Montreal Children's Hospital, Division of Paediatric General and Thoracic Surgery, Montreal, Quebec, Canada.
University of Florida, Division of Pediatric Surgery, Gainesville, Florida, USA.
BJS Open. 2020 Feb;4(1):78-85. doi: 10.1002/bjs5.50222. Epub 2019 Nov 17.
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.
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.
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).
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.
儿童生存计划历来优先致力于减少传染病和孕产妇疾病导致的儿童发病率和死亡率。在资源有限的环境中，儿童受伤问题很少受到关注。本研究旨在评估撒哈拉以南非洲国家的儿科损伤情况，以努力改善预防和治疗效果。
2011 年 5 月至 2015 年 7 月，在卢旺达大学的两个大学教学校区建立了一个前瞻性创伤登记处，系统地记录患者的人口统计学资料、院前护理、初始生理状况和患者结局。对人口统计学特征、损伤机制、地理位置和结局进行单变量分析。对死亡率进行多变量分析。
在登记处的 11036 名患者中，有 3010 名（27.3%）年龄在 18 岁以下。儿科患者主要为男孩（69.9%），中位年龄为 8 岁。死亡率为 4.8%。跌倒伤最为常见（45.3%），其次是道路交通伤（30.9%）、烧伤（10.7%）和钝器伤/袭击（7.5%）。在首都基加利治疗的患者头部损伤发生率更高（7.6%，而在农村城镇为 2.0%，P<0.001；比值比（OR）4.08，95%置信区间（CI）2.61 至 6.38），整体损伤相关死亡率更高（调整 OR 3.00，1.50 至 6.01；P=0.019）。行人与其他道路使用者相比，整体损伤相关死亡率更高（调整 OR 3.26，1.37 至 7.73；P=0.007）。
儿科损伤是发病率和死亡率的一个重要原因。在资源有限的环境中，确定创伤的人口统计学特征对于规划资源利用和能力建设工作以解决儿科损伤问题和确定弱势群体非常重要。
