Epidemiologic Characteristics of Pediatric Trauma Patients Receiving Prehospital Care in Kigali, Rwanda

Abstract

Background Pediatric trauma is a significant public health problem in resource-constrained settings; however, the epidemiology of injuries is poorly defined in Rwanda. This study describes the characteristics of pediatric trauma patients transported to the emergency department (ED) of the Centre Hospitalier Universitaire de Kigali by emergency medical services in Kigali, Rwanda. Methods This cohort study was conducted at the Centre Hospitalier Universitaire de Kigali from December 2012 to February 2015. Patients 15 years or younger brought by emergency medical services for injuries to the ED were included. Prehospital and hospital-based data on demographics, injury characteristics, treatments, and outcomes were gathered. Results Data from 119 prehospital patients were accrued, with corresponding hospital data for 64 cases. The median age was 9.5 years, with most patients being male (67.2%). Injured children were most frequently brought from a street setting (69.6%). Road traffic injuries accounted for 69.4% of all mechanisms, with more than two thirds due to pedestrians being struck. Extremity trauma was the most common region of injury (53.1%), followed by craniofacial (46.8%). The most frequent ED interventions were analgesia (66.1%) and intravenous fluids (43.6%). Half of the 16 obtained head computed tomography scans demonstrated acute pathology. Twenty-eight patients (51.9%) were admitted, with 57.1% requiring surgery and having a median in-hospital care duration of 9 days (range, 1–122 days). Conclusions In this cohort of Rwandan pediatric trauma patients, injuries to the extremities and craniofacial regions were most common. Theses traumatic patterns were predominantly due to road traffic injury, suggesting that interventions addressing the prevention of this mechanism, and treatment of the associated injury patterns, may be beneficial in the Rwandan setting.

Impact of emergency medicine training implementation on mortality outcomes in Kigali, Rwanda: An interrupted time-series study

“…Cases were identified and data were queried from institutional records via protocolised methods, as previously described [25] , [26] , [27] , [28] . Briefly, using a multipoint composite index generated from an electronic hospital database, all EC cases during each month of the accruement periods were identified.…”

Elaborated plan for incoming surgical emergency management in Sub-Saharan Africa

“…Moreover, this study recommended establishment of effective measures for management of these injuries. 12 This was also emphasized by Stephens et al 13 through a study done in Uganda that limited resources settings significantly affect management of lower limb injury specifically femur and tibia fractures, as the study resulted in showing that volumes of cases outweighed available resources. 13 Although a little is known about the pattern of injury in our region, there was a report in Rwanda where 7% of surgical admissions were due to injury; moreover, Yamuragiye et al, 1 through a retrospective descriptive study, reported RTIs to be the main cause of injury and also reported that young males were the most vulnerable group.…”

“…In Rwanda, a study done by Aluisio et al 12 demonstrated that limb trauma followed by head injury were the prevalent pediatric injuries received. Moreover, this study recommended establishment of effective measures for management of these injuries.…”

Prehospital epidemiology and management of injured children in Kigali, Rwanda

“…SAMU has 70 employees including staff, dispatchers, Basic Life Support (BLS)trained drivers, Advanced Cardiovascular Life Support (ACLS)/BLS-trained nurses and non-physician anaesthetists. They offer emergency transportation throughout Rwanda and interventional care in Kigali, including stabilisation of patients, provision of life saving interventions and emergent transportation to the nearest healthcare facility 5–7…”

“…One study in Rwanda showed that children represented approximately 8% of all injured patients seen in the prehospital setting in Kigali 6. A study including 64 paediatric trauma cases found that the most common injuries involved the head and extremities 7. Both studies, however, had small sample sizes and lacked description of the mechanism of injury, acuity and management.…”