L. N. Purcell1, J. Gallaher1, B. Cairns1, A. Charles1 1University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NC, USA
Introduction: In sub-Saharan Africa, trauma is a leading cause of mortality in people less than 45 years old. Injury mechanism and cause of death is difficult to characterize in the absence of pre-hospital care and a trauma surveillance database. Pre-hospital deaths (PHD) and in-hospital deaths (IHD) were compared to elucidate comprehensive mortality injury characteristics.
Methods: A retrospective, descriptive analysis of adults (≥ 18 years) presenting to Kamuzu Central Hospital in Lilongwe, Malawi from 2008 to 2013 was performed. Utilizing an emergency department-based trauma surveillance database, patient and injury characteristics of pre-hospital and in-hospital deaths were compared with univariate and bivariate analysis.
Results: 54,504 adult trauma patients presented to KCH between 2008 and 2013. Of those patients, 587 and 473 were BID and DIH, respectively. The majority were men with a mean age of 32.4 ± 12.6 and 38.8 ± 15.2 years, BID and IHD respectively. Head injuries (48.9% vs. 46.4%) due to motor vehicle crash (MVC, 47.4% vs. 60.4%) were the leading cause of death in both groups (BID vs. IHD). Transportation to the hospital was primarily via police (56.5%) for PHD and private vehicle (45.8%) for IHD, with ambulance services transporting less than 7% of patients for both groups. The average time to presentation to the hospital for PHD and IHD was 0.5 ± 1.1 and 1.2 ± 1.7 hours, respectively. The mean time to mortality for IHD was 1.9 ± 2.4 days.
Conclusion: Head injury from MVC is the leading cause of PHD and IHD in Malawi. The majority of patients are transported via police for PHD and private vehicle for IHD, which is consistent with the absence of a pre-hospital care system in Malawi. Improving pre-hospital care, with a special focus on head injury and strategies for vehicular injury prevention within a trauma system, will improve adult trauma mortality in Malawi.