Original Research

What presents to a rural district emergency department: A case mix

Nadishani T. Meyer, Gareth D. Meyer, Charles B. Gaunt
African Journal of Primary Health Care & Family Medicine | Vol 12, No 1 | a2275 | DOI: https://doi.org/10.4102/phcfm.v12i1.2275 | © 2020 Nadishani T. Meyer, Gareth D. Meyer, Charles B. Gaunt | This work is licensed under CC Attribution 4.0
Submitted: 17 October 2019 | Published: 28 July 2020

About the author(s)

Nadishani T. Meyer, Jabulani Rural Health Foundation, Mqanduli, South Africa; and, Zithulele Hospital, Mqanduli, South Africa
Gareth D. Meyer, Zithulele Hospital, Mqanduli, South Africa
Charles B. Gaunt, Zithulele Hospital, Mqanduli, South Africa

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Background: There is little information available on the range of conditions presenting to generalist run rural district hospital emergency departments (EDs) which are the first point of acute care for many South Africans.

Aim: This study aims to assess the range of acute presentations as well as the types of procedures required by patients in a rural district hospital context.

Setting: Zithulele is a 147-bed district hospital in rural Eastern Cape.

Methods: This is a cross-sectional study assessing all patients presenting to the Zithulele hospital emergency department from 01 October 2015 to 31 December 2015. Data collected included the triage acuity using the South African Triage Scale system, patient demographics, diagnosis, outcome and procedures performed. Diagnoses were coded retrospectively according to the international statistical classification of diseases and related health problems version 10 (ICD 10).

Results: Of the 4 002 patients presenting to the ED during the study period, 2% were triaged as emergencies and 45% as non-urgent. The most common diagnostic categories were injuries, infections and respiratory illnesses respectively. Diagnoses from all broad categories of the ICD-10 were represented. 67% of patients required no procedure. Diagnostic procedures (n = 877) were more prevalent than therapeutic procedures (n = 377). Only 2.4% of patients were transferred to a referral centre acutely.

Conclusion: Patients with conditions from all categories of the ICD-10 present for management at rural district hospitals. Healthcare professionals working in this setting need to independently diagnose and manage a wide range of ED presentations and execute an assortment of procedures.


case mix; rural hospital emergency department; rural health; rural medicine; Specialist Emergency Medicine


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