Trauma registries as a tool for improved clinical assessment of trauma patients in an urban African hospital

This combined retrospective and prospective study describes trauma patients in an urban African Hospital and assesses whether use of trauma registries leads to  improved clinical assesment. The Kampala Trauma Score (KTS) is assessed as an injury  severity filter. The level of clinical assessment was defined by Model Rural Trauma Project (MRTP) trauma triage criteria. Trauma registries were filled out  systematically for every alternate patient on arrival in the casualty department, and the patient status was recorded two weeks after admission. This retrospective study showed that 52% of the trauma patients were inadequately assessed.  Amongst the deaths, 72.7% had been inadequately assessed (p value = 0.0193). Prospective data showed that injuries were most common amongst young males (72.7%), in and around the city following road traffic injuries (50.7%). The  mean time between injury and arrival at the hospital was 0.363 hours (SD 0.331) and the mean hospital response time was 0.36 hours SD 0.245) The rate of inadequate assessment decreased significantly after the introduction of the registry (p value =  0.000). The case fatalities before and after the introduction of the registry was,  however, not statistically significant. The KTS  was found to be a reliable severity filter for injured patients, with a KTS score of less than 14 increasing the likelihood of death by at least three times. The results showed a cut off value of 12 by the ROC curve (0.8755; 95% CI = 0.8455 - 0.9055).Key words: trauma registries, audit, clinical assessment, Afric

Patterns of traumatic brain injury and six-month neuropsychological outcomes in Uganda

Abstract Background Traumatic brain injuries in Uganda are on the increase, however little is known about the neuropsychological outcomes in survivors. This study characterized patients with traumatic brain injury (TBI) and the associated six-month neuropsychological outcomes in a Ugandan tertiary hospital. Methods Patients admitted at Mulago Hospital with head injury from November 2015 to April 2016 were prospectively enrolled during admission and followed up at six months after discharge to assess cognition, posttraumatic stress symptoms (PTSS), depression symptoms and physical disability. The outcomes were compared to a non-head-injury group recruited from among the caretakers, siblings and neighbours of the patients with age and sex entered as covariates. Results One hundred and seventy-one patients and 145 non-head injury participants were enrolled. The age range for the whole sample was 1 to 69 years with the non-head injury group being older (mean age (SD) 33.34 (13.35) vs 29.34 (14.13) years of age, p = 0.01). Overall, motorcycle crashes (36/171, 38.6%) and being hit by an object (58/171, 33.9%) were the leading causes of TBI. Head injury from falls occurred more frequently in children < 18 years (13.8% vs 2.8%, p = 0.03). In adults 18 years and older, patients had higher rates of neurocognitive impairment (28.4% vs 6.6%, p < 0.0001), PTSS (43.9% vs 7.9%, p < 0.0001), depression symptoms (55.4% vs 10%, p < 0.0001) and physical disability (7.2% vs 0%, p = 0.002). Lower Glasgow Coma Score (GCS) on admission was associated with neurocognitive impairment (11.6 vs 13.1, p = 0.04) and physical disability (10 vs 12.9, p = 0.01) six months later. Conclusion This first such study in the East-African region shows that depth of coma on admission in TBI is associated with neurocognitive impairment and physical disability.https://deepblue.lib.umich.edu/bitstream/2027.42/147735/1/12883_2019_Article_1246.pd

Epidemiology of injuries presenting to the national hospital in Kampala, Uganda: implications for research and policy

BackgroundDespite the growing burden of injuries in LMICs, there are still limited primary epidemiologic data to guide health policy and health system development. Understanding the epidemiology of injury in developing countries can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortality.AimTo estimate the epidemiology of the injury seen in patients presenting to the government hospital in Kampala, the capital city of Uganda.MethodsA secondary analysis of a prospectively collected database collected by the Injury Control Centre-Uganda at the Mulago National Referral Hospital, Kampala, Uganda, 2004-2005.ResultsFrom 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded; a final sample of 3,481 records were analyzed. The majority of patients (62%) were treated in the casualty department and then discharged; 38% were admitted. Road traffic injuries (RTIs) were the most common causes of injury for all age groups in this sample, except for those under 5 years old, and accounted for 49% of total injuries. RTIs were also the most common cause of mortality in trauma patients. Within traffic injuries, more passengers (44%) and pedestrians (30%) were injured than drivers (27%). Other causes of trauma included blunt/penetrating injuries (25% of injuries) and falls (10%). Less than 5% of all patients arriving to the emergency department for injuries arrived by ambulance.ConclusionsRoad traffic injuries are by far the largest cause of both morbidity and mortality in Kampala. They are the most common cause of injury for all ages, except those younger than 5, and school-aged children comprise a large proportion of victims from these incidents. The integration of injury control programs with ongoing health initiatives is an urgent priority for health and development

Injury prevention and safety promotion in Africa - local actors and global partners

No Abstract. African Safety Promotion: A Journal of Injury and Violence Prevention Vol. 4(1) 2006: 44-5

Trauma registries as a tool for improved clinical assessment of trauma patients in an urban African hospital

This combined retrospective and prospective study describes trauma patients in an urban African Hospital and assesses whether use of trauma registries leads to improved clinical assesment. The Kampala Trauma Score (KTS) is assessed as an injury severity filter. The level of clinical assessment was defined by Model Rural Trauma Project (MRTP) trauma triage criteria. Trauma registries were filled out systematically for every alternate patient on arrival in the casualty department, and the patient status was recorded two weeks after admission. This retrospective study showed that 52% of the trauma patients were inadequately assessed. Amongst the deaths, 72.7% had been inadequately assessed (p value = 0.0193). Prospective data showed that injuries were most common amongst young males (72.7%), in and around the city following road traffic injuries (50.7%). The mean time between injury and arrival at the hospital was 0.363 hours (SD 0.331) and the mean hospital response time was 0.36 hours SD 0.245) The rate of inadequate assessment decreased significantly after the introduction of the registry (p value = 0.000). The case fatalities before and after the introduction of the registry was, however, not statistically significant. The KTS was found to be a reliable severity filter for injured patients, with a KTS score of less than 14 increasing the likelihood of death by at least three times. The results showed a cut off value of 12 by the ROC curve (0.8755; 95% CI = 0.8455 - 0.9055)

The effect of an overpass on pedestrian injuries on a major highway in Kampala - Uganda

Objectives: To describe the pedestrian population, their use of an overpass, and to assess pedestrian perceptions and responses to the risk of traffic crashes, determine pedestrian injuries in relation to traffic flow, and compare traffic crash and pedestrian injury rates before and after the overpass construction. Setting: The study was conducted in Nakawa trading center approximately six kilometers from the center of Kampala city on a major highway. The trading center has a busy market, small retail shops, industries, a sports stadium, offices, low cost housing estates, schools, and an estimated population of 6,226 residents, 15.1% of them students. Methodology: Pedestrian road behavior and traffic patterns were observed, and police traffic crash records reviewed, one year before and one year after overpass construction. A convenient sample of overpass and non-overpass users was interviewed to assess their perceptions of risk. Results: A total of 13,064 pedestrians were observed (male: female ratio= 2.2:1). The overall prevalence of pedestrian overpass use was 35.4%. A bigger proportion of females (49.1%) crossed on the overpass compared to males (29.2%). More children (79.7 %) than adults (27.3%) used the overpass. The majority of pedestrians (77.9%) were worried about their safety in traffic but only 6.6% thought of the overpass as an appropriate means to avoid traffic accidents. Traffic was not segregated by vehicle type. Mean traffic flow varied from 41.5 vehicles per minute between 0730-0830 hours, to 39.3 vehicles per minute between 1030-1130 hours and 37.7 vehicles per minute between 1730-1830 hours. The proportion of heavy vehicles (lorries, trailers, tankers, and tractors) increased from 3.3% of total vehicle volume in the morning to 5.4% in the evening (t = 2.847,

The impact of traumatic brain injuries: A global perspective

Traumatic brain injury (TBI), according to the World Health Organization, will surpass many diseases as the major cause of death and disability by the year 2020. With an estimated 10 million people affected annually by TBI, the burden of mortality and morbidity that this condition imposes on society, makes TBI a pressing public health and medical problem. The burden of TBI is manifest throughout the world, and is especially prominent in Low and Middle Income Countries which face a higher preponderance of risk factors for causes of TBI and have inadequately prepared health systems to address the associated health outcomes. Latin America and Sub Saharan Africa demonstrate a higher TBI-related incidence rate varying from 150-170 per 100,000 respectively due to RTIs compared to a global rate of 106 per 100,000. As highlighted in this global review of TBI, there is a large gap in data on incidence, risk factors, sequelae, financial costs, and social impact of TBI. This should be addressed through planning of comprehensive TBI prevention programs in LMICs through well-established surveillance systems. Greater resources for research and prioritized interventions are critical to promote evidence-based policy for TBI. © 2007 - IOS Press and the authors. All rights reserved

Epidemiology of child injuries in Uganda: challenges for health policy.

Globally, 90% of road crash deaths occur in the developing world. Children in Africa bear the major part of this burden, with the highest unintentional injury rates in the world. Our study aims to better understand injury patterns among children living in Kampala, Uganda and provide evidence that injuries are significant in child health. Trauma registry records of injured children seen at Mulago Hospital in Kampala were analysed. Data were collected when patients were seen initially and included patient condition, demographics, clinical variables, cause, severity, as measured by the Kampala trauma score, and location of injury. Outcomes were captured on discharge from the casualty department and at two weeks for admitted patients. From August 2004 to August 2005, 872 injury visits for children &lt;18 years old were recorded. The mean age was 11 years (95% CI 10.9-11.6); 68% (95% CI 65-72%) were males; 64% were treated in casualty and discharged; 35% were admitted. The most common causes were traffic crashes (34%), falls (18%) and violence (15%). Most children (87%) were mildly injured; 1% severely injured. By two weeks, 6% of the patients admitted for injuries had died and, of these morbidities, 16% had severe injuries, 63% had moderate injuries and 21% had mild injuries. We concluded that, in Kampala, children bear a large burden of injury from preventable causes. Deaths in low severity patients highlight the need for improvements in facility based care. Further studies are necessary to capture overall child injury mortality and to measure chronic morbidity owing to sequelae of injuries