O. C. Nwanna-Nzewunwa1, A. C. Mefire2,3, V. V. Siysi2,3, I. Feldhaus1, R. A. Dicker1, C. Juillard1 1University Of California – San Francisco,Center For Global Surgical Studies,San Francisco, CA, USA 2University Of Buea,Faculty Of Health Sciences,Buea, , Cameroon 3Regional Hospital Limbe,Limbe, , Cameroon
Introduction:
Trauma is a leading cause of morbidity and mortality worldwide. Data characterizing the burden of trauma in low- and middle-income countries (LMIC), such as Cameroon, are limited. Regular, prospective injury surveillance can address the shortcomings of existing hospital administrative logs. This study aims to characterize trauma as seen at the emergency department of a Regional Referral Hospital and assess the completeness of trauma registry data relative to administrative records.
Methods:
From January 2008 to October 2013, we prospectively captured data on injured patients using a strategically designed, context-relevant trauma registry instrument filled out by clinicians during their normal course of work. Indicators around patient demographics, injury characteristics, delay in accessing care, and treatment outcomes were recorded. Descriptive, bivariate, and multivariate statistical analyses were conducted. A two-sample test of proportions was used to compare this trauma registry data with historical data from each of the following sources: 1) administrative records at the same facility, 2) a Central Hospital trauma registry, and 3) the central hospital administrative records.
Results:
A total of 5,617 patients with mean age of 26.04 years (95% C.I.) presented to the hospital with an injury; 67% were male. Students (27%) were the most affected occupation category. Road traffic injuries (RTIs) comprised the leading cause of injury (56%), followed by assault (22%), and domestic accidents (13%). Overall, proportions of missing data typically ranged from 0.5% to 8.2% with the exception of RTS and type of collision variables. Relative to the administrative records, the trauma registry at the Regional Referral Hospital showed a significantly higher level of documentation of patient occupation, vital signs, injury severity score (ISS), Glasgow Coma Score (GCS) and anatomical location, transport time, treatment outcome (p<0.001). Improvement in documentation was highest for transport time (88%), ISS (84%), GCS (59%) and blood pressure (58%) but respiratory rate had the lowest improvement rate (24%) . The Regional Hospital registry had lower documentation rates for vital signs, ISS, and GCS than the Central Hospital registry (p<0.001).
Conclusion:
Implementation of a context-appropriate trauma registry by providers is feasible in developing settings. It can provide valuable, high-quality data that can inform trauma care quality improvement efforts and policy development. Study findings point towards the need for injury prevention interventions and policies that will prioritize high-risks groups, such as those aged 20-29 years, men, and those working in occupations requiring frequent road travel.
