A total of 893 articles were extracted, 22 articles were duplicate which were removed before screening. One hundred fifty (150) articles were included in the review out of 871 following the eligibility criteria Fig. 1.
A total of 871 articles were included out of which 531 dint meet the inclusion criteria on initial review, further more articles were excluded on reviewing the title, abstract and full text accounting to 40, 102 and 48 respectively consequentially 150 articles were finalized.
*n = total number
Table 2 demonstrates the quality of 19 included case reports published in ED of Pakistan from 2012 to 2021. From 2014 to 2017, all reports (n = 9) are rated as moderate however rest of the reports majorly reported as moderate but 3 reports were classified as strong in the year 2021 (n = 5) while in 2020 (n = 5) only 1 fell in the aforementioned category and a single report is considered weak. The focus areas of the case reports comprise of various specialties but Neurology (n = 4) and Infectious Diseases (n = 5) had the utmost publications while others had limited reports.
Table 3
Quality of Studies published in Emergency Departments of Pakistan.
Area of study/Theme | Study design | Quality of Publication | Year of publication |
Internal Medicine | Cross-sectional | Moderate | 2018 |
Quality/ internal medicine | Cross-sectional | Strong | 2017 |
Internal Medicine / EMS | Cross-sectional | Moderate | 2017 |
Infectious Disease | Cross-sectional | Strong | 2017 |
Trauma | Cross-sectional | Moderate | 2017 |
Internal Medicine | Cross-sectional | Moderate | 2017 |
Neurology / Pharmacology | Cross-sectional | Moderate | 2017 |
EMS, Psychiatry | Cross-sectional | Moderate | 2017 |
Psychiatry | Cross-sectional | Moderate | 2016 |
Trauma | Cross-sectional | Moderate | 2015 |
Psychiatry | Cross-sectional | Moderate | 2015 |
Trauma | Cross-sectional | Moderate | 2015 |
Toxicology | Cross-sectional | Moderate | 2015 |
Mass Hospital Care | Cross-sectional | Moderate | 2015 |
EMS | Cross-sectional | Moderate | 2014 |
Emergency Medicine | Cross-sectional | Moderate | 2014 |
Triaging System | Cross-sectional | Moderate | 2014 |
Infectious diseases | Cross-sectional | Moderate | 2014 |
Toxicology | Cross-sectional | Moderate | 2014 |
Psychiatry | Cross-sectional | Moderate | 2014 |
Pediatric/infectious disease | Cross-sectional | Moderate | 2014 |
Infectious Disease | Cross-sectional | Moderate | 2013 |
Pediatric/infectious disease | Cross-sectional | Moderate | 2013 |
Infectious disease | Cross-sectional | Moderate | 2013 |
Infectious disease | Cross-sectional | Moderate | 2013 |
Infectious disease | Cross-sectional | Moderate | 2013 |
Infectious disease | Cross-sectional | Moderate | 2013 |
Infectious disease | Cross-sectional | Moderate | 2013 |
Infectious disease | Cross-sectional | Moderate | 2013 |
Infectious disease / Pediatric | Cross-sectional | Moderate | 2012 |
Infectious disease | Cross-sectional | Moderate | 2012 |
Infectious disease | Cross-sectional | Moderate | 2012 |
Infectious disease | Cross-sectional | Moderate | 2012 |
Infectious disease | Cross-sectional | Moderate | 2012 |
Infectious disease / Pediatric | Cross-sectional | Moderate | 2020 |
Infectious disease | Cross-sectional | Moderate | 2020 |
Infectious disease | Cross-sectional | Strong | 2020 |
Infectious disease | Cross-sectional | Moderate | 2020 |
Infectious disease | Cross-sectional | Moderate | 2020 |
Patient care | Cross-sectional | Moderate | 2017 |
Emergency Management | Cross-sectional | Moderate | 2016 |
EMS | Cross-sectional | Moderate | 2016 |
Internal Medicine | Cross-sectional | Moderate | 2019 |
Neurology | Cross-sectional | Weak | 2019 |
Neurosurgery | Cross-sectional | Weak | 2018 |
Pulmonology / ID | Cross-sectional | Strong | 2021 |
Pulmonology / ID | Cross-sectional | Moderate | 2021 |
Infectious Disease / Nephrology | Cross-sectional | Moderate | 2021 |
Infectious Diseases/ Pharmacology | Cross-sectional | Moderate | 2021 |
Pulmonology / Infectious Disease / Psychiatry | Cross-sectional | Moderate | 2021 |
Infectious Disease | Cross-sectional | Moderate | 2021 |
Psychiatry | Cross-sectional | Moderate | 2019 |
Infectious Disease | Cross-sectional | Moderate | 2020 |
Toxicology | Cross-sectional | Moderate | 2020 |
Pulmonology / Infectious Disease | Cross-sectional | Moderate | 2020 |
Cardiology | Cross-sectional | Moderate | 2020 |
Pediatric | Cross-sectional | Moderate | 2020 |
Infectious Disease / Pulmonology | Cross-sectional | Moderate | 2020 |
Rabies vaccine / infectious Disease | Cross-sectional | Moderate | 2016 |
Infectious Disease | Cross-sectional | Moderate | 2020 |
Antibiotic stewardship | Cross-sectional | Weak | 2020 |
Internal Medicine | Cohort | Moderate | 2017 |
Infectious Disease/pediatric | Cohort | Moderate | 2016 |
Cardiology | Cohort | Moderate | 2016 |
Pediatric Oncology | Cohort | Moderate | 2016 |
Trauma | Cohort | Moderate | 2015 |
Pediatrics Medicine | Cohort | Moderate | 2015 |
Intensive Care / Pediatrics. | Cohort | Moderate | 2015 |
Emergency/internal medicine | Cohort | Moderate | 2013 |
Pediatrics / infectious diseases | Cohort | Moderate | 2012 |
Pediatrics / infectious diseases | Cohort | Moderate | 2012 |
Pediatrics / infectious diseases | Cohort | Moderate | 2018 |
Pediatrics / infectious diseases | Cohort | Moderate | 2018 |
Pediatrics / infectious diseases | Cohort | Moderate | 2020 |
Pediatrics / infectious diseases | Cohort | Moderate | 2020 |
Trauma checklist In Emergency Department. | Cohort | Moderate | 2016 |
Internal Medicine | Cohort | Moderate | 2018 |
Environment/neurology | Case control | Moderate | 2015 |
Environment/oncology | Case control | Moderate | 2013 |
Environment/oncology | Case control | Moderate | 2013 |
Environment/pulmonology/ pediatric | Case control | Strong | 2020 |
Environment/oncology | Case control | Weak | 2019 |
Sepsis/pediatric | Randomized controlled trial | Moderate | 2013 |
Sepsis/pediatric | Randomized controlled trial | Moderate | 2013 |
Sepsis/pediatric | Randomized controlled trial | Moderate | 2020 |
Sepsis/pediatric | Randomized controlled trial | Moderate | 2020 |
Sepsis/pediatric | Randomized controlled trial | Moderate | 2020 |
Sepsis/pediatric | Randomized controlled trial | Moderate | 2020 |
Sepsis/pediatric | Randomized controlled trial | Strong | 2021 |
Obstetrics | Randomized controlled trial | Moderate | 2020 |
Violence and Trauma | Mixed Method | Moderate | 2021 |
Ethics | Qualitative | Moderate | 2015 |
Internal Medicine | Commentary | Moderate | 2017 |
Triaging | Commentary | Strong | 2017 |
Internal Medicine /Obstetrics | Commentary | Moderate | 2016 |
Pediatrics/ Emergency | Commentary | Moderate | 2016 |
Pediatrics/ Emergency | Commentary | Moderate | 2016 |
Emergency Medicine | Commentary | Moderate | 2016 |
Research | Commentary | Moderate | 2014 |
Research | Commentary | Strong | 2014 |
Ethics and Practices | Commentary | Moderate | 2016 |
Internal Medicine | Commentary | Moderate | 2016 |
Pediatrics | Commentary | Moderate | 2021 |
Infectious Diseases | Commentary | Moderate | 2020 |
Internal Medicine | Prospective Study | Weak | 2021 |
Urology | Prospective | Weak | 2020 |
Pulmonology | Prospective test validation study | Moderate | 2018 |
Delay admission from Emergency Department | Retrospective | Moderate | 2016 |
Trauma/ Pediatrics | Retrospective | Moderate | 2017 |
Traumatic Brain Injury | Retrospective observational | Moderate | 2015 |
Emergency/internal medicine | Retrospective study | Moderate | 2014 |
Toxicology | Retrospective, case series | Moderate | 2013 |
Emergency medicine | Retrospective Study | Moderate | 2013 |
Emergency/internal medicine | Retrospective study | Strong | 2020 |
Endocrinology / Internal Medicine | Retrospective study | Moderate | 2019 |
Traumatic Brain Injury | Retrospective study | Weak | 2019 |
Patient flow and crowding in Emergency Department | Retrospective study | Weak | 2019 |
Cardiology | Clinical Audit | Moderate | 2015 |
Psychology | Communication | Weak | 2017 |
Leadership/Emergency Medicine | Communication | Weak | 2017 |
Infectious diseases | Review | Moderate | 2016 |
Research in ED | Review | Moderate | 2015 |
Internal medicine | Review | Strong | 2020 |
Infectious diseases | Survey | Moderate | 2019 |
Cardiology | Survey | Weak | 2020 |
Table 3 shows 61 cross-sectional studies from the year 2012 to 2021. Commencing from 2012 to 2016 (n = 29) are moderate in quality, conjointly. But in 2017 (n = 8) 2 studies were rated as strong, so was a single study in each year 2020 (n = 13) and 2021 (n = 6) whereas, only one study each for the years 2019 (n = 3), 2018 (n = 2) and 2020 were reported weak while all others were ranked moderate. With respect to the area of the study, almost one-fourth (n = 27) cross sectional studies encompasses the theme of Infectious Diseases followed by Psychiatry (n = 5), Pulmonology (n = 5) and Internal Medicine (n = 4) nevertheless cardiology and EMS accounting to sole article each; however due to inadequate data set ambiguity would pertain.
Data further demonstrates 16 Cohort Studies published from 2012 to 2018 however it was observed that none were published from 2019 to 2021, nonetheless all published studies rated as moderate quality-wise. The themes show various specialities (Internal Medicine, toxicology, cardiology, oncology, trauma, Intensive care) however the theme to have dominance was infectious diseases especially in the pediatric population (n = 7).
Meanwhile, 5 case control studies were held in the succeeding years; 2013 has two publications whereas rest of the years had single study each i.e. 2015, 2019 and 2020. According to the quality assessment, a singular study was put in each group of strong and weak respectively yet rest of the studies are moderately ranked. All of these studies were investigating environmental exposures and its effects on the population.
There were 8 Randomised control trials (RCTs), 2 published in 2013, 5 in 2020 and only 1 in 2021, the latter is categorized as strong in reference to quality, remaining all are moderate. The themes are all related to effectiveness of different treatments for sepsis in children except one trial, which is related to obstetrics.
There was a single study in category of mix-method study published in 2021 and qualitative study in 2015, both are ranked moderate in quality. As far as the area of study is concerned, the former was pertinent to Violence and trauma however the latter has relevance to ethics.
The rest of the data highlights 33 different categories of publications, including commentary (n = 12), prospective study (n = 3), retrospective (n = 10), clinical audit (n = 1), communication (n = 2), review (n = 3) and survey (n = 3) published from 2013 to 2021. Regarding the quality of these publications, 4 are categorized as strong, 7 as weak and remaining as moderate. As per the themes, a subtle influence of research (n = 3), Infectious disease (n = 3) and a few topics directly and indirectly related to emergency medicine (n = 6).