Botchey Isaac M, Hung Yuen W, Bachani Abdulgafoor M, Paruk Fatima, Mehmood Amber, Saidi Hassan, Hyder Adnan A
Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.
Surgery. 2017 Dec;162(6S):S45-S53. doi: 10.1016/j.surg.2017.01.030. Epub 2017 Apr 3.
Injury is a leading cause of disability and death worldwide, accounting for over 5 million deaths each year. The injury burden is higher in low- and middle-income countries where more than 90% of injury-related deaths occur. Despite this burden, the use of prospective trauma registries to describe injury epidemiology and outcomes is limited in low- and middle-income countries. Kenya lacks robust data to describe injury epidemiology and care. The objective of this study was to investigate the epidemiology and outcomes of injuries at 4 referral hospitals in Kenya using hospital-based trauma registries.
From January 2014 to May 2015, all injured patients presenting to the casualty departments of Kenyatta National, Thika Level 5, Machakos Level 5, and Meru Level 5 Hospitals were enrolled prospectively. Data collected included demographic characteristics, type of prehospital care received, prehospital time, injury pattern, and outcomes.
A total of 14,237 patients were enrolled in our study. Patients were predominantly male (76.1%) and young (mean age 28 years). The most common mechanisms of injury were road traffic injuries (36.8%), falls (26.4%), and being struck/hit by a person or object (20.1%). Burn was the most common mechanism of injury in the age category under 5 years. Body regions commonly injured were lower extremity (35.1%), upper extremity (33.4%), and head (26.0%). The overall mortality rate was 2.4%. Significant predictors of mortality from multivariate analysis were Glasgow Coma Scale ≤12, estimated injury severity score ≥9, burns, and gunshot injuries.
Hospital-based trauma registries can be important sources of data to study the epidemiology of injuries in low- and middle-income countries. Data from such trauma registries can highlight key needs and be used to design public health interventions and quality-of-care improvement programs.
损伤是全球致残和致死的主要原因，每年导致超过500万人死亡。低收入和中等收入国家的损伤负担更高，超过90%与损伤相关的死亡发生在这些国家。尽管有如此重的负担，但在低收入和中等收入国家，使用前瞻性创伤登记来描述损伤流行病学和结局的情况却很有限。肯尼亚缺乏描述损伤流行病学和医疗情况的有力数据。本研究的目的是利用基于医院的创伤登记来调查肯尼亚4家转诊医院的损伤流行病学和结局。
2014年1月至2015年5月，前瞻性纳入所有前往肯雅塔国家医院、锡卡五级医院、马查科斯五级医院和梅鲁五级医院急诊科就诊的受伤患者。收集的数据包括人口统计学特征、院前接受的护理类型、院前时间、损伤模式和结局。
共有14237名患者纳入我们的研究。患者以男性为主（76.1%）且较为年轻（平均年龄28岁）。最常见的损伤机制是道路交通伤（36.8%）、跌倒（26.4%）以及被人或物体撞击（20.1%）。烧伤是5岁以下年龄组最常见的损伤机制。常见受伤身体部位为下肢（35.1%）、上肢（33.4%）和头部（26.0%）。总体死亡率为2.4%。多变量分析中死亡的显著预测因素为格拉斯哥昏迷量表评分≤12、估计损伤严重程度评分≥9、烧伤和枪伤。
基于医院的创伤登记可以成为研究低收入和中等收入国家损伤流行病学的重要数据来源。这些创伤登记的数据可以突出关键需求，并用于设计公共卫生干预措施和改善医疗质量的项目。
