The Prehospital Burden of Disease due to Trauma in KwaZulu‐Natal: The Need for Afrocentric Trauma Systems

Hardcastle, Timothy Craig; Finlayson, Melissa; Heerden, Marc van; Johnson, Ben; Samuel, Candice; Muckart, David James Jackson

doi:10.1007/s00268-012-1852-1

Cited by 32 publications

(40 citation statements)

References 47 publications

(49 reference statements)

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“…However, globally it would appear that in contrast to other public health problems such as cardiac diseases and infectious diseases, TBI has not been subject to adequate investigation or surveillance. [11][12][13][14][15][16][17][18] SA, with its excessive trauma burden, is typical in this regard. There is no national trauma registry to track the epidemic in general and there are only a handful of local reports and audits which document the situation as it pertains to TBI in SA.…”

Section: Researchmentioning

confidence: 99%

The spectrum and outcome of paediatric traumatic brain injury in KwaZulu-Natal Province, South Africa has not changed over the last two decades

et al. 2017

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Section: Researchmentioning

confidence: 99%

The spectrum and outcome of paediatric traumatic brain injury in KwaZulu-Natal Province, South Africa has not changed over the last two decades

et al. 2017

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“…Regardless of injury severity, the majority of patients are transported to district hospitals, which have limited imaging and surgical facilities. [17] If outcome is to be improved, delays in transfer to an appropriate level of care must be minimised, multiple transfers between health facilities discouraged, and standard referral patterns abandoned. [17] Importantly, our mortality statistics do not reflect the extent of the trauma problem, as our results exclude deaths at the scene and address only critically injured children admitted to a level 1 TICU.…”

Section: Fig 2 Frequency (%) Of Body Regions Injured According To Imentioning

confidence: 99%

“…[17] If outcome is to be improved, delays in transfer to an appropriate level of care must be minimised, multiple transfers between health facilities discouraged, and standard referral patterns abandoned. [17] Importantly, our mortality statistics do not reflect the extent of the trauma problem, as our results exclude deaths at the scene and address only critically injured children admitted to a level 1 TICU. For every severely injured child there are many more who have suffered less devastating injuries and are admitted to regional or district hospitals.…”

Section: Fig 2 Frequency (%) Of Body Regions Injured According To Imentioning

confidence: 99%

The wrong and wounding road: Paediatric polytrauma admitted to a level 1 trauma intensive care unit over a 5-year period

Naidoo

Muckart

2015

S Afr Med J

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Corresponding author: D J J Muckart (davidmuc@ialch.co.za)Background. Injury in childhood is a major cause of potentially preventable morbidity and mortality. In order to implement effective preventive strategies, epidemiological data on mechanisms of injury and outcome are essential. Objectives. To assess the causation, severity of injury, morbidity and mortality of paediatric trauma admitted to a level 1 trauma intensive care unit (TICU). Methods. Children were defined as being <16 years of age. The study covered the 5-year period January 2008 -December 2012. Eligible patients were identified from a prospective database maintained in the level 1 TICU at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Data extracted were referral source, mechanism of injury, age and gender distribution, injury severity score (ISS), anatomical distribution of injury and mortality. Results. A total of 181 patients admitted during the study period accounted for 15.9% of all admissions. There were 84 females (46.4%) and 97 males (53.6%), with a median age of 7 years (interquartile range (IQR) 4 -10). Sources of admission were directly from the scene in 38 cases (21.0%), from a primary healthcare facility in 47 (26.0%), from a regional hospital in 56 (31.0%) and from a tertiary facility in 40 (22.0%). Mortality rates according to location of transfer were regional hospital 8 deaths (30.8%), tertiary facility 7 (26.9%), primary health clinic 7 (26.9%), and from the scene 4 (15.4%). Mechanisms of injury were pedestrian-motor vehicle collision (PMVC) in 105 cases (58.0%), motor vehicle passenger in 38 (21.0%), non-vehicular blunt trauma in 18 (10.0%), gunshot wounds (GSWs) in 12 (6.6%), stab wounds in 6 (3.3%), bull goring in 1 (0.5%) and bicycle accident 1 (0.5%). The median ISS for all admissions was 25 . ISSs were >25 in 98 patients (54.1%), 16 -25 in 51 (28.2%), 9 -15 in 9 (4.9%) and <9 in 13 (7.2%); 61.9% of patients had head injuries, 48.1% injuries to the extremities, 41.4% abdominal trauma, 40.3% thoracic trauma, 20.4% external soft-tissue trauma, 9.9% cervical injury and 9.4% facial trauma. There were 26 deaths (14.4%), of which PMVCs accounted for 16 (61.5%), motor vehicle passengers for 7 (26.9%), blunt trauma for 2 (7.7%) and GSWs for 1 (3.8%). The majority of deaths (92%) were of patients with an ISS >25. Of the 26 patients who died, 88.4% had a head injury, 46.2% an extremity injury, 38.5% an external injury, 34.6% abdominal or chest injuries, 19.2% neck injury and 11.5% facial injury. Conclusions. Motor vehicle-related injuries, especially PMVCs, dominate severe paediatric trauma and there is an urgent need for more road traffic education and stringent measures to decrease the incidence and associated morbidity and mortality.

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“…A study on patients with traumatic brain injuries in an area without a standardized trauma system showed a substantially longer time for patient arrival in the hospital for definitive treatment when those patients had to be transferred first [31]. Hardcastle et al [27] reported for an African country the prehospital trauma service was below nationally accepted time norms because of the lack of an appropriate trauma system. These studies suggest a potential benefit of the development of trauma systems adapted to every country's requirements.…”

Section: Discussionmentioning

confidence: 99%

Trauma Care in Germany: An Inclusive System

Sturm

Pape²,

Dienstknecht³

2013

Clinical Orthopaedics &Amp; Related Research

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The Prehospital Burden of Disease due to Trauma in KwaZulu‐Natal: The Need for Afrocentric Trauma Systems

Cited by 32 publications

References 47 publications

The spectrum and outcome of paediatric traumatic brain injury in KwaZulu-Natal Province, South Africa has not changed over the last two decades

The spectrum and outcome of paediatric traumatic brain injury in KwaZulu-Natal Province, South Africa has not changed over the last two decades

The wrong and wounding road: Paediatric polytrauma admitted to a level 1 trauma intensive care unit over a 5-year period

Trauma Care in Germany: An Inclusive System

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