OpenUCT :: Browsing by Author "Hendrikse, Clint"

Browsing by Author "Hendrikse, Clint"

Now showing 1 - 12 of 12

Open Access
Access to acute stroke care: a description of stroke patients' journey to a district hospital
(2024) O'Meara, Ryan Mark; Hendrikse, Clint; Ganas, Ushira
Introduction The burden of stroke in Africa has increased in the last two decades, with the population undergoing a rapid epidemiological transition, with a rise in the incidence of stroke risk factors together with the gradual aging of the population. Evidence-based guidelines for acute stroke care are often not feasible in resource challenged settings but even when resources are available, considerable delays to definitive care exists. This study aims to describe the factors that influence time from symptom onset to hospital arrival in patients that present to a district level hospital Emergency Centre with confirmed ischaemic strokes. Methods A descriptive analysis was performed using retrospective folder and database review. All adult patients with a confirmed ischaemic stroke presenting to Mitchells Plain Hospital Emergency Centre during the study period of 12 months (1st of January 2019 to 31st of December 2019), were eligible for inclusion. Data were collected from existing electronic patient databases and the time from onset of symptoms to hospital arrival was extracted from the clinical notes. Results A total of 730 (2%) patients presented with a diagnosis of stroke, of which 381 (52%) were included (CT confirmed ischaemic strokes). Only 48 (13%) presented within 4.5 hours of symptom onset and the median time from onset of symptoms to presentation to the hospital was 24 hours (IQR 12-72 hours). The majority of patients (31%) arrived via a primary public emergency medical service (EMS) call, while 29% presented directly to the hospital as self-referrals with private transport. Primary public EMS calls had the shortest call-to-hospital-arrival time (1 hour and 31 minutes), even though the median time from symptom onset to hospital arrival was still 16 hours. Conclusion The median time from symptom onset to hospital arrival for patients with stroke symptoms is much longer than what evidence-based guidelines suggest. The chain of survival for emergency stroke care is only as strong as its weakest link and the data from this study suggest that improvement campaigns should target stroke education and access to care.
Open Access
Adherence to and effectiveness of guidelines for routine investigations of adult patients with mental and behavioural disturbances
(2023) Jere, Solomon; Hendrikse, Clint
Background The process of medical clearance aims to exclude a general medical condition as an underlying cause for the mental and behavioural disorder and involves routine screening with special investigations. Mitchells Plain District Hospital's emergency centre follows the Western Cape Provincial guidelines when screening for general medical conditions in these patients. Adherance and effectiveness of these guidelines is unknown. Aim This study aimed to determine the effectiveness of and adherance to the Western Cape Provincial guidelines for routine investigations of adult patients with mental and behavioural disturbances presenting to a district level emergency centre. Methods This descriptive study was conducted at Mitchells Plain Hospital in Cape Town, South Africa. Data was collected from existing electronic registries over a 6-month period. Adult mental health care users were risk stratified into the probability of having a general medical condition according to provincial guidelines and the results of their special investigations were described against their outcome. Results Of the 688 patients included in this study, 66% had abnormal vital signs and of the 312 patients who received special investigations, 56% were abnormal, including 18% who were clinically significantly abnormal. Abnormal special investigations changed the clinical outcome for 3 (<1%) patients. Adherence to the provincial guidelines was reasonable (82%) but non-adherence resulted in numerous unnecessary investigations. Conclusion The results of this study support the existing evidence that clinical assessment and clinician gestalt should guide the need for special investigations and that there is no benefit to routine screening in the EC. The results also demonstrate reasonable adherence to the current guidelines even though this rarely changed patients' outcome. Decisions were based on clinical findings and clinician gestalt, and not abnormal special investigations or vital signs – which were both prevalent.
Open Access
An assessment of emergency care capacity at hospitals in Harare Metropolitan: A descriptive cross-sectional study
(2025) Deka, Prince; Hodkinson, Peter; Hendrikse, Clint
Objectives of literature review. The literature review aims to: To describe Zimbabwe's country profile, highlighting key demographic, economic, and social factors impacting its healthcare system. To describe the evolution of emergency medicine in Africa, emphasising the contextual factors derailing its development in Zimbabwe. To give an overview of African EC systems, focusing on Zimbabwe's unique challenges and advancements. To discuss the significance of and tools for appraising EC systems.
Open Access
Attrition amongst Emergency Medicine Registrars in the Western Cape: an exploration of contributing factors
(2018) Van Koningsbruggen, Candice Ann; Geduld, Heike; Hendrikse, Clint
Background. Attrition of registrars impedes the development of Emergency Medicine (EM) in South Africa and Africa, which negatively affects health systems strengthening. Factors relating to attrition of registrars in the EM training program in the Western Cape had not previously been explored. Understanding these factors will enable the development of a framework to be used to conduct formal exit interviews. This exit interview will allow the Division to continually document and address factors related to attrition. Objectives. To explore the factors contributing towards attrition amongst EM Registrars in the Western Cape, to enable a framework for a formal exit interview to be developed. Methods. An explorative qualitative study was conducted using semi-structured interviews. Data was analysed using NVivo software and thematic qualitative analysis. Results. Seven participants were interviewed (5 female and 2 male; ages 28-33). They joined the EM training program at different times (2005-2013) and their time spent in the program varied (8 months to 20 months). Despite their diverse histories, they voiced similar concerns regarding the training program (i.e. lack of support, unsociable hours), regarding relationships (i.e. motherhood, family time), and also with regards to self (i.e. burnout, work-life balance). Conclusion. This study highlights the need for a formal exit interview to address attrition in the Division of EM. The framework for the exit interview should encompass factors related to self, relationships and the training program.
Open Access
Computed tomography (CT) head studies in a district emergency department: a focused study of CT related imaging and analysis of current practice
(2022) Lesar, Ursula; Hendrikse, Clint; Vallabh, Kamil
Introduction: The South African population has a significant emergency burden of disease. In South Africa, immediate access to computed tomography (CT) imaging may not always be available. Globally, the number of all imaging studies is increasing annually. Due to access challenges patients requiring CT head imaging needs to be carefully selected to ensure safe management and discharge. Patient demographics, clinical presentation and type of expected emergency pathology known about this population will assist the emergency physician in making appropriate management decisions. Methodology: This study was conducted in two parts: a literature review and a retrospective, descriptive analysis conducted at Mitchells Plain Hospital, Cape Town, exploring the type and prevalence of pathology identified by CT head imaging in the emergency department. Data for the descriptive study was collected over a one-year period and the demographics, indications and reported pathology were described for all CT head requests in the emergency department. Statistically significant differences between groups were calculated using the Chi-squared test, depending on the sample characteristics. Statistical significance was defined as p-value <0.05. Results: There was a male predominance (57%) in this study with the most common comorbidity being hypertension. The cumulative yield of pathology was identified at 58% on imaging (new pathology 40% and existing pathology 18%). Stroke (32%), trauma (30%) and seizures (16%) were the most common indications for imaging with a yield per indication of 54%, 48% and 20% respectively. The most common imaging finding across all categories was an ischaemic stroke. Stroke indicated CT head imaging pathology demonstrated ischaemic (19%) to haemorrhagic (3%) stroke pathology. The most common finding on a trauma indicated CT head was an ischaemic stroke (13%). Seizure indicated CT head imaging demonstrated 18% with new pathology and 36%that had existing pathology. Emergency imaging was performed on average under seven hours post consultation. Conclusion: Acquiring CT head imaging in a resource limited setting requires appropriate clinical history, examination as well as awareness of the most prevalent pathology of the community the doctor is treating. Even though yield of pathology was considered high when compared to HIC there was similarity in yield to local and international LMICs. Stroke, trauma and seizures are common indications for imaging in the South African setting with the most common pathology identified to be an ischaemic stroke.
Open Access
Prehospital advanced airway management practices by advanced life support providers: A retrospective observational study of emergency medical service providers in South Africa
(2020) Burke, Jan; Hendrikse, Clint; Wylie, Craig
Introduction: The skill of endotracheal intubation to achieve a definitive airway for critically ill and injured patients in the prehospital setting is frequently performed by advanced life support providers. Several methods may be utilised, including intubation without the use of medication, the use of sedatives or a rapid sequence intubation. There is a paucity of data available that assesses prehospital advanced airway intubation practices in South Africa. The aim of this study is to describe the advanced airway management practices of advanced life support providers across South Africa. Methods: A retrospective, observational study method was used (chart review). Electronic patient care records were sourced from private and public emergency medical services companies and collated accordingly. Results: A total of 704 cases were included. Intubation during cardiac arrest was the most common approach to airway management (n=280, 40%) followed by rapid sequence intubation (n=202, 28%), medication-facilitated intubations (n=152, 22%) and a nomedication approach (n=70, 10%). Successful intubation using an endotracheal tube was reported in 197 (98%) of rapid sequence intubation cases, 134 (88%) of the medication facilitated cases, 61 (87%) of no-medication cases and 228 (81%) of cardiac arrest cases. A first-pass success rate was described in 260 (79%) cases, with the cardiac arrest group having a first-pass success of 85%, followed by the rapid sequence intubation group (83%), the nomedication group (71%) and the medication facilitated group (61%). Hypotension and cardiac arrest were the most common adverse events. A total of 496 (70%) patients were alive at hospital handover. The average scene time and transportation time was 42 minutes and 24 minutes respectively for the rapid sequence intubation group, 42min and 27min for the medication facilitated group, 44min and 25min for the no-medication group and 57min and 16min for the cardiac arrest group. Discussion: The study described the prehospital airway management practices by advanced life support providers in South Africa. Rapid sequence intubation had the highest endotracheal intubation success rate overall and the lowest prevalence of adverse events. There was no statistical difference in survival between the rapid sequence intubation, medication facilitated and no-medication group. Due to a lack in standardised treatment guidelines, differences in fluid administration, post-intubation care, confirmation of placement and ventilation were noted. No standard approach to record keeping was found, with the quality of patient care records being variable. A standardised advanced airway management report would be beneficial as it would improve the quality of data recorded and allow for better comparisons to be made.
Open Access
The availability of acute care resources to treat major trauma in different income settings: a self-reported survey of acute care providers
(2019) Alibhai, Alyshah Zulfikar; Bruijns, Stevan R; Hendrikse, Clint
Introduction: Injury and violence is a neglected global health problem, despite being largely predictable and therefor preventable. This study aimed to indirectly describe and compare the availability of resources to manage major trauma between high income, and low- to middle-income countries, as self-reported by delegates at the 2016 International Conference on Emergency Medicine held in Cape Town, South Africa. Materials and methods: A survey was distributed to delegates at the International Conference on Emergency Medicine 2016, Cape Town to achieve the study aim. The survey instrument was based on the 2016 NICE guidelines for the management of patients with major trauma. It captured responses from participants working in both pre- and in hospital settings. Responses were grouped according to income group (either high income, or low- to middle-income) based on the responding delegate’s nationality (using the World Bank definition for income group). A Fisher’s Exact test was conducted to compare delegate responses Results: The survey was distributed and opened by 980 delegates, of whom 392 (40%) responded. A total of 206 (53%) respondents were from high-income countries and 186 (47%) were from low- to middle-income countries. Responders of this self-reported survey described a significant discrepancy between the resources and services available to high income countries s and low- to middle-income countries to adequately care for major trauma patients both pre- and in-hospital. Shortages ranged from consumables to analgesia, imaging to specialist services, pre-hospital to in-hospital. Discussion: Resource restriction is a major concern in the care for major trauma patients in low- to middle-income countries. Current accepted reference standards does not take the resource restrictions that apply to the vast majority of the world’s injured patients into account. More research is required to describe the problem of resource restrictions in low to middle-income countries, and then working out how to overcome it.
Open Access
The association between length of emergency department boarding and hospital length of stay for patients with mental health and behavioural disorders
(2022) Hendrikse, Clint; Van Hoving, D J; Hodkinson, Peter W
Background Psychiatric boarding in Emergency Departments is a global challenge. Patients with mental and behavioural disturbances are disproportionally affected with boarding times up to three times longer than other patients. This retrospective cross-sectional study investigated the impact of an initiative to reduce psychiatric boarding on length of stay and readmission rate, as well as exploring the relationship between boarding times and length of stay. Methods All adult patients referred over a 24-month period (June 2017 – May 2019) for psychiatric admission from the Emergency Department of a Cape Town district hospital were included. This included a 9-month period prior to the initiative, after which inpatient capacity was increased, and inpatient hallway boarding was implemented. Data relating to admission processes and outcomes were extracted from electronic registries. Results In total, 2607 patients were referred for psychiatric admission (2.7% of all Emergency Department patients). The initiative was associated with a decrease of 95% (56 vs 3 hours, p24-hour boarding category (351 vs 360 hours, p=0.047). The readmission rate increased from 12% to 18% post intervention. Conclusion A significant improvement in hospital length of stay and psychiatric boarding times occurred after the initiative was implemented. The benefits should be weighed up against a subsequent higher readmission rate. From a lean- and economical perspective, the results of this study suggest that psychiatric boarding equates to waste as it is independent of ward length of stay. The observational nature of this study precludes concrete conclusions and further investigations into psychiatric inpatient hallway boarding are recommended.
Open Access
The burden of firearm injuries at two district level emergency centres in Cape Town, South Africa: a descriptive analysis
(2022) Bush, Luke Anthony; Evans, Katya; Hendrikse, Clint; Van Koningsbruggen, Candice
Introduction Firearm injuries account for an increasingly significant portion of violence related trauma experienced in South Africa. The related burden on district level emergency care, surgical and inpatient services is poorly described. This research aims to provide epidemiological and health service data on patients sustaining firearm injuries presenting at Mitchells Plain Hospital and Heideveld Emergency Centre. The research also assesses the association of the Triage Early Warning Score with anatomical location of injury, the need for surgical intervention and mortality. A geographical analysis of incident location with respect to home address has also been undertaken. Methods All patients who presented to these emergency centres with a firearm injury over a 12-month period (1 Jan 2019 – 31 Dec 2019) were eligible for inclusion in a retrospective chart review. Results Seven-hundred-and-seventy-six firearm injuries were analysed with those injured having a mean age of 27 years and 91% of those injured being male. Sixty-seven percent of patients self-presented and there were 18 deaths in the emergency centre and a further 23 as an inpatient. The Triage Early Warning Score and Shock Index both showed statistical significance when comparing those not surviving to hospital discharge against those that did survive (p<0.01). Discussion Firearm injuries represented 5.7% of all trauma seen at these two facilities and likely form a higher proportion of the injury profile than at other district services in the City of Cape Town. Although a significant number of those injured are transferred out to tertiary centres that are better capacitated to manage these injuries, many remain at district level for their care. Conclusion Firearm injuries, the immediate surgical needs of those injured and the long-term consequence of those injuries pose a significant burden on limited healthcare resources. Multi-sectoral action, supported by evidence-based primary and secondary preventative strategies, is required to reduce this intentional injury burden, and mitigate the effects.
Open Access
The prevalence of atrial fibrillation in patients with ischaemic stroke in a district hospital in the Western Cape
(2019) Mayet, Mohammed; Hendrikse, Clint; Vallabh, Kamil
Background Cerebrovascular disease remains one of the leading causes of morbidity and mortality globally. In South Africa, cerebrovascular disease was the fourth leading cause of death in 2016, responsible for 5.1 % of all deaths - the leading cause of death in individuals 65 years and older. Atrial fibrillation accounts for 15% of all strokes and a 25% of patients with AF-related stroke have this arrhythmia diagnosed at the time of the stroke. Objectives This study sets out to determine the prevalence of atrial fibrillation in patients with ischaemic stroke, as confirmed on CT scan, at a district level hospital in the Western Cape, South Africa. Methods This descriptive study was conducted at Mitchell’s Plain Hospital in Cape Town and data was collected over a year. Patients diagnosed with a stroke were identified from an electronic patient register and relevant radiology and clinical data was sourced retrospectively. The diagnosis of ischaemic stroke was confirmed by a CT scan report and ECGs were independently screened by two Emergency Physicians. Categorical data was described in percentages and descriptive statistics. Continuous variables were described by median and interquartile range (IQR). Statistical significance is defined as a p< 0.05. Categorical data was compared using the Fisher’s exact test. This project has been approved by UCT Human Research Ethics Committee [790/2018]. Results The proportion of adult patients with a diagnosis of stroke was 2%. Of those, 64% had ischaemic strokes, 9% had intracranial bleeds, 20% did not have a CT scan and 7% had stroke mimics. 11% of all participants with ischaemic stroke had atrial fibrillation, 67% of those presumed new. A total of 90 (22%) of all participants with ischaemic stroke was less than 51 years of age. The mortality rate was statistically higher in patients who had AF. Conclusion The results from this study suggests that screening practices to detect both Atrial Fibrillation in asymptomatic patients, as well as in those with an ischaemic stroke, are not effective. With the increasing population life expectancy, and prevalence of cardiovascular disease, the prevalence of AF and its complications will increase. Since the risk of stroke related to AF can be reduced significantly by oral anticoagulation, further studies should aim to explore barriers and challenges to effective screening.
Open Access
The prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis
(2024) Raghubeer, Nishen; Hendrikse, Clint; Lahri, Sa'ad
Introduction: Pulmonary embolism represents the third leading cause of mortality globally after myocardial infarction with an overall mortality of 30%. ECG findings may play a valuable role in the prognostication of patients with PE, with various ECG abnormalities proving to be reasonable predictors of haemodynamic decompensation, cardiogenic shock, and even mortality. This study aims to assess the prognostic value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism, as diagnosed with computed tomography pulmonary angiogram. Method: This was a retrospective cohort design study based at Tygerberg Hospital, Cape Town, South Africa. Eligible patients were identified from all CT-PA performed between 1 January 2017 and 31 December 2019. The ECGs were independently screened by two blinded emergency medicine physicians for predetermined signs that are associated with right heart strain and higher pulmonary artery pressures, and these findings were analysed to in-hospital mortality. Results: Of the included 81 patients, 61 (75%) were female. Of the 41 (51%) patients with submassive PE and 8 (10%) with massive PE, 7 (17%) and 3 (38%) suffered inpatient mortality (p=0.023) respectively. Univariate ECG analysis revealed that complete right bundle branch block (OR, 8.6; 95% CI, 1.1 to 69.9; p=0.044) and right axis deviation (OR, 5.6; 95% CI, 1.4 to 22.4; p=0.015) were significant predictors of inpatient mortality. Conclusion: Early identification of patients with pulmonary embolism at higher risk of clinical deterioration and in-patient mortality remains a challenge. Even though no clinical finding or prediction tool in isolation can reliably predict outcomes in patients with pulmonary embolism, this study demonstrated two ECG findings at presentation that were associated with a higher likelihood of inpatient mortality. This single-centre observational study with a small sample precludes concrete conclusions and a large follow-up multi-centre study is advised.
Open Access
The value of shock index, modified shock index and age shock index to predict critical outcomes in a district level emergency centre
(2023) Aleka, Patrick; Hendrikse, Clint
Introduction Triage is the first and single most important step in patients' journey through an Emergency Centre (EC) and directly impacts the time to critical actions. Vital signs influence triage decisions, predict hospital admission and in-hospital mortality. The shock index (SI), modified shock index (MSI) and age shock index (ASI) are clinical markers derived from vital signs and correlate with tissue perfusion in critically ill patients. This study aimed to assess the value of SI, MSI and ASI to predict critical outcomes in all adult patients presenting to a district level emergency centre in South Africa. Methods This diagnostic study was performed as a retrospective observational study, using data from an existing electronic database at a district level hospital emergency centre over a period of 24 months. All adult patients who presented to Mitchells Plain Hospital were eligible for inclusion. Sensitivity, specificity and likelihood ratios were calculated for each variable as a predictor of critical outcomes with pre-determined thresholds. Results During the study period of 24 months, a total of 61 329 patients ≥ 18 years old presented to the EC with 60 599 included in the final sample. A red SATS triage category (+LR = 7.2) and SI ≥1.3 (+LR = 4.9) were the only two predictors of critical outcomes with any significant clinical value. The same two markers performed well for both patients with trauma and without trauma and specifically for patient who died while under the care of the emergency centre. Discussion The study demonstrated that patients with a SI≥1.3 have a significantly higher likelihood of having a critical outcome, whether the presenting complaint is trauma related or not, especially to predict mortality while under the care of the EC. Incorporating this marker as triage alerts could expedite the identification of patients with critical outcomes and improve patient throughput in the emergency centre.

Browsing by Author "Hendrikse, Clint"

Results Per Page

Sort Options