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Citation
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Christie SA, Zheng D, Dissak-Delon F, Kinge T, Njock R, Nkusu D, Tsiagadigui JG, Mbianyor M, Dicker R, Chichom-Mefire A, Juillard C. J. Trauma Acute Care Surg. 2022; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Injury deaths in sub-Saharan Africa are among the world's highest, but hospital data rarely have sufficient granularity to direct quality improvement. We analyzed clinical care patterns among trauma patients who died in a prospective, multi-center sub-Saharan cohort to pinpoint trauma quality improvement intervention targets.
METHODS: In-hospital trauma deaths in four Cameroonian hospitals between 2017 and 2019 were included. Trauma registry data on patient demographics, injury characteristics, and clinical care were analyzed to identify opportunities for systems improvements.
RESULTS: Among 9423 trauma patients, there were 236 deaths. Overall, 83% of patients who died in the emergency department were living on arrival (LOA). Among 183 LOA patients, 30% presented with normal vital signs, but 11% had no vital signs taken, often due to lack of equipment (43%). Of LOA patients presenting with GCS < 9 (56%), few received neurosurgery consults (15%), C-collar placement (9%) or intubation (1%). The most common reason for lack of c-collar placement was failure to recognize that it was indicated (66%). Tracheal deviation, unequal breath sounds, or paradoxical chest movement were present in 63% of LOA patients, but only 2 patients had chest tubes placed. Hypotension or active bleeding was present in 80% of LOA patients; while crystalloid bolus was given to 96% of these patients, few received transfusion (8%), tourniquet placement for extremity injury (6%) or an operation (4%).
CONCLUSION: Primary survey interventions are underperformed in trauma non-survivors in Cameroon. Protocolizing early treatment for head injury, hemorrhagic shock, and chest wall trauma could reduce trauma mortality. LEVEL OF EVIDENCE: Level III, prognostic (prospective) study.
Language: en |