Trauma Ward Mental Health Discharge Medication Reconciliation Gaps and Antidepressant Persistence Among Kenyan Survivors: A Target-Trial Emulation of Pharmacist Review Windows

Discharge from trauma wards is a pharmacologically fragile moment: reconciliation errors and antidepressant discontinuation cluster in the days after transfer, yet the causal effect of pharmacist review timing on persistence remains unidentified in East African settings. No observational data are used or claimed. Under a declared variance structure (between-cluster SD = 6.0, residual SD = 4.5, intraclass correlation = 0.64), power was estimated across 2000 design cells for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. The design achieves 80% power at 5 percentage points only with 54 clusters, a requirement that exceeds the cluster counts examined. Minimum detectable effects at 80% power fall steeply as clusters increase from 8 to 32, and the coefficient plots show that interval width, not point-estimate bias, dominates the precision problem. The contribution is a design specification and a feasibility bound: reconciliation-window effects of the magnitude plausibly produced by pharmacist review cannot be reliably detected in the small-cluster configurations that Kenyan trauma units can realistically supply, which reframes the evidentiary problem from measurement to design.