Starr Nichole, Ayehu Mengistu, Zhuang Alex, Minalu Habtamu Tamiru, Alemu Genet Kifle, Fisseha Samuel, Chekol Sisay, Habtemariam Aklile, Hadis Makida, Alemtsehay Biruh, Mengiste Minale, Kefeni Bori Ashenafi
University of California San Francisco, San Francisco, California, USA.
ALERT Trauma Center, Addis Ababa, Ethiopia.
Trauma Surg Acute Care Open. 2024 May 21;9(1):e001453. doi: 10.1136/tsaco-2024-001453. eCollection 2024.
Injury is a major cause of death and disability in Ethiopia. ALERT Hospital, one of only three designated trauma centers in the country, has employed a basic trauma registry since its inception in 2016; however, these data had not been used. In joint efforts with the Federal Ministry of Health, we aimed to understand patient injury characteristics and predictors of mortality, to inform priorities in resource and training investments.
Data from 12 816 consecutive patients in the first 3 years of the trauma registry were reviewed retrospectively. Modified Early Warning Score was used at triage to indicate injury severity (red=critically injured, green=minor injury). No physiologic data for calculating Injury Severity Scores or in-hospital intervention data were available. Triage groups were compared and multivariate logistic regression conducted to determine predictors of in-emergency department (ED) mortality.
Most patients presented with minor injuries with 64.7% triaged as 'yellow' and 16.4% triaged as 'green', and most (75.9%) referred from another facility. Of those who were critically injured, only 31.0% arrived by ambulance. Most injuries were soft tissue (51.1%) and fractures (23.0%); when stratified by triage category, most critical ('red') patients had sustained head injuries (52.7%). Arrival by ambulance (OR 2.20, p=0.017) and head injury (OR 3.11, p<0.001) were independent predictors of death in the ED.
This study of injured patients presenting to an Ethiopian trauma center is one of the largest to date, highlighting the need for more accessible and streamlined prehospital trauma care. Opportunities for improvement include staff training in initial trauma management and implementation of a more comprehensive trauma registry containing physiologic, intervention, and outcomes data to support a robust quality improvement program. Efforts by the Federal Ministry of Health are ongoing to support these improvements in care.
Level 3, observational study.
在埃塞俄比亚，伤害是导致死亡和残疾的主要原因。ALERT医院是该国仅有的三个指定创伤中心之一，自2016年成立以来一直采用基本创伤登记系统；然而，这些数据尚未得到利用。我们与联邦卫生部共同努力，旨在了解患者的损伤特征和死亡率预测因素，为资源和培训投资的优先事项提供依据。
回顾性分析创伤登记系统前3年连续12816例患者的数据。在分诊时使用改良早期预警评分来表明损伤严重程度（红色=重伤，绿色=轻伤）。没有用于计算损伤严重程度评分的生理数据或住院干预数据。比较分诊组并进行多因素逻辑回归以确定急诊科死亡的预测因素。
大多数患者为轻伤，64.7%被分诊为“黄色”，16.4%被分诊为“绿色”，大多数（75.9%）从其他机构转诊而来。在重伤患者中，只有31.0%乘坐救护车到达。大多数损伤为软组织损伤（51.1%）和骨折（23.0%）；按分诊类别分层时，大多数危急（“红色”）患者有头部损伤（52.7%）。乘坐救护车到达（比值比2.20，p=0.017）和头部损伤（比值比3.11，p<0.001）是急诊科死亡的独立预测因素。
这项对埃塞俄比亚创伤中心就诊的受伤患者的研究是迄今为止规模最大的研究之一，强调了需要更便捷、更简化的院前创伤护理。改进机会包括对工作人员进行初始创伤管理培训，以及实施一个更全面的创伤登记系统，包含生理、干预和结果数据，以支持强有力的质量改进计划。联邦卫生部正在努力支持这些护理改进措施。
3级，观察性研究。
