Hospital mortality following trauma: an analysis of a hospital-based injury surveillance registry in sub-Saharan Africa

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.

Keywords: Medical Knowledge; Patient Care; Systems-Based Practice; developing health care systems; trauma; trauma mortality; trauma sub-Saharan Africa.