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

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

The Experience and Psychosocial Needs of Patients with Traumatic Fractures Treated for More than Six Months at Doctors on Call for Service Hospital; Goma; Democratic Republic of Congo

Trauma-related consultations; admissions and complications are the leading problems at Doctors on Call for Service (DOCS) Hospital; Goma; Democratic Republic of Congo; and yet no studies have been carried out to document the experience of long-stay traumatic-fracture patients in this hospital. Aim: The aim of this study was to explore the experience and psychosocial needs of patients with traumatic fractures treated for more than six months at DOCS Hospital. Methods: Six free-attitude interviews were conducted with purposively selected patients. The interviews were recorded with a tape recorder and transcribed verbatim; and content analysis was used to identify themes from the interviews. Results: All patients could clearly connect the injury experience to severe pain that lingered on for weeks or months for some patients; accompanied by other symptoms such as insomnia; poor appetite and psychological symptoms. Most patients felt disabled; were abandoned by relatives or friends and experienced financial problems. Some benefited from the injury by way of strengthened marital links. Some patients complained of poor information about their illness and the management plan and did not appreciate the treatment from caregivers; while some disclosed their needs and expectations and appreciated the caregivers who showed interest in them. Conclusions: The experience of long-term trauma has negative effects on the whole person of the patient; including his or her work and family; and some patients continue to suffer from the effects of the traumatic event up to six months later. The needs of patients suffering from trauma include reassurance by physicians and nurses; more information and participation in the decision-making process; regular visits from friends and family; and better bedside manners from caregivers

Seasonal Incidence and Nature of Cricket Injuries among Elite South African Schoolboy Cricketers

Objective. To identify the incidence and nature of injuries sustained by elite South African schoolboy cricketers. Design. Data were collected retrospectively using a questionnaire. Cricketers recalled all injuries from June 2003 to May 2004. Setting. The population consisted of 196 cricketers representing all provincial teams in the 2004 under-19 Coca-Cola Khaya Majola cricket week. Results. Sixty-seven injuries were sustained by 196 cricketers; with an incidence of 34.2during the period under review. Injuries occurred during matches (71.6); throughout the season due to repetitive stresses sustained during matches and practices (14.9); during practice (11.9) and during other forms of training (1.5). Bowling accounted for 50.7of the injuries; fielding 32.8; batting 14.9and the remaining 1.5occurred while warming up or training. The primary mechanism of injury occurred during the delivery stride and follow through of the fast bowler (34.3). Eighty seven per cent of the injuries were first-time injuries while 13were recurrent. Most injuries (40.6) reported were severe and took the cricketers more than 21 days to recover. Cricketers were more prone to injury during December and January. Conclusion. The incidence and nature of injuries have been recorded and potential risk factors for injury have been identified. It is suggested that coaches and cricketers partake in continuous educational processes that focus on all the physical; mental and technical components necessary for success in cricket; with a national database

A Review of Cricket Injuries and the Effectiveness of Strategies to Prevent Cricket Injuries at all Levels

Objective. This review evaluates the scientific research on cricket injuries; including long-term injury surveillance studies; the consensus statement paper for injury surveillance; specific counter-measures to reduce the risk of cricket injuries and finally identifies areas of future concern. Results. The literature shows that three major cricketplaying countries; Australia; England and South Africa; have collected long-term injury data. While these sets of data show definite trends; it was not always possible tomake direct comparisons between data collected in various countries. As a result a consensus statement paper with regards to definitions and methods to calculate injuryrates; incidence and prevalence was developed. The first study using this newly accepted injury surveillance method showed injury patterns in West Indies domestic andnational cricket teams. There have been three primary studies carried out with regards to interventions aimed at reducing the risk of injury to fast bowlers. These includeda coaching interventions programme; the use of a bowling aid in an attempt to modify bowling technique and a study that evaluated the recommended bowling workloadsin young cricketers. The implications of the changes to the laws relating to the bowling action and the increased usage of the sliding stop in fielding are reviewed. Conclusion. From the review it is evident that there is a need to continue with injury surveillance; as well as a need to continue with and increase the number of studies that evaluate the efficacy of intervention strategies in order to reduce the risk of injury to cricketers

Nature and Proportion of Total Injuries at the Stellenbosch Rugby Football Club: a Comparason of the Years 1973 1975 with 2003 -2005A Review of Cricket Injuries and the Effectiveness of Strategies to Prevent Cricket Injuries at all Levels

Objective. The purpose of this study was to compare the nature and proportion of total injuries occurring at Stellenbosch Rugby Football Club in Stellenbosch; South Africa;between the years 1973 - 1975 and 2003 - 2005. Design. Retrospective; descriptive study. Main outcome measures. Injured rugby players from the Stellenbosch Rugby Football Club from the different time periods were included in the study. Results from the 1973 - 1975 time period were obtained from two previously published articles (Roy; 1974; Van Heerden; 1976); while data from the 2003 - 2005 time period were available through the Stellenbosch University Rugby Injury Database. Results. An increase in the proportion of head and facial injuries from 1973 - 1975 (21) to 2003 - 2005 (42) was found as well as a doubling in the proportion of concussions between the two time periods (12- 23). There was an overall decrease in total injuries between the two time periods. Conclusion. The findings highlight the high and increased proportion of head and facial injuries in the game of rugby at the Stellenbosch Rugby Football Club. This is a matter that should be further investigated

Injury Profile in KwaZulu-Natal; South Africa: Implications for Prevention

Background: Prevention and control of injuries require generating relevant information on the magnitude; characteristics and determinants of injuries. Objective: The objective of this study was to describe the characteristics of injuries and predict the severity of injury with other variables. Design: A cross - sectional descriptive study was conducted at the hospitals of KwaZulu - Natal. Information was gathered from a total of 428 injured patients randomly selected from hospital attendances. Multivariate logistic regression analysis was performed to identify the risk factors for severity of injury. Results: Over 60of injury victims were below the age of 30 years. The economically active group (21 - 60 years) also constituted about 60of injury victims. Over half of the victims reported that the scene of incidence was private house; yard and road. One fifth was transport related injury whereas majority was violence (50). Unintentional injury was 28.8. Most of the injuries were minor (42.3) to moderate (41.1) in severity. Odds Ratio for alcohol related violence was 11. Conclusion: In order to reduce injuries appropriate multisectoral interventions; broader policies and strategies; regulating transport and alcohol use; routine testing of alcohol to identify the problem-drinkers for rehabilitation. Interventions should also include health education and health promotion and law enforcement