Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry

Abstract

Background: Child survival initiatives historically prioritized efforts to reduce child morbidity and mortality from infectious diseases and maternal conditions. Little attention has been devoted to paediatric injuries in resource-limited settings. This study aimed to evaluate the demographics and outcomes of paediatric injury in a sub-Saharan African country in an effort to improve prevention and treatment.Methods: A prospective trauma registry was established at the two university teaching campuses of the University of Rwanda to record systematically patient demographics, prehospital care, initial physiology and patient outcomes from May 2011 to July 2015. Univariable analysis was performed for demographic characteristics, injury mechanisms, geographical location and outcomes. Multivariable analysis was performed for mortality estimates.Results: Of 11 036 patients in the registry, 3010 (27⋅3 per cent) were under 18 years of age. Paediatric patients were predominantly boys (69⋅9 per cent) and the median age was 8 years. The mortality rate was 4⋅8 per cent. Falls were the most common injury (45⋅3 per cent), followed by road traffic accidents (30⋅9 per cent), burns (10⋅7 per cent) and blunt force/assault (7⋅5 per cent). Patients treated in the capital city, Kigali, had a higher incidence of head injury (7⋅6 per cent versus 2⋅0 per cent in a rural town, P < 0⋅001; odds ratio (OR) 4⋅08, 95 per cent c.i. 2⋅61 to 6⋅38) and a higher overall injury-related mortality rate (adjusted OR 3⋅00, 1⋅50 to 6⋅01; P = 0⋅019). Pedestrians had higher overall injury-related mortality compared with other road users (adjusted OR 3⋅26, 1⋅37 to 7⋅73; P = 0⋅007).Conclusion: Paediatric injury is a significant contributor to morbidity and mortality. Delineating trauma demographics is important when planning resource utilization and capacity-building efforts to address paediatric injury in low-resource settings and identify vulnerable populations.

The Kampala Trauma Score: A 20-year track record

“…Two studies noted that blood pressure is not always an accurate measure, such as in severely hypotensive patients or morbidly obese patients 58,59 . Another publication noted the KTS does not account for the different physiological and hemodynamic status of young children 15 . Another three studies noted issues like lack of proper BP cuffs for children or a shortage of staff as hindering the ability to calculate the score 58–60 .…”

“… 11 Each component is straightforward, and relatively easy to collect in most settings, though a few trauma registries in LMICs have experienced difficulty recording respiratory rate. In response, a “modified” version of the KTS (m-KTS) emerged which excludes this variable where respiratory rate data is either unavailable or of low quality 15–17 . All three versions (the KTS, the KTS II, and the m-KTS) require simple addition to calculate and far less time and effort from clinical staff or data collectors than other ISSs.…”

Understanding the barriers and facilitators to trauma registry development in resource-constrained settings: A survey of trauma registry stewards and researchers

“…Another interesting question that requires further exploration is where most trauma registries are receiving their funding from. There are multiple sources that have been written about previously, including funds from local, provincial, or national governments [27] , NGOs, foreign grants [28][29][30] , and even private companies [22] . To understand this mix and where the money is coming from to support these registries would be a critical piece of information for those looking to establish their own trauma registries in the future and should be examined in a future study.…”

Developing Sustainable Prehospital Pediatric Care in Rwanda

“…Pediatric injuries are common in Rwanda, with 20 deaths per 100,000 people 23 . The most common pediatric injuries are falls, road traffic crashes, burns, and assault 24 . The Service d'Aide Medicale Urgente (SAMU) is a division of the Ministry of Health.…”

“…23 The most common pediatric injuries are falls, road traffic crashes, burns, and assault. 24 The Service d'Aide Medicale Urgente (SAMU) is a division of the Ministry of Health. The SAMU provides injury and emergency care to adults and children in Kigali, Rwanda (population 1.4 million) and the surrounding area through a centralized emergency dispatch center.…”