Reviewer ’s report  
 
Title: Aetiologies and outcomes of patients with a bdominal pain presenting to an emergency  
department of a tertiary hospital in Tanzania: a Prospective Cohort Study  
 
Version: 0 Date: 24 May 2019  
 
Reviewer: Christian Backer Mogensen  
 
Reviewer's report:  
 
Thank you for getting the chance to review the manuscript from MMC, Tanzania, concerning 
presentations and mortality and risk factors for death among patients in the ED with abdominal 
pain as presenting sympto ms.  
 
Knowledge about epidemiology in ED in middle income countries is sparse and thus the topic of 
this paper relevant.  
 
However, in the present form it is not suitable for publication. I hope the following comments 
will help in this process and would lik e to encourage the authors to get their carefully collected 
observations publishable.    
 
 
Major comments:  
The overall aim of the study is not clear. It is not stated anywhere, but might be interpreted as 
mortality and risk factors for mortality in patients with abdominal pain.  
The large part is, however, much more descriptive of patients characteristics, find ings and 
investigations and treatment offered, which might be interesting but at the same time blurs the 
intention with the paper, and more coherence between background, aim, methods and results is 
required.  
 
 
Minor comments:  
 
Abstract: what is the aim? If m ortality and risk factors, why mention treatments in details ?  
 
Background:  should build up to lead to the aim, and since the aim is not clear, this section 
appears unstructured.  
 
Methods:  
What mortality is used? 24 - 7 days or total - not clear. Why such a small sample if the intention is 
analysis of risk factors for mortality - the size will not allow any multivariate analysis which is 
warranted if risk factors is the secondary outcome.  
 
 
 
Results:  
No loss of follow up? This is impressing, that among 199 none was lost for follow up in a middle 
income country with weak public registration systems.  
Fig 1: miscalculation of 7 days mortality from theatre (4/199 = 2 %)  
Table 1:  1 column describes the total cohort with longitunal % , second and third column 
survivo rs and death with horizontal % calculations, which is confusion and does not allow any 
comparison of the two groups against the mentioned variables.  Furthermore the numbers of 
patients in column two and three does not add up to the totals of 178 and 21 in  several places ( ex 
gender: 63+120 =183, but you only have 178 in the group)  
A range of clinical variables are mentioned, but not seen in tables (fever is rare = ?).  
Table 2 reports a range of  lab investigations, but the table is not even mentioned  in t he result 
section or used in any analysis of data for mortality. Why is included?  
The risk factor section is not easy to understand, and very short in respect to that this was the 
secondary outcome.  What is reported is the frequence of prevealence ( ex ho w many male 
patient in the study (73) ) but nothing about the RR for death.  
 
Discussion:  
No comments at this point,  but should be revised when the above mentioned points have been 
addressed.   
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content o f the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any  non-financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no co mpeting interest  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included i n my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Aetiologies and outcomes of patients with a bdominal pain presenting to an emergency  
department of a tertiary hospital in Tanzania: a Prospective Cohort Study  
 
Version: 0 Date: 24 May 2019  
 
Reviewer: Christian Backer Mogensen  
 
Reviewer's report:  
 
Thank you for getting the chance to review the manuscript from MMC, Tanzania, concerning 
presentations and mortality and risk factors for death among patients in the ED with abdominal 
pain as presenting sympto ms.  
 
Knowledge about epidemiology in ED in middle income countries is sparse and thus the topic of 
this paper relevant.  
 
However, in the present form it is not suitable for publication. I hope the following comments 
will help in this process and would lik e to encourage the authors to get their carefully collected 
observations publishable.    
 
 
Major comments:  
The overall aim of the study is not clear. It is not stated anywhere, but might be interpreted as 
mortality and risk factors for mortality in patients with abdominal pain.  
The large part is, however, much more descriptive of patients characteristics, find ings and 
investigations and treatment offered, which might be interesting but at the same time blurs the 
intention with the paper, and more coherence between background, aim, methods and results is 
required.  
 
 
Minor comments:  
 
Abstract: what is the aim? If m ortality and risk factors, why mention treatments in details ?  
 
Background:  should build up to lead to the aim, and since the aim is not clear, this section 
appears unstructured.  
 
Methods:  
What mortality is used? 24 - 7 days or total - not clear. Why such a small sample if the intention is 
analysis of risk factors for mortality - the size will not allow any multivariate analysis which is 
warranted if risk factors is the secondary outcome.  
 
 
 
Results:  
No loss of follow up? This is impressing, that among 199 none was lost for follow up in a middle 
income country with weak public registration systems.  
Fig 1: miscalculation of 7 days mortality from theatre (4/199 = 2 %)  
Table 1:  1 column describes the total cohort with longitunal % , second and third column 
survivo rs and death with horizontal % calculations, which is confusion and does not allow any 
comparison of the two groups against the mentioned variables.  Furthermore the numbers of 
patients in column two and three does not add up to the totals of 178 and 21 in  several places ( ex 
gender: 63+120 =183, but you only have 178 in the group)  
A range of clinical variables are mentioned, but not seen in tables (fever is rare = ?).  
Table 2 reports a range of  lab investigations, but the table is not even mentioned  in t he result 
section or used in any analysis of data for mortality. Why is included?  
The risk factor section is not easy to understand, and very short in respect to that this was the 
secondary outcome.  What is reported is the frequence of prevealence ( ex ho w many male 
patient in the study (73) ) but nothing about the RR for death.  
 
Discussion:  
No comments at this point,  but should be revised when the above mentioned points have been 
addressed.   
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content o f the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any  non-financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no co mpeting interest  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included i n my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Aetiologies and outcomes of patients with a bdominal pain presenting to an emergency  
department of a tertiary hospital in Tanzania: a Prospective Cohort Study  
 
Version: 0 Date: 24 May 2019  
 
Reviewer: Christian Backer Mogensen  
 
Reviewer's report:  
 
Thank you for getting the chance to review the manuscript from MMC, Tanzania, concerning 
presentations and mortality and risk factors for death among patients in the ED with abdominal 
pain as presenting sympto ms.  
 
Knowledge about epidemiology in ED in middle income countries is sparse and thus the topic of 
this paper relevant.  
 
However, in the present form it is not suitable for publication. I hope the following comments 
will help in this process and would lik e to encourage the authors to get their carefully collected 
observations publishable.    
 
 
Major comments:  
The overall aim of the study is not clear. It is not stated anywhere, but might be interpreted as 
mortality and risk factors for mortality in patients with abdominal pain.  
The large part is, however, much more descriptive of patients characteristics, find ings and 
investigations and treatment offered, which might be interesting but at the same time blurs the 
intention with the paper, and more coherence between background, aim, methods and results is 
required.  
 
 
Minor comments:  
 
Abstract: what is the aim? If m ortality and risk factors, why mention treatments in details ?  
 
Background:  should build up to lead to the aim, and since the aim is not clear, this section 
appears unstructured.  
 
Methods:  
What mortality is used? 24 - 7 days or total - not clear. Why such a small sample if the intention is 
analysis of risk factors for mortality - the size will not allow any multivariate analysis which is 
warranted if risk factors is the secondary outcome.  
 
 
 
Results:  
No loss of follow up? This is impressing, that among 199 none was lost for follow up in a middle 
income country with weak public registration systems.  
Fig 1: miscalculation of 7 days mortality from theatre (4/199 = 2 %)  
Table 1:  1 column describes the total cohort with longitunal % , second and third column 
survivo rs and death with horizontal % calculations, which is confusion and does not allow any 
comparison of the two groups against the mentioned variables.  Furthermore the numbers of 
patients in column two and three does not add up to the totals of 178 and 21 in  several places ( ex 
gender: 63+120 =183, but you only have 178 in the group)  
A range of clinical variables are mentioned, but not seen in tables (fever is rare = ?).  
Table 2 reports a range of  lab investigations, but the table is not even mentioned  in t he result 
section or used in any analysis of data for mortality. Why is included?  
The risk factor section is not easy to understand, and very short in respect to that this was the 
secondary outcome.  What is reported is the frequence of prevealence ( ex ho w many male 
patient in the study (73) ) but nothing about the RR for death.  
 
Discussion:  
No comments at this point,  but should be revised when the above mentioned points have been 
addressed.   
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in t he manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content o f the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any  non-financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no co mpeting interest  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included i n my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant