Proportion of Brought-in-Dead Cases among Patients presenting at the Emergency Department at a Tertiary Care Hospital in Kathmandu, Nepal

Abstract

Introduction: Brought dead (BID) cases, patients declared deceased upon arrival at a health facility before receiving any medical care, represent a significant yet underexplored indicator of emergency system performance. Despite their frequency, there is limited research linking BID cases to deficiencies in prehospital emergency care (PHEC), a system that remains largely underdeveloped in Nepal.

Methods: This is a cross-sectional study was conducted at Tribhuvan University Teaching Hospital (TUTH) in Kathmandu. Phase I involved a retrospective analysis of 322 BID cases (2017–2019). Follow up162 by telephone interviews with bereaved families. Phase II analyzed BID - records from 2019–2022 (n=509). Survey data explored health-seeking behaviour, ambulance use, and emergency response knowledge.

Results: From 2019–2022, BID cases accounted for 45.1% of all emergency department deaths at TUTH with SD 21.65 years; male (57%); arrived via informal transport (59%) and no participants reported using the national emergency number (102) to initiate an ambulance response. Public awareness of first aid and emergency procedures was minimal. BID cases
were reported from both within and outside Kathmandu, with wide variability in travel times. In 86% of cases, no cause of death was documented.

Conclusions: The notably high levels of BID patients witnessed at TUTH highlight critical gaps in Nepal’s prehospital emergency care, including poor public awareness, inadequate ambulance utilisation and systemic delays. Addressing these challenges through improved public education, emergency response infrastructure and accessible PHEC could reduce avoidable prehospital deaths and improve emergency care outcomes.