The burden of trauma presenting to the government referral hospital in Freetown, Sierra Leone: An observational study

Abstract

Introduction Trauma accounts for a significant proportion of the global burden of disease, with highest mortality rates seen in Africa. This epidemic is predicted to increase with urbanisation and an aim of the Sustainable Development Goals is to reduce deaths and trauma caused by road accidents. Data available on urban trauma in Sierra Leone is limited. Methods We conducted a retrospective observational study of trauma and injury related presentations to the emergency centre (EC) of Connaught Hospital, the principal adult tertiary referral centre in Freetown, Sierra Leone between January and March 2016. Patient demographics are described with mechanism of injury. Additional data on length of stay and surgical procedures were recorded for admissions to the trauma ward. Results During the 3-month period, a total of 340 patients with injury presented to the EC, accounting for 11.6% of total attendances and 68% of adult surgical admissions. The majority were male (66%) and mean age was 26 years (IQR 15–40). The proportion of trauma presentations were higher in the evening and at weekends and 41% of patients were triaged as emergency or very urgent cases. Road traffic accidents were the most frequent cause of injury (55%) followed by falls (17%) and assaults (14%). Burns were more common in children. Head and lower limbs were the most commonly injured body parts and a minority of patients underwent surgical procedures. Median length of stay for adult patients was 4.5 days (IQR 2–11) and 7 days (IQR 4–14) for children. Discussion Injury accounts for a high burden of disease at Connaught Hospital and consumes a significant proportion of EC and hospital resources. Efforts should be directed towards strengthening the pre-hospital and emergency trauma systems with accurate, formal data collection as well as targeting injury prevention initiatives and improving road safety to reduce morbidity and mortality.

Are Primary Trauma Care (PTC) courses beneficial in low- and middle-income countries - A systematic review

“…Of note, injuries from road traffic accidents, interpersonal violence and war are among the leading causes of death in LMICs 4 . For those who survive their injuries, there is an associated high burden of morbidity accounting for an economic cost of 6% of global years lived with disability 5 .…”

“…As a result, those who sustain injuries in LMICs continue to face significant barriers to accessing the necessary trauma care 5 .…”

The characteristics and outcomes of trauma admissions to an adult general surgery ward in a tertiary teaching hospital

“…However, this is not the case with Oceania, and West, Central, and Southern sub-Saharan Africa [ 1 ]. The impact is magnified in LMICs where organised trauma systems including injury surveillance and prevention, in-hospital care and post-discharge rehabilitation, and social welfare infrastructure are poorly developed [ 4 , 11 , 12 ]. Injury surveillance in a well-developed trauma system translates to an effective resource allocation, personnel training, and quality improvement [ 2 , 4 , 10 , 12.…”

“…In many LMICs, data on injury epidemiology and patient outcome are lacking or poorly documented [ 4 , 5 , 11 , 13 ]. Most data on evidence-based interventions for RTCs, especially for non-fatal outcomes, are from high-income countries (HICs) which cannot be applied to LMICs' environments [ 4 ].…”

Guest Editorial: Introduction to the Trauma Special Issue

“…This aspect is addressed in four of the papers included in this special issue, ranging from low income to middle income countries. [3] , [5] , [6] , [7] …”