Analysis of Prospective Trauma Registry Data in Francophone Africa: A Pilot Study from Cameroon

Abstract

Introduction Injury rates in sub-Saharan Africa are among the highest in the world, but prospective, registrybased reports from Cameroon are limited. We aimed to create a prospective trauma registry to expand the data elements collected on injury at a busy tertiary center in Yaoundé Cameroon. Methods Details of the injury context, presentation, care, cost, and disposition from the emergency department (ED) were gathered over a 6-month period, by trained research assistants using a structured questionnaire. Bivariate and multivariate models were built to explore variable relationships and outcomes.Results There were 2,855 injured patients in 6 months, comprising almost half of all ED visits. Mean age was 30 years; 73 % were male. Injury mechanism was road traffic injury in 59 %, fall in 7 %, penetrating trauma in 6 %, and animal bites in 4 %. Of these, 1,974 (69 %) were discharged home, 517 (18 %) taken to the operating room, and 14 (1 %) to the intensive care unit. The body areas most severely injured were pelvis and extremity in 43 %, head in 30 %, chest in 4 %, and abdomen in 3 %. The estimated injury severity score (eISS) was\9 in 60 %, 9-24 in 35 %, and[25 in 2 %. Mortality was 0.7 %. In the multivariate analysis, independent predictors of mortality were eISS C9 and Glasgow Coma Score B12. Road traffic injury was an independent predictor for the need to have surgery. Trauma registry results were presented to the Ministry of Health in Cameroon, prompting the formation of a National Injury Committee. Conclusions Injuries comprise a significant proportion of ED visits and utilization of surgical services in Yaoundé. A prospective approach allows for more extensive information. Thorough data from a prospective trauma registry can be used successfully to advocate for policy towards prevention and treatment of injuries.

Choice of injury scoring system in low- and middle-income countries: Lessons from Mumbai

“…When stratifying MGAP scores as low (23)(24)(25)(26)(27)(28)(29), intermediate (18)(19)(20)(21)(22) and high (3-17) risk for death, the in-hospital mortality rates were uniformly higher than in the original validation cohort of the MGAP score in France (Table 3). The area under the ROC curve for the MGAP score in the French validation cohort was 0.90, compared with 0.85 in the subset of patients with sufficient data to Fig.…”

“…Because ISS is a composite of AIS values, incomplete patient evaluation can result in underestimation of injury severity, which is a common threat in low-and middle-income countries due to lack of radiographic, intra-operative or autopsy data [22]. Several studies have used modified approaches to calculate ISS in low-and middle-income countries, such as retrospective analyses of billing codes or estimations based on initial clinical presentation [23,24]. However, even when full diagnostic information is available, ISS calculation is a labour-intensive process that requires specially trained staff, which is often unsustainable in low-and middle-income countries [7].…”

Risk factors and injury characteristics among trauma patients in the Gambia

“…Our findings suggest almost three-quarters of the injuries reported to the study hospitals occurred among men. This is consistent with similar studies in Ghana, Cameroon, and Kenya (Mock CN 2003, Juillard, Stevens et al 2014, Saidi, Mutiso et al 2014. Gender differences in developing countries are important in road traffic safety because they may be markers for differences in how men and women interact with the roadway environment.…”

Key findings from a prospective trauma registry at a regional hospital in Southwest Cameroon

“…Although reviews of hospital administrative and medical records can be a useful first step, these are often incomplete sources of information essential to the care of the acutely injured [7,13,14]. Administrative data are often inaccurate and may result in underreporting, missing data, and they often do not incorporate information pertaining to costs, outcomes, and key risk factors [15,16]. These limitations are typical of retrospective analyses of administrative records in Cameroon and similar settings [9,13,17–19].…”