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Comparative Epidemiology and Outcomes among Trauma Patients transported by Private and Formal Pre-hospital Care Modes in Kigali, Rwanda

Article scientifique 2021 Anglais

Résumé

Abstract IntroductionInjuries account for approximately five million deaths worldwide and have high burdens in low- and middle-income countries, where pre-hospital systems are being developed to improve acute injury care. This study compares the characteristics and outcomes between trauma patients transported by formal emergency medical services (EMS), known as Service d’Aide Medicale Urgente, and by private transport to the emergency department (ED) at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda.MethodsThis retrospective cohort study analysed a random sample of trauma patients from of the CHUK ED presenting between 1 August 2015 and 30 July 2016. Non-trauma patients and transferred patients were excluded. The primary outcomes were ED and inpatient dispositions and outcome characteristics of: admission, length of stay (LOS), mortality. Descriptive analyses were performed and differences in outcomes assessed based on transport modalities via Pearson Chi-Squared or Fisher’s Exact tests.ResultsThere were 556 trauma patients analysed, of which 87.1% were transported by private transport and the remainder by EMS. The median age was 28 years (IQR:18-39), 52.1% had serious injuries, based on the triage system at CHUK. Common mechanisms of injury included road traffic crashes (62.7%) and falls (17.1%). Median inpatient LOS for private transport patients was 7 days (IQR:3-16 days), compared to 9.5 days for EMS patients (IQR:4-18 days) (p=0.301). There was a significant relationship between ED disposition and transport method (p=0.005), with a higher number of admissions among EMS-transported patients. The observed mortality of EMS and privately transported patients were not significant different, however there were a higher percentage of deaths in the ED and inpatient setting among those who were privately transported. ConclusionWhile mortality and hospital LOS between EMS and private transport patients were not statistically significantly different, this may not reflect a lack of clinical significance. Future research will be needed to continue to assess the EMS utilisation rate, quality and impact on patient-centred outcomes and should include studies that prospectively investigate larger samples of patients to better evaluate the effects of EMS trauma care in Rwanda.

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Nzabandora, J., Bilal, S., Henry, M., Beeman, A., Mbanjumucyo, G., Rosenberg, N., Nyinawankusi, J., Sharma, V., Ndebwanimana, V., Muragizi, J., Aluisio, A. (2021). Comparative Epidemiology and Outcomes among Trauma Patients transported by Private and Formal Pre-hospital Care Modes in Kigali, Rwanda. https://doi.org/10.21203/rs.3.rs-428668/v1

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Auteur(s)

Jean Paul Nzabandora Saadiyah Bilal M. Henry Aly Beeman Gabin Mbanjumucyo Noah Rosenberg Jeanne D’Arc Nyinawankusi Vinay Sharma Vincent Ndebwanimana Jean Muragizi Adam R. Aluisio

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