Hill K, Calvello Hynes EJ. Developing emergency care systems: a human rights-based approach. Bull World Health Organ. 2019;97(9):612\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eHirshon JM, Risko N, Calvello EJ, Stewart De Ramirez S, Narayan M, Theodosis C, et al. Health systems and services: the role of acute care. Bull World Health Organ. 2013;91(5):386\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eMesselu MA, Amlak BT, Mekonnen GB, Belayneh AG, Tamre S, Adal O, et al. Mortality and its determinants among patients attending in emergency departments. BMC Emerg Med. 2024;24(1):125.\u003c/li\u003e\n\u003cli\u003eYosha HD, Tadele A, Teklu S, Melese KG. A two-year review of adult emergency department mortality at Tikur Anbesa specialized tertiary hospital, Addis Ababa, Ethiopia. BMC Emerg Med. 2021;21(1):33.\u003c/li\u003e\n\u003cli\u003eStefanovski PH, Radkov VR, Ilkov LT, Tonchev PT, Mladenova YT, Manchev VK, et al. Analysis of mortality in the emergency department at a university hospital in Pleven. J Int Med Res. 2017;45(5):1553\u0026ndash;61.\u003c/li\u003e\n\u003cli\u003eMukhtar S, Saleem SG, Ali S, Khatri SA, Yaffee AQ. Standing at the edge of mortality: five-year audit of an emergency department of a tertiary care hospital in a low resource setup. Pak J Med Sci. 2021;37(3).\u003c/li\u003e\n\u003cli\u003eValli G, Galati E, De Marco F, Bucci C, Fratini P, Cennamo E, et al. In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission. Clin Exp Emerg Med. 2021;8(4):325\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eOlusegun-Joseph A, Akande O, Otrofanowei E, Nwoye E, Olopade O, Ajuluchukwu J. Medical mortality in an emergency department in Nigeria: the transition is obvious! Afr Health Sci. 2021;21(1):172\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eRukewe A, Fatiregun A, Okolo C, Ojifinni K, Akinola O, Nweke M. Emergency department deaths in a Nigerian University Hospital: deaths too many. West Indian Med J. 2015. Available from: https://www.mona.uwi.edu/fms/wimj/article/2041\u003c/li\u003e\n\u003cli\u003eDode W, Alemayehu G, Tebebe B, Getachew T, Tigistu S, Aklog E, et al. Pattern and predictors of mortality in emergency department of Saint Paul Hospital Millennium Medical College Addis Ababa, Ethiopia: retrospective study. Research Square; 2024;38(2). doi: 10.20372/ejhd.v38i.6367\u003c/li\u003e\n\u003cli\u003eHunchak C, Teklu S, Meshkat N, Meaney C, Puchalski Ritchie L. Patterns and predictors of early mortality among emergency department patients in Addis Ababa, Ethiopia. BMC Res Notes. 2015;8(1):605.\u003c/li\u003e\n\u003cli\u003eAbebe F, Habtamu A, Workina A. Risks of early mortality and associated factors at adult emergency department of Jimma University Medical Center. Open Access Emerg Med. 2023;15:293\u0026ndash;302.\u003c/li\u003e\n\u003cli\u003eMisganaw A, Mariam DH, Araya T, Ayele K. Patterns of mortality in public and private hospitals of Addis Ababa, Ethiopia. BMC Public Health. 2012;12(1):1007.\u003c/li\u003e\n\u003cli\u003eMisganaw A, Mariam DH, Araya T, Ayele K. Patterns of mortality in public and private hospitals of Addis Ababa, Ethiopia. BMC Public Health. 2012;12(1):1007.\u003c/li\u003e\n\u003cli\u003eMeara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569\u0026ndash;624.\u003c/li\u003e\n\u003cli\u003eCreswell JW, Plano Clark VL. Designing and Conducting Mixed Methods Research. 3rd ed. Thousand Oaks, CA: SAGE Publications; 2018.\u003c/li\u003e\n\u003cli\u003eCalvello EJ, Skog AP, Tenner AG, Wallis LA. Applying the lessons of maternal mortality reduction to global emergency health. Bull World Health Organ. 2015;93(6):417\u0026ndash;23.\u003c/li\u003e\n\u003cli\u003eRhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304\u0026ndash;77.\u003c/li\u003e\n\u003cli\u003eBaelani I, Jochberger S, Laimer T, et al. Availability of critical care resources to treat patients with severe sepsis or septic shock in Africa: a self-reported, continent-wide survey of anaesthesia providers. Crit Care. 2011;15(1):R10.\u003c/li\u003e\n\u003cli\u003eSchultz MJ, Dunser MW, Dondorp AM, et al. Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future. Intensive Care Med. 2017;43(5):612\u0026ndash;24.\u003c/li\u003e\n\u003cli\u003eBhatt M, Amalakumar L, Patel A, Mehta S. Point-of-care ultrasound in the management of septic shock in resource-limited settings: a systematic review. J Crit Care. 2020;57:212\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eTran A, Fernando SM, Brodie D, et al. Prognostic factors associated with mortality in patients with COVID-19 and sepsis. J Intensive Care Med. 2022;37(3):399\u0026ndash;407.\u003c/li\u003e\n\u003cli\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u0026ndash;57.\u003c/li\u003e\n\u003cli\u003eVon Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"emergency department mortality, sepsis, Ethiopia, Tikur Anbessa, predictors, pre-hospital emergency care, mixed methods","lastPublishedDoi":"10.21203/rs.3.rs-9469916/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9469916/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEmergency department (ED) mortality remains disproportionately high in low- and middle-income countries, posing a significant public health concern. In Ethiopia, the Ministry of Health defines ED mortality as death occurring within 24 hours of admission, excluding cases of dead-on-arrival, with a national target set below 0.6%. Despite this benchmark, local evidence on the prevalence and determinants of 24-hour ED mortality remains limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn explanatory sequential mixed-methods study was conducted at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia, from October 2024 to September 2025. The quantitative phase retrospectively analyzed all adult patients (aged\u0026thinsp;\u0026ge;\u0026thinsp;14 years) who died within 24 hours of ED admission, yielding a sample of 154 cases after necessary exclusions. Descriptive statistics and multivariable logistic regression were performed using SPSS version 25. A focus group discussion (FGD) involving nine emergency and critical care postgraduate students was subsequently conducted to elaborate on the predominant finding of sepsis as the primary cause of death, with results triangulated with the quantitative data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study revealed a 24-hour ED mortality rate of 1.13%, surpassing the national target, with medical causes accounting for 84.4% of deaths; sepsis contributed to 54.1%. Over a third (37.9%) of these deaths occurred very early, within 6 hours of admission. Multivariable logistic regression identified symptom duration of less than 12 hours, cardiovascular and renal diagnoses, and oxygen saturation above 90% as significant predictors of very early mortality. Factors such as delayed antibiotic initiation, insufficient monitoring, drug shortages, and overcrowding emerged from the FGD as key contributors to sepsis-related mortality.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe 24-hour ED mortality rate at TASH surpasses the national target, primarily driven by sepsis stemming from pulmonary sources. Urgent interventions are needed, including sepsis training for healthcare practitioners, institution-specific protocols, involvement of infectious disease physicians in daily rounds, and enhanced pre-hospital ambulance utilization. These results carry direct implications for the formulation of national Emergency Medical Services (EMS) policy.\u003c/p\u003e","manuscriptTitle":"The Magnitude of Adult Emergency Department Mortality and Associated Determinant Factors at a Tertiary Hospital, Addis Ababa, Ethiopia: A Mixed-Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-18 06:01:15","doi":"10.21203/rs.3.rs-9469916/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-14T14:49:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133392549797524282104301773612380797856","date":"2026-05-14T11:27:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249066648286044882915305630623554913291","date":"2026-05-12T14:36:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131430907070466536918211768280258285709","date":"2026-05-09T16:52:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152153251937423306088796226729819277292","date":"2026-05-08T03:01:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43516513057336522654302043211844551874","date":"2026-05-07T23:17:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261735209903493269333140505299168334912","date":"2026-05-07T14:05:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-07T12:40:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-28T10:19:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-24T17:55:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-24T17:54:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2026-04-20T09:15:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"242c8e27-1d23-49e2-bf5e-1a204045bca0","owner":[],"postedDate":"May 18th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-14T14:49:19+00:00","index":44,"fulltext":""},{"type":"reviewerAgreed","content":"133392549797524282104301773612380797856","date":"2026-05-14T11:27:28+00:00","index":43,"fulltext":""},{"type":"reviewerAgreed","content":"249066648286044882915305630623554913291","date":"2026-05-12T14:36:19+00:00","index":42,"fulltext":""},{"type":"reviewerAgreed","content":"131430907070466536918211768280258285709","date":"2026-05-09T16:52:13+00:00","index":41,"fulltext":""},{"type":"reviewerAgreed","content":"152153251937423306088796226729819277292","date":"2026-05-08T03:01:09+00:00","index":39,"fulltext":""},{"type":"reviewerAgreed","content":"43516513057336522654302043211844551874","date":"2026-05-07T23:17:10+00:00","index":38,"fulltext":""},{"type":"reviewerAgreed","content":"261735209903493269333140505299168334912","date":"2026-05-07T14:05:01+00:00","index":37,"fulltext":""},{"type":"reviewersInvited","content":"12","date":"2026-05-07T12:40:34+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T06:01:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-18 06:01:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9469916","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9469916","identity":"rs-9469916","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}