Jessica Eaton1, Joanna Grudziak2, Asma Bilal Hanif3, Wanangwa C Chisenga3, Eldad Hadar4, Anthony Charles5. 1. UNC -Project Malawi, Lilongwe, Malawi; University of Louisville School of Medicine, Louisville, KY, United States. 2. Department of Surgery, University of North Carolina, Chapel Hill, NC, United States. 3. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. 4. Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, United States. 5. UNC -Project Malawi, Lilongwe, Malawi; Department of Surgery, University of North Carolina, Chapel Hill, NC, United States; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. Electronic address: anthchar@med.unc.edu.
Abstract
INTRODUCTION: Injury is a significant cause of death, with approximately 4.7 million people mortalities each year. By 2030, injury is predicted to be among the top 20 causes of death worldwide. We sought to characterize and compare the mortality probability in trauma patients in a resource-poor setting based on anatomic location of injury. METHODS: We performed a retrospective analysis of prospectively collected data using the trauma database at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. We included all adult trauma patients (≥16years) admitted between 2011 and 2015. We stratified patients according to anatomic location of injury, and used descriptive statistics to compare characteristics and management of each group. Bivariate analysis by mortality was done to determine covariates for our adjusted model. A Cox proportional hazard model was performed, using upper extremity injury as the baseline comparator. Descriptive statistics were used to describe the trend in incidence and mortality of head and spine injuries over five years. RESULTS: Of the 76,984 trauma patients who presented to KCH from 2011 to 2015, 49,126 (63.8%) were adults, and 8569 (17.4%) were admitted. The most common injury was to the head or spine, seen in 3712 patients (43.6%). The highest unadjusted hazard ratio for mortality was in head and spine injury patients, at 3.685 (95% CI=2.50-5.44), which increased to 4.501 (95% CI=2.78-7.30) when adjusted for age, sex, injury severity, transfer status, injury mechanism, and surgical intervention. Abdominal trauma had the second highest adjusted hazard of mortality, at 3.62 (95% CI=1.92-6.84) followed by thoracic trauma (HR=1.3621, 95% CI=0.49-3.56). CONCLUSION: In our setting, head or spine injury significantly increases the hazard of mortality significantly compared to all other anatomic injury locations. The prioritization of timely operative and non-operative head injury management is imperative. The development of head injury units may help attenuate trauma- related mortality in resource poor settings.
INTRODUCTION: Injury is a significant cause of death, with approximately 4.7 million people mortalities each year. By 2030, injury is predicted to be among the top 20 causes of death worldwide. We sought to characterize and compare the mortality probability in traumapatients in a resource-poor setting based on anatomic location of injury. METHODS: We performed a retrospective analysis of prospectively collected data using the trauma database at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. We included all adult traumapatients (≥16years) admitted between 2011 and 2015. We stratified patients according to anatomic location of injury, and used descriptive statistics to compare characteristics and management of each group. Bivariate analysis by mortality was done to determine covariates for our adjusted model. A Cox proportional hazard model was performed, using upper extremity injury as the baseline comparator. Descriptive statistics were used to describe the trend in incidence and mortality of head and spine injuries over five years. RESULTS: Of the 76,984 traumapatients who presented to KCH from 2011 to 2015, 49,126 (63.8%) were adults, and 8569 (17.4%) were admitted. The most common injury was to the head or spine, seen in 3712 patients (43.6%). The highest unadjusted hazard ratio for mortality was in head and spine injurypatients, at 3.685 (95% CI=2.50-5.44), which increased to 4.501 (95% CI=2.78-7.30) when adjusted for age, sex, injury severity, transfer status, injury mechanism, and surgical intervention. Abdominal trauma had the second highest adjusted hazard of mortality, at 3.62 (95% CI=1.92-6.84) followed by thoracic trauma (HR=1.3621, 95% CI=0.49-3.56). CONCLUSION: In our setting, head or spine injury significantly increases the hazard of mortality significantly compared to all other anatomic injury locations. The prioritization of timely operative and non-operative head injury management is imperative. The development of head injury units may help attenuate trauma- related mortality in resource poor settings.
Authors: Laura N Purcell; Emily Nip; Jared Gallaher; Carlos Varela; Yotamu Gondwe; Anthony Charles Journal: Injury Date: 2020-05-11 Impact factor: 2.586
Authors: Kiran J Agarwal-Harding; Linda C Chokotho; Nyengo C Mkandawire; Claude Martin; Elena Losina; Jeffrey N Katz Journal: J Bone Joint Surg Am Date: 2019-05-15 Impact factor: 5.284
Authors: Kiran J Agarwal-Harding; Linda Chokotho; Sven Young; Nyengo Mkandawire; Mabvuto Chawinga; Elena Losina; Jeffrey N Katz Journal: PLoS One Date: 2019-11-20 Impact factor: 3.240