The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town

Introduction:Trauma is a leading cause of unnatural death and disability in South Africa. The aim of the study was to determine whether method of transport, hospital arrival time or prehospital transport time intervals were associated with in-hospital mortality among trauma patients presenting to Khayelitsha Hospital, a district-level hospital on the outskirts of Cape Town, South Africa.Methods:The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for trauma-related patients presenting to the resuscitation area between 1 November 2014 and 30 April 2015. Missing data and additional variables were collected by means of a chart review. Eligible patients' folders were scrutinised for hospital arrival time, transport time intervals, transport method and in-hospital mortality. Descriptive statistics were presented for all variables. Categorical data were analysed using the Fisher's Exact test and Chi-square, continuous data by logistic regression and the Mann Whitney test. A confidence interval of 95% was used to describe variance and a p-value of <0.05 was deemed significant.Results:The majority of patients were 19­44 year old males (n = 427, 80.3%) and penetrating trauma the most frequent mechanism of injury (n = 343, 64.5%). In total, 258 (48.5%) patients arrived with their own transport, 254 (47.7%) by ambulance and 20 (3.8%) by the police service. The arrival of trauma patients peaked during the weekend, and was especially noticeable between midnight and six a.m. In-hospital mortality (n = 18, 3.4%) was not significantly affected by transport method (p = 0.26), hospital arrival time (p = 0.22) or prehospital transport time intervals (all p-values >0.09).Discussion:Method of transport, hospital arrival time and prehospital transport time intervals did not have a substantially measurable effect on in-hospital mortality. More studies with larger samples are suggested due to the small event rate.African relevance

Injury Patterns and Mortality Rates of Motorcycle-Related Head Injuries in Kenya

Background: Motorcycles are an emerging means of public transportation in many developing countries and has a poor safety record when compared to other road users. Subsequently; motorcycle injuries have been on the rise and head injuries are the leading cause of death; severe injury and disability globally.Objectives: To determine the injury patterns and mortality rate of motorcycle-related head injuries. Design: A retrospective descriptive study. Setting: Moi Teaching and Referral Hospital Subjects: All motorcycle-related head injuries from the year 2010 to 2013. Results: One hundred and fourteen files were reviewed. The study sample was predominantly male (n=106; 93%) with a mean age of 30.2 years (SD=14.01). More than half of the patients sustained skull fractures and intra-cranial haemorrhage (n=68; 59.6%). About 9.6% (n=11) of the patients succumbed to their injuries out of which 63.6% (n=7) sustained severe head injuries. There was a significant association between helmet use and the mortality rate of patients (?2=5.684; p=0.017). The use of helmets also had an influence on the type of injury sustained (p=0.004) as patients not wearing helmets sustained more serious injuries such as skull fractures; intra-cranial bleeding; cerebral oedema and diffuse axonal injuries.Conclusion: There is a relationship between helmet use; the type of injury sustained and the mortality rate of the patients. Hence; the need for public education programmes on motorcycle safety and helmet use to curb the negative impact of motorcycle-related injuries on the society and economy

Pattern and Mortality Rate of Traumatic Injuries in a Tertiary Hospital in Nigeria- 2 Year Comparative Analysis

BACKGROUND.Trauma ranks as one of the leading cause of mortality in Sub-Saharan Africa. The aim of this study was to compare the pattern of injuries and mortality rates in our hospital.METHODS.Demographic and clinical data of patients that sustained injuries due to trauma to all regions of the body were included in the study. The cause; type and site of the injuries were documented. Cases of mortality with the sites and severity of injuries and number of days on admission before death was documented for each period.RESULTS.A total of 673 patients presented in the first period (March 2011 to February 2012) and 1869 in the second period (March 2012 to February 2013). More males were involved with injuries in both periods. RTA and Burns were responsible for most of the injuries in both periods. Head injury was highest followed by the extremities in both periods. In the first period; a total of 46 patients died with mortality rate of 6.8%; in the second period; a total of 47 patients died with mortality rate of 2.5%.CONCLUSION.There was an increase in the cases of trauma in the second period of the study. The pattern in both periods was similar but mortality figure was much lower in the second period

Motor Traffic Injuries in Sub-Saharan Africa

Introduction: Motor traffic injuries are recognized as a major public health problem in developing countries. MTIs continue to cause morbidity; mortality and disability in Sub Saharan Africa (SSA). Objectives: To describe the magnitude of MTI's in SSA and to find the magnitude of morbidity and mortality caused by MTI's. Methodology:The World Health Organization (WHO); PUBMED and EMBASE databases were used to identify documents and articles on MTIs in SSA and its effects. The literature review was supplemented by document review and interviews with a key informant in one region of Tanzania to determine the magnitude of morbidity and mortality associated with MTI's in Tanzania. Results: The mortality rate due to MTI's in Lower and Middle Income Countries (LMIC's) including SSA is about 20 per 100;000 population while in High Income Countries(HIC's) it is about 10.3 per 100;000 population. MTI's also represent the ninth leading cause of Disability Adjusted Life Years (DALY's) lost and are forecasted by WHO to be the third leading cause of DALY's lost by 2020. Total number of reported accidents in Kilimanjaro region in 2008 was 906 while in 2009 it was 1;125 accounting for an increase of 24. The total mortality reported in 2008 was 147 and 202 in 2009 with an increase of 37The total morbidity was 622 in 2008 and 933 in 2009 accounting for a 50increase. Discussion: The high mortality rate in SSA of about 20 per 100;000 population is contributed mainly by human factors with the major being reckless driving and negligence of drivers; pedestrians and passengers. Morbidity and mortality due to MTI's is increasing gradually over time as seen from the Kilimanjaro documents. The burden of MTI morbidity and mortality is predicted to rise by 80in SSA and fall by 30in HIC's by 2020

Motorcycle Road Traffic Injuries in Southern Nigeria: The Small Motorcycle as a Prevention Strategy

Background: The commonest mode of public transportation in Uyo is by motorcycle. There are two sizes of motorcycle in common use - the big one (Qlink or Skygo model; made in China) and the small one (C90; made in China). The study was carried out to determine if there is a lower risk of RTI severe enough to be brought to the hospital; attributable to using a small motorcycle. Methods: Motorcycle RTI victims admitted at the Accident and Emergency department of the University of Uyo Teaching Hospital (UUTH); were reviewed prospectively over a 15 month period. Three community visual surveys of the proportion of small to large motorcycles were also conducted. Results: A total of 131 RTI victims were reviewed over 15 months. The visual surveys of motorcycles in Uyo revealed that the mean proportion of small to large is 38 to 62; a ratio of 1:1.6. Eighty-three (63.3) of the 131 RTI's involved motorcycles. 74 of these occurred in large motorcycles. There was a statistically significant relationship between motorcycle size and occurrence of an RTI severe enough to be brought to hospital. Conclusion: There is a lower risk of RTI severe enough to be brought to hospital; from using a small motorcycle