Analysis of a National Trauma Registry in Cameroon: Implications for Prehospital Care Strengthening

Juillard, Catherine; Dicker, Rochelle; Nwanna-Nzewunwa, Obieze; Christie, S. Ariane; Carvalho, Melissa; Motwani, Girish; Dissak-Delon, Fanny Nadia; Ngamby, Marquise Kouo; Mballa, Georges Alain Etoundi; Nsongoo, Pierre; Saidou, Arabo; Molony, David

doi:10.5005/jp-journals-10030-1216

Cited by 9 publications

(3 citation statements)

References 31 publications

(28 reference statements)

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“…Four regional hospitals in Cameroon participate in national CTR data collection [ 21 , 22 , 24 ]. One facility is a 710-bed public national referral hospital that serves a catchment population greater than 3 million.…”

Section: Methodsmentioning

confidence: 99%

“…We extracted data from the previously described CTR at four participating hospitals [ 18 , 22 ]. All injured patients presenting to the emergency departments of the four participating hospitals between 2017 and 2019 and enrolled in the CTR were included.…”

Section: Methodsmentioning

confidence: 99%

“…This finding likely underrepresents the true prevalence of injury, as a population-based survey discovered that only about 60% of injured patients seek formal care [ 20 ]. Since 2015, the Cameroon Trauma Registry (CTR) has collected detailed data on injured patients at multiple sites in Cameroon to provide a basis for ongoing trauma quality improvement [ 21 , 22 ]. As in many LMICs, routine calculation of conventional anatomic injury scores such as ISS has not been widely feasible in Cameroon due to limited availability of cross-sectional imaging.…”

Section: Introductionmentioning

confidence: 99%

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Back to the basics: Clinical assessment yields robust mortality prediction and increased feasibility in low resource settings

Yost

Carvalho

Mbuh

et al. 2023

PLOS Glob Public Health

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Introduction Mortality prediction aids clinical decision-making and is necessary for trauma quality improvement initiatives. Conventional injury severity scores are often not feasible in low-resource settings. We hypothesize that clinician assessment will be more feasible and have comparable discrimination of mortality compared to conventional scores in low and middle-income countries (LMICs). Methods Between 2017 and 2019, injury data were collected from all injured patients as part of a prospective, four-hospital trauma registry in Cameroon. Clinicians used physical exam at presentation to assign a highest estimated abbreviated injury scale (HEAIS) for each patient. Discrimination of hospital mortality was evaluated using receiver operating characteristic curves. Discrimination of HEAIS was compared with conventional scores. Data missingness for each score was reported. Results Of 9,635 presenting with injuries, there were 206 in-hospital deaths (2.2%). Compared to 97.5% of patients with HEAIS scores, only 33.2% had sufficient data to calculate a Revised Trauma Score (RTS) and 24.8% had data to calculate a Kampala Trauma Score (KTS). Data from 2,328 patients with all scores was used to compare models. Although statistically inferior to the prediction generated by RTS (AUC 0.92–0.98) and KTS (AUC 0.93–0.99), HEAIS provided excellent overall discrimination of mortality (AUC 0.84–0.92). Among 9,269 patients with HEAIS scores was strongly predictive of mortality (AUC 0.93–0.96). Conclusion Clinical assessment of injury severity using HEAIS strongly predicts hospital mortality and far exceeds conventional scores in feasibility. In contexts where traditional scoring systems are not feasible, utilization of HEAIS could facilitate improved data quality and expand access to quality improvement programming.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%