Trauma Systems in Kenya

Wesson, Hadley K.H.; Stevens, Kent A.; Bachani, Abdulgafoor M.; Mogere, Stephen; Akungah, Daniel; Nyamari, Jackim; Wekesa, John Masasabi; Hyder, Adnan A.

doi:10.1177/1049732314562890

Cited by 27 publications

(12 citation statements)

References 17 publications

(22 reference statements)

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“…These findings are collaborated by other studies that have recorded a high percentage of pre hospital deaths [8,24]. While this may be an indication of the initial seriousness of the injury, it may also be due to other factors such as weak pre-hospital care systems [24–26]. The pre-hospital care systems in developing countries have been shown to be inefficient in infrastructure and human resources capacity as shown in a study by Wesson et al [24].…”

Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 72%

“…While this may be an indication of the initial seriousness of the injury, it may also be due to other factors such as weak pre-hospital care systems [24–26]. The pre-hospital care systems in developing countries have been shown to be inefficient in infrastructure and human resources capacity as shown in a study by Wesson et al [24]. In Kenya, devolution of health services including ambulance services took place in 2013 and sub-national entities sought to increase the number of ambulances in their jurisdiction.…”

Section: Discussionmentioning

confidence: 99%

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Demographic profile and pattern of fatal injuries in Nairobi, Kenya, January–June 2014

2017

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BackgroundViolence and Injuries are a significant global public health concern characterized by marked regional variation in incidence. Approximately five million people die from injuries each year, accounting 9% of all deaths worldwide. In Kenya, injuries are increasingly becoming a cause of hospital admissions and mortality where they account for 10% of all the deaths. The objective of this study was to determine the magnitude, demographic profile and pattern of fatal injuries in Nairobi.MethodsRetrospective review of death certificates from the Department of Civil Registration was done for deaths caused by injuries that occurred in Nairobi during the period, January to June 2014. Data was collected using a standardized form. Data entry, cleaning and analysis was done using Epi info version 7.0.ResultsA total of 11,443 records were reviewed. From this data, deaths resulting from injuries were 1,208 accounting for 10.6% of all recorded deaths. Majority of the deaths resulting from injuries occurred in persons aged 25 to 44 years (48.1%). Males accounted for 85% of all the injuries. The leading cause of injury was assault by blunt force at 30.5%, followed by road traffic injuries at 25.9% and fire arm injuries at 15%. Pre-hospital deaths accounted for 51.4% of all the deaths. Nineteen percent of the deaths resulting from injuries had autopsies performed on them.ConclusionOur study found that injuries are an important cause of fatality in Nairobi, accounting for one in ten deaths. There is need for multisectoral collaboration as some of the preventive measures that target the most prevalent injuries such as assault and road traffic injuries lie outside the health sector. There exists information gaps on the death certificates hence there is need to adequately capacity build both clinicians and death certifiers. There is also a need to revise the death certificates and to improve the pre-hospital care system for the injured persons.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3958-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Demographic profile and pattern of fatal injuries in Nairobi, Kenya, January–June 2014

2017

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“…About 70% of the trauma patients included in the present study arrived at the ED by police car, taxi, or private car, which is in line with findings in previous studies [ 12 , 29 ]. This mode of arrival shows significant gaps in pre-hospital organization resulting in a delay of definitive care.…”

Section: Discussionsupporting

confidence: 92%

Potential benefits of triage for the trauma patient in a Kenyan emergency department

et al. 2018

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BackgroundImproved trauma management can reduce the time between injury and medical interventions, thus decreasing morbidity and mortality. Triage at the emergency department is essential to ensure prioritization and timely assessment of injured patients. The aim of the present study was to investigate how a lack of formal triage system impacts timely intervention and mortality in a sub-Saharan referral hospital. Further, the study attempts to assess potential benefits of triage towards efficient management of trauma patients in one middle income country.MethodsA prospective descriptive study was conducted. Adult trauma patients admitted to the emergency department during an 8-month period at Moi Teaching and Referral Hospital in Eldoret, Kenya, were included. Mode of arrival and vital parameters were registered. Variables included in the analysis were Injury Severity Score, time before physician’s assessment, length of hospital stay, and mortality. The patients were retrospectively categorized according to the Rapid Emergency Triage and Treatment System (RETTS) from patient records.ResultsA total of 571 patients were analyzed, with a mean Injury Severity Score of 12.2 (SD 7.7) with a mean length of stay of 11.6 (SD 18.3) days. The mortality rate was 1.8%. The results obtained in this study illustrate that trauma patients admitted to the emergency department at Eldoret are not assessed in a timely fashion, and the time frame recommendations postulated by RETTS are not adhered to. Assessment of patients according to the triage algorithm used revealed a significantly higher average Injury Severity Score in the red category than in the other color categories.ConclusionThe results from this study clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. This is further demonstrated by the retrospective triage classification of patients, which identified patients with high ISS as in urgent need of care. Since no significant difference in to time to assessment regardless of injury severity was observed, the need for a well-functioning triage system is apparent.

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“…According to World Health Organization, Kenya has a particularly high burden of injuries, accounting for 88.4 deaths per population of 100,000 per year [7] . However, despite recent attempts to prioritise injury prevention in Kenya, trauma care and trauma care systems (for both adults and children) have not been adequately assessed [8] . Given such a heavy paediatric trauma burden on sub-Saharan countries and on Kenya, there is thus a need for research and policy development to help curb the related morbidity and mortality; but first, documentation of causes, morbidity, and mortality are essential for planning, implementation and evaluation of these policies.…”

Section: Introductionmentioning

confidence: 99%

Patterns and outcomes of paediatric trauma at a tertiary teaching hospital in Kenya

Ndung'u

Sun

Musau

et al. 2019

African Journal of Emergency Medicine

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Introduction Trauma continues to be a major cause of morbidity and mortality especially in the paediatric population of low- and middle-income countries such as Kenya. The aim of this study was to establish the profile and outcomes of admitted paediatric trauma cases at the Aga Khan University Hospital, Nairobi. Methods This retrospective, descriptive study involved a 12-month chart review (January 2016–December 2016). A total of 218 records were identified of which 144 were reviewed. Results Most injuries were amongst boys (65.3%) and the very young (mean age 6), occurred in private residences (42.4% homes, 25.7% residential institutions), were typically caused by falls (56.3%) or penetrating trauma (13.2%), mostly resulted in extremity fractures (45.8% closed, 4.9% open) and burn or head injuries (in infants and small children), and got very little or no pre-hospital care (51.4% no care). Additionally, children with burns, brain injuries, or poly-trauma had the longest hospital stays and highest rates of mortality. A more detailed description of the patterns and outcomes seen are included in the study. Discussion Paediatric injuries remain a major public health problem and contribute a substantial proportion of all paediatric surgical admissions at the Aga Khan University Hospital in Nairobi. Based on the patterns and outcomes seen in this study, we therefore recommend for Nairobi (and possibly Kenya) to establish greater supervision and safety measures for children; targeting safety interventions at all children but particularly at boys, the very young, at home and in residential buildings; building pre-hospital emergency care that can accommodate children; and equipping paediatric trauma hospitals to especially handle bony fractures, burns, head injuries, and poly-traumas. A bespoke trauma registry would benefit the hospital, and likely the country as a whole.

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Trauma Systems in Kenya

Cited by 27 publications

References 17 publications

Demographic profile and pattern of fatal injuries in Nairobi, Kenya, January–June 2014

Demographic profile and pattern of fatal injuries in Nairobi, Kenya, January–June 2014

Potential benefits of triage for the trauma patient in a Kenyan emergency department

Patterns and outcomes of paediatric trauma at a tertiary teaching hospital in Kenya

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