Mulima Gift, Purcell Laura N, Maine Rebecca, Bjornstad Erica C, Charles Anthony
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Afr J Emerg Med. 2021 Jun;11(2):258-262. doi: 10.1016/j.afjem.2021.03.011. Epub 2021 Apr 5.
Trauma is among the leading causes of death and disability in both adults and children worldwide. In Malawi, trauma patients are commonly brought in dead (BID). We aimed to describe the prevalence, sociodemographic, and injury-related characteristics of patients BID to Kamuzu Central Hospital (KCH), a referral hospital in Lilongwe, Malawi.
We retrospectively reviewed records of all patients BID in the trauma surveillance registry at KCH from February 2008 to September 2019. We excluded patients BID that did not present to the emergency centre, and were instead taken to the mortuary directly. We used descriptive statistics to evaluate the epidemiology of patients BID.
We reviewed 106,198 trauma records and 1889 (1.8%) were BID patients. Most patients BID were male, in both adult ( = 1337/1528, 88.4%) and children ( = 231/360, 64.9%) cohorts. The mean age was 34.7 (SD 11.9) years in adults and 7.8 (SD 5.4) years in children. Among the adult BID patients, 33.2% were unemployed, 25.6% were construction workers, and 10.1% were small business owners or managers. The common injury mechanisms in adults were road traffic-related injuries (RTIs) (47.1%) and assaults (23.6%). In children, injuries resulted from RTIs (39.7%), with 74.4% of those were pedestrians hit by cars, drowning (22.9%), and burns (12.4%). In both groups, most injuries occurred on roads (60.2%) or at home (22.1%). Reported alcohol use at the time of trauma was present in 6.3%. The police (57.9%) and privately-owned vehicles (26.6%) transported most BID patients to KCH.
Efforts to reduce prehospital trauma mortality must focus on improving prehospital care, including training the police and community in basic life support and improving resources towards prehospital trauma care. Further efforts to reduce prehospital mortality must aim to decrease injuries on the roads and at home.
创伤是全球成人和儿童死亡及残疾的主要原因之一。在马拉维，创伤患者通常送来时已死亡（BID）。我们旨在描述被送往马拉维利隆圭的一家转诊医院——卡穆祖中央医院（KCH）的BID患者的患病率、社会人口学特征和与损伤相关的特征。
我们回顾性审查了2008年2月至2019年9月KCH创伤监测登记处所有BID患者的记录。我们排除了未前往急诊中心而是直接被送往太平间的BID患者。我们使用描述性统计来评估BID患者的流行病学情况。
我们审查了106198份创伤记录，其中1889例（1.8%）为BID患者。大多数BID患者为男性，在成人（n = 1337/1528，88.4%）和儿童（n = 231/360，64.9%）队列中均如此。成人的平均年龄为34.7（标准差11.9）岁，儿童为7.8（标准差5.4）岁。在成人BID患者中，33.2%失业，25.6%为建筑工人，10.1%为小企业主或经理。成人中常见的损伤机制是道路交通相关损伤（RTIs）（47.1%）和袭击（23.6%）。在儿童中，损伤原因是RTIs（39.7%），其中74.4%是被汽车撞到的行人、溺水（22.9%）和烧伤（12.4%）。在两组中，大多数损伤发生在道路上（60.2%）或家中（22.1%）。报告创伤发生时饮酒的占6.3%。大多数BID患者由警察（57.9%）和私家车（26.6%）送往KCH。
降低院前创伤死亡率的努力必须集中在改善院前护理上，包括培训警察和社区进行基本生命支持以及增加院前创伤护理资源。进一步降低院前死亡率的努力必须旨在减少道路和家中的损伤。
