Elderly trauma mortality in a resource-limited setting: A benchmark for process improvement

Williams, Brittney M.; Kayange, Linda; Purcell, Laura N.; Charles, Anthony; Gallaher, Jared

doi:10.1016/j.injury.2021.07.001

Cited by 7 publications

(4 citation statements)

References 39 publications

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“…Notably, the number of patients was markedly decreased in 2020 and 2021 during the pandemic, as previously discussed. The mean age increased during the study period, consistent with previous reports from Malawi showing that the proportion of elderly trauma patients was increasing [ 23 ]. In 2011, the mean age was 23.4 (SD 15.3) years and increased to 28.0 years (SD 15.3, p < 0.001) in 2021 and 2022.…”

Section: Resultssupporting

confidence: 89%

Reallocation of Hospital Resources During COVID‐19 Pandemic and Effect on Trauma Outcomes in a Resource‐Limited Setting

et al. 2022

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Background The COVID-19 pandemic has caused unprecedented disruptions to surgical care worldwide, particularly in low-resource countries. We sought to characterize the association between pre-and intra-pandemic trauma clinical outcomes at a busy tertiary hospital in Malawi. Methods We analyzed trauma patients that presented to Kamuzu Central Hospital in Lilongwe, Malawi, from 2011 through July 2021. Burn patients were excluded. We compared patients based on whether they presented before or during the pandemic (defined as starting March 11, 2020, the date of the official WHO designation). We used logistic regression modeling to estimate the adjusted odds ratio of death based on presentation. Results A total of 137,867 patients presented during the study period, with 13,526 patients during the pandemic. During the pandemic, patients were more likely to be older (mean 28 vs. 25 years, p < 0.001), male (79 vs. 74%, p < 0.001), and suffer a traumatic brain injury (TBI) as their primary injury (9.7 vs. 4.9%, p < 0.001). Crude trauma-associated mortality was higher during the pandemic at 3.7% vs. 2.1% ( p < 0.001). The odds ratio of mortality during the pandemic compared to pre-pandemic presentation was 1.28 (95% CI 1.06, 1.53) adjusted for age, sex, initial AVPU score, transfer status, injury type, and mechanism. Conclusions During the pandemic, adjusted trauma-associated mortality significantly increased at a tertiary trauma center in a low-resource setting despite decreasing patient volume. Further research is urgently needed to prepare for future pandemics. Potential targets for improvement include improving pre-hospital care and transportation, planning for intensive care utilization, and addressing nursing shortages.

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Section: Resultssupporting

confidence: 89%

Reallocation of Hospital Resources During COVID‐19 Pandemic and Effect on Trauma Outcomes in a Resource‐Limited Setting

et al. 2022

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“…The most common mechanisms of injury among geriatric patients admitted to CHUK, falls and RTAs, are consistent with known general trends for geriatric trauma [ 7 , 8 , 12 , 13 ]. The frequency of falls may be due to reduced stability among geriatric patients, and increased rates of osteoporosis in this population likely contribute to more severe fall-related injuries that require medical intervention.…”

Section: Discussionsupporting

confidence: 79%

“…As many countries in Sub-Saharan Africa experience demographic transitions and the elderly population grows, the fraction of geriatric trauma patients is rapidly increasing, as has been found in existing research in the region [7] . Studies in Sub-Saharan Africa have also found that mortality rates are associated with older age among trauma patients [ 7 , 8 ]. In 2015, there were 356,000 people aged 65 or older in Rwanda, representing 3.16% of the total population [9] .…”

Section: Introductionmentioning

confidence: 95%

Epidemiology and outcomes of geriatric trauma patients consulting at the center hospitalier universitaire de Kigali emergency department

Sabigaba,

Jing,

Mbanjumucyo

et al. 2023

African Journal of Emergency Medicine

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“…Despite the overall decline in FRI, the probability of presenting to medical attention after falling has remained relatively constant for the older adult population. For those admitted to the hospital following FRI, the in‐hospital mortality rate has previously been demonstrated to remain relatively unchanged despite the increasing availability of resources and interventions over the same period [19].…”

Section: Discussionmentioning

confidence: 99%

Fall‐Related Injuries in Malawi: Outcomes and Trends Over Time

Ngwira

Davis

et al. 2023

World j. surg.

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Background Fall-related injury (FRI) is a leading cause of injuries worldwide. Data on injury patterns and trends over time are lacking in resource-limited settings. Methods We performed a retrospective analysis of FRI at Kamuzu Central Hospital in Malawi from 2009 to 2021. Outcomes were compared between patients presenting with FRI and those with other injury mechanisms. Bivariate and multivariate regressions were used to determine predictors of presentation following falls and mortality. We also analyzed time trends. Results A total of 166,047 patients were included, of which 41,695 were patients presenting after falls (25.7%). Most FRI patients were between 5 and 45 (67.2%) and male (66.9%). Most falls occurred at home (67.3%) and resulted in extremity injuries (51.6%). The predicted probability of hospital presentation after falling is highest for children B 5 years and adults [ 60 years and decreases over time. On multivariate analysis, patients between 5 and 15 [adjusted odds ratio (AOR) 1.70, 95% confidence interval (CI) 1.63-1.77] and [ 60 (AOR 1.14, 95% CI 1.07-1.22) and women (AOR 1.13, 95% CI 1.10-1.16) are more likely to present with FRI. Compared to patients with non-FRI, those with FRI were more likely to have been injured at school (AOR 2.16, 95% CI 2.01-2.32) and during sports and recreation (AOR 4.53,. Conclusion FRI is the most common injury presentation after motor vehicle injury in this low-resource setting. This study provides essential information about FRI in Malawi over time. Our findings can help inform resource allocation and injury prevention initiatives.

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Elderly trauma mortality in a resource-limited setting: A benchmark for process improvement

Cited by 7 publications

References 39 publications

Reallocation of Hospital Resources During COVID‐19 Pandemic and Effect on Trauma Outcomes in a Resource‐Limited Setting

Reallocation of Hospital Resources During COVID‐19 Pandemic and Effect on Trauma Outcomes in a Resource‐Limited Setting

Epidemiology and outcomes of geriatric trauma patients consulting at the center hospitalier universitaire de Kigali emergency department

Fall‐Related Injuries in Malawi: Outcomes and Trends Over Time

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