Chokotho Linda, Croke Kevin, Mohammed Meyhar, Mulwafu Wakisa, Bertfelt Jonna, Karpe Saahil, Milusheva Sveta
Department of Surgery, College of Medicine, University of Malawi, Mahatma Gandhi, Blantyre, Malawi.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA.
Inj Epidemiol. 2022 Apr 19;9(1):14. doi: 10.1186/s40621-022-00379-5.
Large-scale multisite trauma registries with broad geographic coverage in low-income countries are rare. This lack of systematic trauma data impedes effective policy responses.
All patients presenting with trauma at 10 hospitals in Malawi from September 2018 to March 2020 were enrolled in a prospective registry. Using data from 49,241 cases, we analyze prevalence, causes, and distribution of trauma in adult patients, and timeliness of transport to health facilities and treatment.
Falls were the most common mechanism of injury overall, but road traffic crashes (RTCs) were the most common mechanism of serious injury, accounting for (48%) of trauma admissions. This pattern was consistent across all central and district hospitals, with only one hospital recording < 40% of admissions due to RTCs. 49% of RTC-linked trauma patients were not in motorized vehicles at the time of the crash. 84% of passengers in cars/trucks/buses and 48% of drivers of cars/trucks/buses from RTCs did not wear seatbelts, and 52% of motorcycle riders (driver and passenger) did not wear helmets. For all serious trauma cases (defined as requiring hospital admission), median time to hospital arrival was 5 h 20 min (IQR 1 h 20 min, 24 h). For serious trauma cases that presented on the same day that trauma occurred, median time to hospital arrival was 2 h (IQR 1 h, 11 h). Significant predictors of hospital admission include being involved in an RTC, age > 55, Glasgow Coma Score < 12, and presentation at hospital on a weekend.
RTCs make up almost half of hospitalized trauma cases in this setting, are equally common in referral and district hospitals, and are an important predictor of injury severity. Pedestrians and cyclists are just as affected as those in vehicles. Many of those injured in vehicles do not take adequate safety precautions. Most trauma patients, including those with serious injuries, do not receive prompt medical attention. Greater attention to safety for both motorized and especially non-motorized road users, and more timely, higher quality emergency medical services, are important policy priorities for Malawi and other developing countries with high burdens of RTC trauma.
在低收入国家，具有广泛地理覆盖范围的大规模多地点创伤登记系统很少见。缺乏系统的创伤数据阻碍了有效的政策应对。
2018年9月至2020年3月期间，在马拉维的10家医院就诊的所有创伤患者均被纳入前瞻性登记系统。利用49241例病例的数据，我们分析了成年患者创伤的患病率、原因和分布情况，以及转运至医疗机构和治疗的及时性。
总体而言，跌倒为最常见的受伤机制，但道路交通碰撞（RTC）是导致严重受伤的最常见机制，占创伤入院病例的48%。这种模式在所有中心医院和地区医院都是一致的，只有一家医院记录的因RTC导致的入院病例不到40%。49%与RTC相关的创伤患者在碰撞发生时未乘坐机动车。在RTC中，84%的轿车/卡车/公交车乘客和48%的轿车/卡车/公交车司机未系安全带，52%的摩托车骑行者（司机和乘客）未戴头盔。对于所有严重创伤病例（定义为需要住院治疗），到达医院的中位时间为5小时20分钟（四分位间距1小时20分钟，24小时）。对于创伤发生当天就诊的严重创伤病例，到达医院的中位时间为小时（四分位间距1小时，11小时）。住院的重要预测因素包括卷入RTC、年龄>55岁、格拉斯哥昏迷评分<12分以及周末到医院就诊。
在这种情况下，RTC占住院创伤病例的近一半，在转诊医院和地区医院同样常见，并且是损伤严重程度的重要预测因素。行人和骑自行车的人与乘车人员受影响程度相同。许多车内受伤人员未采取足够的安全预防措施。大多数创伤患者，包括重伤患者，未得到及时的医疗救治。更加关注机动化道路使用者尤其是非机动化道路使用者的安全，以及更及时、更高质量的紧急医疗服务，是马拉维和其他RTC创伤负担较重的发展中国家重要的政策优先事项。
