Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Emerg Med J. 2019 Jul;36(7):389-394. doi: 10.1136/emermed-2018-207559. Epub 2019 Mar 15.
In Haiti, like many low-income countries, traumatic injuries are leading causes of morbidity and mortality. Yet, little is known about the epidemiology of traumatic injuries in Haitian EDs. Improved understanding of injury patterns is necessary to strengthen emergency services and improve emergency provider education.
This was a retrospective cohort study of trauma patients at an academic hospital in central Haiti over 6 months. Visits were identified from the electronic medical record, and paper charts were manually reviewed. Data, including demographics, timing of presentation, injuries sustained, treatments received and ED disposition were extracted using a standardised form and later analysed in SAS V.9.3.
Of 1401 patients, 66% were male, and the average age was 26.8 years. Most visits were due to road traffic injuries (RTIs; 48%) followed by falls (22%). Trauma mechanism varied significantly by age (p<0.001): falls predominated in children under 5 years (56%) versus RTIs for adults (59%). Only 14% of patients injured on motorcycles used helmets and 30% of those injured in motor vehicles used seatbelts. Only 18% of patients arrived within 1 hour of the trauma. Skin or soft tissue injuries were the most common (58%), followed by extremity or pelvic fractures or dislocations (23%). Most patients (81%) were discharged, 14% were admitted or stayed over 24 hours in the ED and 0.8% died in the ED. Of the admitted patients, 61% had surgery, 79% of which were orthopaedic. Patients using helmets or seatbelts were more likely to be discharged than those not using protective equipment (p=0.008).
In this trauma population, RTIs and falls were the most common trauma mechanisms, safety feature use was rare, and most injuries were musculoskeletal. Presentation was delayed and mortality was low, but many patients required surgery. These findings have significant clinical, public health, operational and training implications.
在海地，与许多低收入国家一样，创伤是发病率和死亡率的主要原因。然而，海地急诊室创伤的流行病学情况知之甚少。为了加强急诊服务和改善急救人员教育，了解伤害模式是必要的。
这是海地中部一所学术医院 6 个月内创伤患者的回顾性队列研究。从电子病历中确定就诊，然后手动审查纸质图表。使用标准表格提取包括人口统计学、就诊时间、受伤情况、接受的治疗和急诊处置的数据，然后使用 SAS V.9.3 进行分析。
在 1401 名患者中，66%为男性，平均年龄为 26.8 岁。大多数就诊是由于道路交通伤害（48%），其次是跌倒（22%）。创伤机制随年龄显著不同（p<0.001）：56%的 5 岁以下儿童为跌倒，而 59%的成年人则为道路交通伤害。只有 14%的骑摩托车受伤的患者使用头盔，30%的乘坐机动车受伤的患者使用安全带。只有 18%的患者在创伤后 1 小时内到达。皮肤或软组织损伤最常见（58%），其次是四肢或骨盆骨折或脱位（23%）。大多数患者（81%）出院，14%住院或在急诊室停留超过 24 小时，0.8%的患者在急诊室死亡。在住院患者中，61%接受了手术，其中 61%为骨科手术。使用头盔或安全带的患者比未使用防护设备的患者更有可能出院（p=0.008）。
在这一创伤人群中，道路交通伤害和跌倒最常见，安全装置使用率低，大多数损伤为肌肉骨骼损伤。就诊时间延迟，死亡率低，但许多患者需要手术。这些发现具有重要的临床、公共卫生、运营和培训意义。
