Zimmerman Armand, Barcenas Loren K, Pesambili Msafiri, Sakita Francis, Mallya Simon, Vissoci Joao Ricardo Nickenig, Park Lawrence, Mmbaga Blandina T, Bettger Janet Prvu, Staton Catherine A
Duke Global Health Institute, Duke University, Durham, North Carlina, United States.
Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Afr J Emerg Med. 2022 Dec;12(4):378-386. doi: 10.1016/j.afjem.2022.08.001. Epub 2022 Aug 29.
Over 5 million people annually die from injuries and millions more sustain non-fatal injuries requiring medical care. Ninety percent of injury deaths occur in low- and middle-income countries (LMICs). This study describes the characteristics, predictors and outcomes of adult acute injury patients presenting to a tertiary referral hospital in a low-income country in sub-Saharan Africa.
This secondary analysis uses an adult acute injury registry from Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. We describe this patient sample in terms of socio-demographics, clinical indicators, injury patterns, treatments, and outcomes at hospital discharge. Outcomes include mortality, length of hospital stay, and functional independence. Associations between patient characteristics and patient outcomes are quantified using Cox proportional hazards models, negative binomial regression, and multivariable logistic regression.
Of all injury patients (n=1365), 39.0% were aged 30 to 49 years and 81.5% were men. Most patients had at least a primary school education (89.6%) and were employed (89.3%). A majority of injuries were road traffic (63.2%), fall (16.8%), or assault (14.0%) related. Self-reported comorbidities included hypertension (5.8%), HIV (3.1%), and diabetes (2.3%). Performed surgeries were classified as orthopedic (32.3%), general (4.1%), neurological (3.7%), or other (59.8%). Most patients reached the hospital at least four hours after injury occurred (53.9%). Mortality was 5.3%, median length of hospital stay was 6.1 days (IQR: 3.1, 15.0), self-care dependence was 54.2%, and locomotion dependence was 41.5%.
Our study sample included primarily young men suffering road traffic crashes with delayed hospital presentations and prolonged hospital stays. Being older, male, and requiring non-orthopedic surgeries or having HIV portends a worse prognosis. Prevention and treatment focused interventions to reduce the burden of injury mortality and morbidity at KCMC are needed to lower injury rates and improve injury outcomes.
每年有超过500万人死于伤害，还有数百万人遭受需要医疗护理的非致命伤害。90%的伤害死亡发生在低收入和中等收入国家（LMICs）。本研究描述了撒哈拉以南非洲一个低收入国家一家三级转诊医院收治的成年急性损伤患者的特征、预测因素和结局。
本二次分析使用了坦桑尼亚莫希的乞力马扎罗基督教医疗中心（KCMC）的成年急性损伤登记数据。我们从社会人口统计学、临床指标、损伤模式、治疗方法以及出院时的结局等方面描述了该患者样本。结局包括死亡率、住院时间和功能独立性。使用Cox比例风险模型、负二项回归和多变量逻辑回归对患者特征与患者结局之间的关联进行量化。
在所有损伤患者（n = 1365）中，39.0%的患者年龄在30至49岁之间，81.5%为男性。大多数患者至少接受过小学教育（89.6%）且有工作（89.3%）。大多数损伤与道路交通（63.2%）、跌倒（16.8%）或袭击（14.0%）有关。自我报告的合并症包括高血压（5.8%）、艾滋病毒（3.1%）和糖尿病（2.3%）。所进行的手术分为骨科手术（32.3%）、普通外科手术（4.1%）、神经外科手术（3.7%）或其他手术（59.8%）。大多数患者在受伤后至少4小时才到达医院（53.9%）。死亡率为5.3%，住院时间中位数为6.1天（四分位间距：3.1，15.0），自我护理依赖率为54.2%，行动依赖率为41.5%。
我们的研究样本主要包括遭受道路交通碰撞的年轻男性，他们到医院就诊延迟且住院时间延长。年龄较大、男性、需要非骨科手术或感染艾滋病毒预示着预后较差。需要采取以预防和治疗为重点的干预措施，以减轻KCMC的伤害死亡率和发病率负担，从而降低伤害发生率并改善伤害结局。
