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 12 publications

(6 citation statements)

References 31 publications

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“…Policymakers should: advocate for the inclusion of trauma in global surgery initiatives and raise awareness about its impact on public health to garner policy attention; develop strategies to reallocate resources effectively, ensuring a balanced approach to addressing various components of the surgical system; strengthen trauma data collection systems to enhance the visibility of traumatic conditions within the national health landscape. The analyses of existing trauma registries have been done in Cameroon [ 51 - 54 ]. Despite not being representative of the nation´s entire trauma burden, stakeholders should use this to inform future policies on trauma care alongside the creation and analysis of more trauma registries.…”

Section: Discussionmentioning

confidence: 99%

Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events

Takoutsing,

Endalle,

Senyuy

et al. 2024

Pan Afr Med J

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Introduction the burden of diseases amenable to surgery, obstetrics, trauma, and anesthesia (SOTA) care is increasing globally but low- and middle-income countries are disproportionately affected. The Lancet Commission on Global Surgery proposed National Surgical, Obstetrics, and Anesthesia Plans as national policies to reduce the global SOTA burden. These plans are dependent on comprehensive stakeholder engagement and health policy analysis. Objective: in this study, we analyzed existing national health policies and events in Cameroon to identify opportunities for SOTA policies. Methods we searched the Cameroonian Ministry of Health´s health policy database to identify past and current policies. Next, the policies were retrieved and screened for mentions of SOTA-related interventions using relevant keywords in French and English, and analyzed using the 'eight-fold path´ framework for public policy analysis. Results we identified 136 policies and events and excluded 16 duplicates. The health policies and events included were implemented between 1967 and 2021. Fifty-nine policies and events (49.2%) mentioned SOTA care: governance (n=25), infrastructure (n=21), service delivery (n=11), workforce (n=11), information management (n=10), and funding (n=8). Most policies and events focused on maternal and neonatal health, followed by anesthesia, ophthalmologic surgery, and trauma. National, multinational civil society organizations and private stakeholders supported these policies and events, and the Cameroonian Ministry of Public Health was the largest funder. Conclusion most Cameroonian SOTA-related policies and events focus on maternal and neonatal care, and health financing is the health system component with the least policies and events. Future SOTA policies should build on existing strengths while improving neglected areas, thus attaining shared global and national goals by 2030.

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Section: Discussionmentioning

confidence: 99%

Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events

Takoutsing,

Endalle,

Senyuy

et al. 2024

Pan Afr Med J

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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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“…We analyzed radiology utilization patterns in a Cameroonian trauma cohort using prospective registry data from the previously described CTR. The CTR was created in accordance with WHO Guidelines for Injury Surveillance and adapted to the local context and interest [17,19,20]. Trauma registrars followed all injured patients from presentation to hospital discharge.…”

Section: Data Sourcementioning

confidence: 99%

Failure to receive prescribed imaging is associated with increased early mortality after injury in Cameroon

Driban,

Dissak-Delon,

Carvalho

et al. 2023

PLOS Glob Public Health

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Despite having the highest rates of injury-related mortality in the world, trauma system capacity in sub-Saharan Africa remains underdeveloped. One barrier to prompt diagnosis of injury is limited access to diagnostic imaging. As part of a larger quality improvement initiative and to assist priority setting for policy makers, we evaluated trauma outcomes among patients who did and did not receive indicated imaging in the Emergency Department (ED). We hypothesize that receiving imaging is associated with increased early injury survival. We evaluated patterns of imaging performance in a prospective multi-site trauma registry cohort in Cameroon. All trauma patients enrolled in the Cameroon Trauma Registry (CTR) between 2017 and 2019 were included, regardless of injury severity. Patients prescribed diagnostic imaging were grouped into cohorts who did and did not receive their prescribed study. Patient demographics, clinical course, and outcomes were compared using chi-squared and Kruskal-Wallis tests. Multivariate logistic regression was used to explore associations between radiologic testing and survival after injury. Of 9,635 injured patients, 47.5% (4,574) were prescribed at least one imaging study. Of these, 77.8% (3,556) completed the study (COMPLETED) and 22.2% (1,018) did not receive the prescribed study (NC). Compared to COMPLETED patients, NC patients were younger (p = 0.02), male (p<0.01), and had markers of lower socioeconomic status (SES) (p<0.01). Multivariate regression adjusted for age, sex, SES, and injury severity demonstrated that receiving a prescribed study was strongly associated with ED survival (OR 5.00, 95% CI 3.32–7.55). Completing prescribed imaging was associated with increased early survival in injured Cameroonian patients. In a resource-limited setting, subsidizing access to diagnostic imaging may be a feasible target for improving trauma outcomes.

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

Cited by 12 publications

References 31 publications

Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events

Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events

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

Failure to receive prescribed imaging is associated with increased early mortality after injury in Cameroon

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