Patterns of injury at an Ethiopian referral hospital: Using an institutional trauma registry to inform injury prevention and systems strengthening

Adam D Laytin; Nebyou Seyoum; Seyoum Kassa; Catherine J Juillard; Rochelle A Dicker

doi:10.1016/j.afjem.2020.01.001

Patterns of injury at an Ethiopian referral hospital: Using an institutional trauma registry to inform injury prevention and systems strengthening

Afr J Emerg Med. 2020 Jun;10(2):58-63. doi: 10.1016/j.afjem.2020.01.001. Epub 2020 Feb 18.

Authors

Adam D Laytin^{1

2

3}, Nebyou Seyoum⁴, Seyoum Kassa⁴, Catherine J Juillard^{2

5}, Rochelle A Dicker^{2

5}

Affiliations

¹ Department of Emergency Medicine, Johns Hopkins University, USA.
² Center for Global Surgical Studies, Department of Surgery, University of California San Francisco, USA.
³ Department Anesthesia and Critical Care Medicine, Johns Hopkins University, USA.
⁴ Department of Surgery, Addis Ababa University, Ethiopia.
⁵ Department of Surgery, University of California Los Angeles, USA.

Abstract

Background: Data about injury patterns and clinical outcomes are essential to address the burden of injury in low- and middle-income countries. Institutional trauma registries (ITRs) are a key tool for collecting epidemiologic data about injury. This study uses ITR data to describe the demographics and patterns of injury of trauma patients in Addis Ababa, Ethiopia in order to identify opportunities for injury prevention, systems strengthening and further research.

Methods: This is an analysis of prospectively collected data from a sustainable ITR at Menelik II Specialized Hospital, a public teaching hospital with trauma expertise. All patients presenting to the hospital with serious injuries requiring intervention or admission over a 13 month period were included. Univariable and bivariable analyses were performed for patient demographics and injury characteristics.

Results: A total of 854 patients with serious injuries were treated during the study period. Median age was 33 years and 74% were male. The most common mechanisms of injury were road traffic injuries (RTI) (37%), falls (30%) and blunt assault (17%). Over half of RTI victims were pedestrians. Median delay in presentation was 2 h; 17% of patients presented over 6 h after injury. 58% of patients were referred from another hospital or a clinic, and referrals accounted for 84% of patients arriving by ambulance. Median emergency center length of stay was 2 h and 62% of patients were discharged from the emergency center.

Conclusion: This study highlights the utility of institutional trauma registries in collecting crucial injury surveillance data. In Addis Ababa, road safety is an important target for injury prevention. Our findings suggest that the most severely injured patients may not be making it to the referral centers with the capacity to treat their injuries, thus efforts to improve prehospital care and triage are needed.

African relevance: Injury is a public health priority in Africa. Institutional trauma registries play a crucial role in efforts to improve trauma care by describing injury epidemiology to identify targets for injury prevention and systems strengthening efforts. In our context, pedestrian safety is a key target for injury prevention. Improving prehospital care and developing referral networks are goals for systems strengthening.

Keywords: Africa; Epidemiology; Ethiopia; Injury prevention; Trauma registry.

Grants and funding

R25 TW009338/TW/FIC NIH HHS/United States