A national study of patients who LWBS in the United States found an overall LWBS proportion of 1.7%[10], but proportions reported at individual institutions within the United States have ranged from

0.84% to 15%[11,12]. In multiple reviews, the lowest LWBS proportion reported was 0.1% in Taiwan[14] while proportions in Australia have been reported from 1.7% to 8.6%[11,12], proportions in the UK from 3.26% to 7.2%[11,12], and proportions in Canada from 1.4% to 4.5%[11,12]. Although these are the proportions reported in the literature, true proportions may be different. Regardless, data from the developing world are limited but at a Inhibitors,research,lifescience,medical public teaching hospital in Trinidad, the proportion Inhibitors,research,lifescience,medical of injured patients who LWBS was found to be 11.6%[15]. In this study we found the proportion of patients who LWBS was 5.7% for patients presenting to the major public referral hospital in the

capital city of Guyana. The proportion of patients who LWBS at this hospital is high by some international standards but is still well below that Inhibitors,research,lifescience,medical seen in many urban public hospital systems in developed countries and below the best available data from other developing countries. We found increased odds of LWBS among adults compared to pediatric age patients. Others have not noted a lower proportion of LWBS among pediatric patients presenting to general EDs[15,16]. Notably, some pediatric hospitals in North America report extremely high LWBS rates, with some as high as 16.6%[16,18]. Inhibitors,research,lifescience,medical The reasons for our finding are unclear but it is possible that pediatric patients seen in the ED in Guyana are sicker than the typical patient in North America or other developed areas

and the parents are more likely to remain for care despite a long wait. It has also been noted that pediatric patients who LWBS in North America almost all have primary care providers[19]. It is possible that a real or perceived decreased ability to access primary care would influence the Inhibitors,research,lifescience,medical decision of the parents to stay for care. In Guyana, although there is access to primary care, it is often not on an appointment basis and wait times in clinics can be Florfenicol prolonged. Similar to previous studies, we found that presenting during the second shift (4PM-12AM) was associated with significantly higher odds of LWBS[3,14,17-20]. The fact that the proportion of patients who LWBS differs by time of day is not unexpected given that high LWBS proportions are usually reflective of congestion within the ED and this has been noted in other studies[6,11,16-19,21]. While the day shift (8AM – 4PM) at GPHC has a higher patient NVP-BKM120 ic50 volume, the cumulative back up of patients starts during the mid-day time period and continues throughout the later shifts, likely contributing to an increased likelihood of LWBS during that time period.