S. A. Christie1, D. C. Dickson1, T. Nana1, P. M. Stern1, R. A. Dicker2, A. Chichom-Mefire3, C. Juillard1 1University Of California – San Francisco,Center for Global Surgical Studies,San Francisco, CA, USA 2University Of California – Los Angeles,Los Angeles, CA, USA 3University Of Buea,Department Of Surgery And Obstetrics- Gynecology, Faculty Of Health Sciences,Buea, SOUTHWEST REGION, Cameroon
Introduction:
Population-based injury data are critical for developing trauma systems, particularly in low- and middle-income countries (LMIC) where many patients do not present to formal medical care. Determining injury severity in population studies would greatly aid risk stratification and policy planning. However, severity surrogates like disability outcomes are confounded by treatment access, while anatomic and physiologic scores cannot be ascertained in the community setting. As part of an 8065 subject community-based study on injury in Cameroon, we designed a novel series of 4 survey questions intended to estimate injury severity. Outcomes of subjects with and without severity indicators were compared.
Methods:
Three-stage cluster sampling was used to select 36 enumeration areas in Southwest Cameroon. Household representatives at each site reported all family injuries in the past 12 months that resulted in death, loss of routine activity, or required medical attention. Loss of consciousness, post-injury disorientation, event amnesia, or cessation of breathing on the day of injury were considered severity indicators. Presence of severity indicators was correlated to data on injury outcomes.
Results:
Among 503 injuries reported in a sample of 8065 subjects, 16.5% resulted at least one severity indicator. Specifically, 8% lost consciousness, 9.4% were disoriented, 1.8% had event amnesia, and 0.4% had respiratory arrest at the scene. All study subjects who died from their injuries had one or more severity indicator. Among subjects who presented to formal care, those with severity indicators had higher rates of hospitalization (50% vs. 26.5%, p=0.004) and longer admissions (11.6 vs. 2.9 hospital nights, p=0.03). Excluding injury deaths and recent injuries, subjects with severity indicators were more likely to report ongoing disability at the time of the survey (OR 1.9, p=0.004). In multiple linear regression adjusted for age and formal care use, presence of severity indicators independently predicted increased disability days (OR 23, p=0.02).
Conclusion:
Survey-based severity indicators were present in all injury deaths and predicted longer hospital stays and increased disability after injury. This novel metric shows promise as a means of estimating severity in population studies, which will improve risk stratification for policy and prevention planning. Prospective hospital-based studies should evaluate correlation of survey-based indicators with conventional severity scoring algorithms.