Establishment of trauma registry at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi and mapping of high risk geographic areas for trauma

doi:10.5847/wjem.j.1920-8642.2019.01.005

Abstract

Abstract:

BACKGROUND: Less attention is directed toward gaining a better understanding of the burden and prevention of injuries, in low and middle income countries (LMICs). We report the establishment of a trauma registry at the Adult Emergency and Trauma Centre (AETC) at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi and identify high risk geographic areas.
METHODS: We devised a paper based two-page trauma registry form. Ten data clerks and all AETC clinicians were trained to complete demographic and clinical details respectively. Descriptive data, regression and hotspot analyses were done using STATA 15 statistical package and ArcGIS (16) software respectively.
RESULTS: There were 3,747 patients from May 2013 to May 2015. The most common mechanisms of injury were assault (38.2%), and road traffic injuries (31.6%). The majority had soft tissue injury (53.1%), while 23.8% had no diagnosis indicated. Fractures (OR 19.94 [15.34-25.93]), head injury and internal organ injury (OR 29.5 [16.29-53.4]), and use of ambulance (OR 1.57 [1.06-2.33]) were found to be predictive of increased odds of being admitted to hospital while assault (OR 0.69 [0.52-0.91]) was found to be associated with less odds of being admitted to hospital. Hot spot analysis showed that at 99% confidence interval, Ndirande, Mbayani and Limbe were the top hot spots for injury occurrence.
CONCLUSION: We have described the process of establishing an integrated and potentially sustainable trauma registry. Significant data were captured to provide details on the epidemiology of trauma and insight on how care could be improved at AETC and surrounding health facilities. This approach may be relevant in similar poor resource settings.

Key words: Trauma Registry, Adult injuries, Hot spot analysis, Low and middle income countries

Linda C. Chokotho, Wakisa Mulwafu, Mulinda Nyirenda, Foster J. Mbomuwa, Hemant G. Pandit, Grace Le, Christopher Lavy. Establishment of trauma registry at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi and mapping of high risk geographic areas for trauma[J]. World Journal of Emergency Medicine, 2019, 10(1): 33-41.

Figures/Tables 4

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Figure 1.

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Injury characteristics	Category	Number (%)
Age (years)	≤20	332 (8.9)
	21-30	1,487 (39.7)
	31-40	1,055 (28.2)
	41-50	406 (10.8)
	51-60	189 (5.0)
	>60	145 (3.9)
Gender	Male	2,964 (79.1)
Gender	Female	783 (20.9)
Mechanism of injury	Assault	1,431 (38.2)
	RTI	1,185 (31.6)
	Falls	403 (10.8)
	Bites	100 (2.7)
	Collapsing structure	103 (2.8)
	Burns	13 (0.4)
	Gunshot wound	10 (0.3)
	Other	499 (13.3)
Location of injury	Road/ street	1,563 (41.7)
	Home	977 (26.1)
	Work	675 (18.1)
	School	59 (1.6)
	Sports	124 (3.3)
	Farm	11 (0.3)
	Other	202 (5.4)
Injury type	Soft tissue injury	1,991 (53.1)
	Fractures/dislocation	510 (13.6)
	Head injury	44 (1.2)
	Organ injury	42 (1.1)
	Foreign body	25 (0.7)
	Gun shot wounds	3 (0.08)
	Others	649 (17.3)
	Not indicated	483 (12.9)
Mode of transport to hospital	Minibus	1,824 (51.6)
	Private vehicle	874 (24.7)
	Police	144 (4.1)
	Ambulance	120 (3.4)
	Walked	260 (7.4)
	Bicycle	13 (0.4)
	Motorcycle	37 (1.0)
	Other	23 (0.7)
Season	Hot and dry (Augst - November)	1,168 (31.2)
	Wet and hot (December - April)	686 (18.3)
	Cold and dry (May - July)	1,893 (50.5)
Disposition	OPD treated and send home Admitted Died Missing	2,844 (75.9) 535 (14.3) 5 (0.1) 363 (9.7)

Parameters	n	Admitted		Crude OR (95 % CI)	P value	AOR (95% CI)	P value
		n	%
Age at baseline (years)
<20	418	64	15	1		1
21-30	1,349	199	15	0.96 (0.70-1.3)	0.78	1.05 (0.72-1.54)	0.79
31-40	958	161	17	1.12 (0.81-1.53)	0.4	1.35 (0.91-2.01)	0.13
41-50	361	59	16	1.08 (0.73-1.59)	0.69	1.29 (0.8-2.09)	0.3
51-60	159	23	14	0.94 (0.56-1.57)	0.8	0.92 (0.49-1.74)	0.8
>60	134	29	22	1.53 (0.93-2.5)	0.09	1.84 (1.0-3.4)	0.05
Gender
Female	701	129	18	1.26 (1.01-1.57)	0.04	1.02 (0.77-1.35)	0.9
Male	2,678	406	15	1		1
Mechanism of injury
RTA	982	190	19	1		1
Falls	458	114	25	1.38 (1.06-1.8)	0.02	0.88 (0.63-1.24)	0.47
Assault	1,408	164	12	0.55 (0.44-0.69)	<0.001	0.69 (0.52-0.91)	0.01
Other	531	67	13	0.60 (0.45-0.81)	<0.001	0.80 (0.55-1.15)	0.22
Seasonal variation
Cold and dry	1,790	297	17	1		1
Hot and dry	948	133	14	0.82 (0.66-1.02)	0.08	0.97 (0.73-1.27)	0.8
Hot and wet	610	100	16	0.97 (0.77-1.26)	0.91	1.15 (0.85-1.57)	0.3
Injury type
Soft tissue injury	2,053	137	7	1		1
Fractures	496	297	60	19.98 (15.66-25.48)	<0.001	19.94 (15.34-25.93)	<0.001
Head and internal organ injury	59	41	69	30.49 (17.11-54.35)	<0.001	29.50 (16.29-53.4)	<0.001
Other	623	44	7	1.02 (0.72-1.44)	0.92	1.04 (0.73-1.49)	0.83
Transport
Public transport	2,801	429	15	1		1
Ambulance	237	65	27	2.10 (1.55-2.84)	<0.001	1.57 (1.06-2.33)	0.03
Other	323	40	12	0.79 (0.56-1.11)	0.17	1.14 (0.76-1.72)	0.52

Challenges	Recommendations
Incomplete data recording from using paper-based registry	Use of mobile data collection using applications like Open Data Kit (ODK);^[23] Regular monitoring and evaluation
Backlog of paper forms not captured electronically in time	Use of mobile data collection using applications like Open Data Kit (ODK)^[23]
Inadequate and unsustainable funding	Trauma data to be integrated into Ministry of Health information system and used in routine clinical care
Too many variables collected	Use of the WHO minimum data set^[24] and adapted to local setting
Lack of follow-up for admitted cases	Linked data for outpatient department and wards
Lack of adequate trained personnel for data collection	Need for longer and targeted training for data collection personnel
Some patients going straight to resuscitation room not captured in our database	Additional resources needed to allocate data clerks to resuscitation room
Lack of institutional buy-in and motivated personnel	Consultative meetings with hospital authorities and staff members to create awareness on the importance of trauma registries