242 Emergency care in India: a retrospective cross-sectional analysis of national data (2019–2020)

<h3>Background</h3> Emergency medical conditions (EMCs) had a global impact of 14,035 disability-adjusted life years (DALYs) per 100,000 people in 2015, with low- and middle-income countries (LMICs) bearing the brunt. Studies in the most populous LMIC- India have found problems in Emergency Medicine (EM) training, personnel, and facilities. However, little emphasis has been placed on the EM department volumes and quality of care outside hospital-based trauma registries. <h3>Objective</h3> To understand the national EM systemic capacity in response to the burden, we study EM department (EMD) admissions and deaths against incidence, deaths, and DALYs of EMCs in India using data from the Health Management and Information System (HMIS) and Global Burden of Diseases (GBD). <h3>Methods</h3> In this retrospective cross-sectional analysis of HMIS and GBD data for 2019, we investigated the registrations and deaths in HMIS and used a previously known framework for defining EMCs from GBD. Capacity was proxied using rates of EMD admissions relative to all (in- and out-patient) admissions. Quality was proxied using rates of EM deaths relative to EM admissions and inpatient deaths. <h3>Results</h3> In 2019, nationwide, 119,103,358 EMD admissions resulted in 298,370 EMD deaths. HMIS-EMD admissions constituted 6.80% of total admissions, while EMCs comprised 27.22% of GBD causes; HMIS-EMD deaths were 45.88% of inpatient deaths, while 57.17% of all-cause deaths in GBD were EMCs deaths. Only 12.14% of HMIS-EMD cases had category-specific data, overlapping with 8.1% of GBD-EMCs. Nationally, poor HMIS-EMD registration was observed compared to GBD-EMCs Incidence Numbers. Manipur had a higher HMIS-EMD Registration Proportion with a lower GBD-EMCs Incidence Proportion, while Rajasthan with a lower HMIS-EMD Registration Proportion had a relatively higher GBD-EMCs Incidence Proportion. Haryana had a higher HMIS-EMD Death Proportion than GBD-EMCs Death Proportion, while Mizoram had a higher GBD-EMCs Death Proportion than HMIS-EMD Death Proportion. <h3>Conclusions</h3> EMCs accounted for a significant proportion of mortality and morbidity in India. However, these findings should be regarded with caution due to discrepancies in data reporting. Future research should focus on standardizing cause-specific case definitions and correcting for bias due to under-reporting in HMIS.