Changing state of pediatric injuries in South Africa: An analysis of surveillance data from a Pediatric Emergency Department from 2007 to 2011

Wesson, Hadley K.H.; Bachani, Abdulgafoor M.; Mtambeka, Patricia; Schulman, Dorothy; Mavengere, Chiedza; Millar, Alastair J. W.; Hyder, Adnan A.; As, A B van

doi:10.1016/j.surg.2017.03.019

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…17,18 We also noticed a high rate of underage victims in Cape Town, which shows the effect of armed violence on an extremely vulnerable group. 19,20 Most patients were admitted to our hospital after an inter-hospital transfer, although 83% were not severely injured (ISS lower than 15) and were inadequate referrals for tertiary emergency care. Trauma overload at local township hospitals, resource restrictions or an initial overestimation of injury severity might be reasons for this.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and injury severity of 294 extremity gunshot wounds in ten months: a report from the Cape Town trauma registry

Engelmann¹,

Maqungo²,

Laubscher³

et al. 2019

SA orthop. j.

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Aims: To describe the epidemiology and injury severity of patients with extremity gunshot injuries in an area with a high rate of interpersonal violence. Patients and methods: This is a prospective cohort study of patients who presented with an extremity gunshot injury and were recorded as part of a trauma registry at a large tertiary care hospital in Cape Town, South Africa, between June 2015 and April 2016. Patient demographics, injury severity scores, injury patterns and referral pathways were evaluated. Results: Of 1 123 gunshot trauma admissions in ten months, 290 (25.8%) patients (91.5% males, n=269) with a median age of 26 years (IQR 13.0) presented with extremity injuries. Median injury severity score (ISS) was 4.0 (IQR 8.0). Only one-fifth of patients had an ISS of 15 or more (n=50, 17%). Upper extremity injuries were associated with a higher risk of fractures (RR 2.15, p=0.05), higher number of nerve injuries (p=0.01), and a two times higher mean ISS (p=0.01). Admissions between 7pm and 7am with limited staffing at the emergency department were twice as high as the day admissions (n=169, 57.5% versus n=79, 26.9%). Conclusion: There is a high trauma load on the emergency department and orthopaedic service due to extremity gunshot injuries. Although upper extremity gunshot wounds constituted a red flag for higher injury severity, the overall injury severity was low. Inadequate timing and selection of emergency referrals of patients with low ISS are avoidable aggravators of this burden and should be targeted to increase efficiencies in the care of these patients.

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Section: Discussionmentioning

confidence: 99%

Epidemiology and injury severity of 294 extremity gunshot wounds in ten months: a report from the Cape Town trauma registry

Engelmann¹,

Maqungo²,

Laubscher³

et al. 2019

SA orthop. j.

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“…In Sub-Saharan Africa (SSA), injuries are a significant cause of mortality, and for every death, there are thousands of non-fatal injuries, which are likely under-reported, but result in serious disabilities which might be preventable with timely treatment (WHO 2013 ; Wesson et al 2017 ). While the burden of traumatic injury is very high, many of these injuries can be prevented by simple and cost effective interventions that can be instituted at the community level, targeting children and families (Delmira de Sousa Petersburgo CEK 2010 ; Sleet 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…While the burden of traumatic injury is very high, many of these injuries can be prevented by simple and cost effective interventions that can be instituted at the community level, targeting children and families (Delmira de Sousa Petersburgo CEK 2010 ; Sleet 2018 ). The lack of published trauma data (Croke et al 2020 ), and specifically pediatric injury data in the region, prevents comprehensive understanding of factors that are associated with pediatric injuries, care processes and outcomes; all of which can support the development of interventions to prevent injury occurrence, post-injury care and long-term rehabilitation care (Wesson et al 2017 ; Herbert et al 2012 ; Gallaher et al 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Pediatric trauma burden in Tanzania: analysis of prospective registry data from thirteen health facilities

et al. 2022

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Background Trauma is among the leading causes of morbidity and mortality among pediatric and adolescent populations worldwide, with over ninety percent of childhood injuries occurring in low-income and middle-income countries. Lack of region-specific data on pediatric injuries is among the major challenges limiting the ability of health systems to implement interventions to prevent injuries and improve outcomes. We aim to characterize the burden of pediatric health injuries, initial healthcare interventions and outcomes seen in thirteen diverse healthcare facilities in Tanzania. Methods This was a prospective cohort study of children aged up to 18 years presenting to emergency units (EUs) of thirteen multi-level health facilities in Tanzania from 1st October 2019 to 30th September 2020. We describe injury patterns, mechanisms and early interventions performed at the emergency units of these health facilities. Results Among 18,553 trauma patients seen in all thirteen-health facilities, 4368 (23.5%) were children, of whom 2894 (66.7%) were male. The overall median age was 8 years (Interquartile range 4–12 years). Fall 1592 (36.5%) and road traffic crash (RTC) 840 (19.2%) were the top mechanisms of injury. Most patients 3748 (85.8%) arrived at EU directly from the injury site, using motorized (two or three) wheeled vehicles 2401 (55%). At EU, 651 (14.9%) were triaged as an emergency category. Multiple superficial injuries (14.4%), fracture of forearm (11.7%) and open wounds (11.1%) were the top EU diagnoses, while 223 (5.2%) had intracranial injuries. Children aged 0–4 years had the highest proportion (16.3%) of burn injuries. Being referred and being triaged as an emergency category were associated with high likelihood of serious injuries with adjusted odds ratio (AOR) 4.18 (95%CI 3.07–5.68) and 2.11 (95%CI 1.75–2.56), respectively. 1095 (25.1%) of patients were admitted to inpatient care, 14 (0.3%) taken to operation theatre, and 25 (0.6%) died in the EU. Conclusions In these multilevel health facilities in Tanzania, pediatric injuries accounted for nearly one-quarter of all injuries. Over half of injuries occurred at home. Fall from height was the leading mechanism of injury, followed by RTC. Most patients sustained fractures of extremities. Future studies of pediatric injuries should focus on evaluating various preventive strategies that can be instituted at home to reduce the incidence and associated impact of such injuries.

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“…While the burden of traumatic injury is very high, many of these injuries can be prevented by simple and cost effective interventions that can be instituted at the community level, targeting children and families (8). The lack of published trauma data (9) and speci cally paediatric injury data in the region prevents the understanding of factors that are associated with paediatric injuries, care processes and outcomes; all of which can support the development of interventions to prevent injury occurrence, post injury care, and long-term rehabilitation care (10)(11)(12) In Tanzania, like most LMICs, there is paucity of published data on paediatric injury, which hampers the capacity of health policymakers to understand the burden of pediatric trauma and to prioritize and design effective interventions, such as customizing resources to cater for the needs of management of paediatric injuries. In an effort to understand the burden of paediatric injuries, care process and outcome of paediatric injuries in Tanzania, we undertook a study to describe the causes, patterns, interventions and outcomes of paediatric injuries, among patients presenting at the Emergency Units (EUs) of thirteen multi-level health facilities that include the diverse scale of administrative structure of Tanzania's public health infrastructure.…”

Section: Introductionmentioning

confidence: 99%

Paediatric Trauma Burden in Tanzania: Analysis of Prospective Registry Data from Thirteen Health Facilities

Sawe

Milusheva²,

Croke

et al. 2021

Preprint

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BackgroundTrauma is among the leading causes of morbidity and mortality among paediatric and adolescent populations worldwide, with over ninety percent of childhood injuries occurring in low-income and middle-income countries. Lack of region-specific data on paediatric injuries is among the major challenges limiting ability to implement interventions to prevent injuries and improve outcomes. We aimed to characterise the burden of paediatric injuries seen at thirteen diverse health facilities in Tanzania.MethodsThis was a prospective descriptive cohort study of children aged up to 18 years, and presenting to emergency units (EUs) of thirteen multi-level health facilities in Tanzania from 1st October 2019 to 30th September 2020. We describe injury patterns, mechanisms and early interventions performed at the emergency units of these health facilities.ResultsAmong 18,553 trauma patients seen in all thirteen-health facilities, 4368 (23.5%) were children, of whom 2894 (66.7%) were male. The overall median age was 8 years (Interquartile range 4-12 years). Fall 1592 (36.5%) and Road Traffic Crash (RTC) 840 (19.2%) were the top mechanisms of injury. Most patients 3748 (85.8%) arrived at EU directly from the injury site, using motorized (two or three) wheeled vehicles 2401 (55%). At EU 651 (14.9%) were triaged as an emergency category. Multiple superficial injuries (14.4%), fracture of forearm (11.7%), and open wounds (11.1%) were the top EU diagnoses, while 223 (5.2%) had intracranial injuries. Children aged 0-4 years had the highest proportion (16.3%) of burn injuries. Being referred, and being triaged as an emergency category was associated with high likelihood of serious injuries with risk ratio 3.3 (95%CI 2.7-4.0) and 2.3 (95% CI 2.0-2.8) respectively. 1095 (25.1%) of patients were admitted to inpatient care and 25 (0.6%) died in the EU.ConclusionsIn these multilevel health facilities in Tanzania, paediatric injuries accounted for nearly one-quarter of all injuries. Over half of injuries occurred at home. Fall from height was the leading mechanism of injury, followed by RTC. Most patients sustained fractures of extremities. Future studies of paediatric injuries should focus on evaluating various preventive strategies that can be instituted at home to reduce the incidence and associated impact of such injuries.

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Changing state of pediatric injuries in South Africa: An analysis of surveillance data from a Pediatric Emergency Department from 2007 to 2011

Cited by 9 publications

References 13 publications

Epidemiology and injury severity of 294 extremity gunshot wounds in ten months: a report from the Cape Town trauma registry

Epidemiology and injury severity of 294 extremity gunshot wounds in ten months: a report from the Cape Town trauma registry

Pediatric trauma burden in Tanzania: analysis of prospective registry data from thirteen health facilities

Paediatric Trauma Burden in Tanzania: Analysis of Prospective Registry Data from Thirteen Health Facilities

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