Citation

Tyson AF, Varela C, Cairns BA, Charles AG. J. Surg. Educ. 2014; 72(4): e66-72.

Affiliation

Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Surgery, University of North Carolina, Chapel Hill, North Carolina. Electronic address: anthchar@med.unc.edu.

Copyright

(Copyright © 2014, Association of Program Directors in Surgery, Publisher Elsevier Publishing)

DOI

10.1016/j.jsurg.2014.09.010

PMID

25451718

Abstract

IMPORTANCE: Injuries are a significant cause of death and disability, particularly in low- and middle-income countries. Health care systems in resource-poor countries lack personnel and are ill equipped to treat severely injured patients; therefore, many injury-related deaths occur after hospital admission.

OBJECTIVES: This study evaluates the mortality for hospitalized trauma patients at a tertiary care hospital in Malawi.

DESIGN: This study is a retrospective analysis of prospectively collected trauma surveillance data. We performed univariate and bivariate analyses to describe the population and logistic regression analysis to identify predictors of mortality. SETTING: Tertiary care hospital in sub-Saharan Africa. PARTICIPANT: Patients with traumatic injuries admitted to Kamuzu Central Hospital between January 2010 and December 2012. MAIN OUTCOME MEASURES: Predictors of in-hospital mortality.

RESULTS: The study population consisted of 7559 patients, with an average age of 27 years (±18 years) and a male predominance of 76%. Road traffic injuries, falls, and assaults were the most common causes of injury. The overall mortality was 4.2%. After adjusting for age, sex, type and mechanism of injury, and shock index, head/spine injuries had the highest odds of mortality, with an odds ratio of 5.80 (2.71-12.40).

CONCLUSION AND RELEVANCE: The burden of injuries in sub-Saharan Africa remains high. At this institution, road traffic injuries are the leading cause of injury and injury-related death. The most significant predictor of in-hospital mortality is the presence of head or spinal injury. These findings may be mitigated by a comprehensive injury-prevention effort targeting drivers and other road users and by increased attention and resources dedicated to the treatment of patients with head and/or spine injuries in the hospital setting.

Language: en