Review of a large trauma registry in Addis Ababa, Ethiopia: insights into prehospital care and provider training for trauma quality improvement

Abstract

BackgroundInjury 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.MethodsData 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.ResultsMost 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.ConclusionThis 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 of EvidenceLevel 3, observational study

Value of trauma registries in improving global trauma outcomes

“… 1 2 Tracking injury data through trauma registries establishes a critical evidence base for quality improvement initiatives and targeted interventions, which have improved outcomes in diverse settings. 3 Starr et al 4 demonstrate that registry implementation in Ethiopia comprises challenges such as inconsistent data entry resulting in data missingness. Data missingness is prevalent in trauma registries collected in well-resourced contexts and should not preclude implementation nor utilization of these data to inform interventions.…”

“…The data missingness described by Starr et al 4 demonstrates the need for trauma registries to perform continuous training, data quality review, and verification. Data collection and verification should be task-shifted to a non-clinical data team since the excessive workload of LMIC healthcare providers limits daily research involvement.…”

“…This commitment is evident and commendable in Ethiopia as the country plans to implement a comprehensive trauma registry in seven trauma hospitals. 4 Moreover, trauma quality improvement and staff training initiatives augment local provider capacities; however, the sustainability of such interventions relies on the acceptance of each hospital staff to conduct continuous review of outcomes in addition to busy clinical workloads.…”