Patterns and Predictors of Timely Presentation and Outcomes of Polytrauma Patients Referred to the Emergency Department of a Tertiary Hospital in Tanzania

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Patterns and Predictors of Timely Presentation and Outcomes of Polytrauma Patients Referred to the Emergency Department of a Tertiary Hospital in Tanzania


JournalEmergency Medicine International
Article typeJournal research article – Clinical research
Publication date – Nov – 2022
Authors – Elishah N. Premji, Said S. Kilindimo, Hendry R. Sawe, Amne O. Yussuf, Alphonce N. Simbila, Hussein K. Manji, Juma A. Mfnanga, Ellen J. Weber
Keywordsemergency medical services (EMS), LMICs, Tanzania, trauma
Open access – Yes
SpecialityTrauma surgery
World region Eastern Africa
Country: Tanzania
Language – English
Submitted to the One Surgery Index on November 28, 2022 at 5:03 am
Abstract:

Background. Polytrauma patients require special facilities to care for their injuries. In HICs, these patients are rapidly transferred from the scene or the frst-health facility directly to a trauma center. However, in many LMICs, prehospital systems do not exist and there are long delays between arrivals at the frst-health facility and the trauma center. We aimed to quantify the delay and determine the predictors of mortality among polytrauma patients. Methodology. We consecutively enrolled adult polytrauma patients (≥18 years) with ISS >15 referred to the Emergency Medicine Department of Muhimbili National Hospital, a major trauma center in Tanzania between August 2019 and January 2020. Based on a pilot study, the arrival of >6 hours after injury was considered a delay. Te outcome of interest was factors associated with delayed presentation and the association of timeliness with 7-day mortality. Results. We enrolled 120 (4.5%) referred polytrauma adult patients. Te median age was 30 years (IQR 25–39) and the ISS was 29 (IQR 24–34). The majority (85%) were males. While the median time from injury to frst-health facility was 40 minutes (IQR 33–50), the median time from injury to arrival at EMD-MNH, was 377 minutes (IQR 314–469). Delayed presentation was noted in more than half (54.2%) of participants, with the odds of dying being 1.4 times higher in the delayed
group (95% CI 0.3–5.6). Having a GCS <8 (AOR 16.3 (95% CI 3.1–86.3), hypoxia <92% (AOR 8.3 (95% CI 1.4–50.9), and hypotension <90 mmHg (R 7.3 (95% CI 1.6–33.6) were all independent predictors of mortality. Conclusion. Te majority of polytrauma patients arrive at the tertiary facilities delayed for more than 6 hours and a distance of more than 8 km between facilities is associated with delay. Hypotension, hypoxia, and GCS of less than 8 are independent predictors of poor outcome. In the interim, there is a need to expedite the transfer of polytrauma patients to trauma care capable centers.

OSI Number – 21826

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