In-Hospital Mortality Following Traumatic Injury in South Africa

Erik Storm, MD; Michelle Smith, MD; Victor Kong, MD; Grant L. Laing, MD; John L. Bruce, MD; Wanda Bekker, MD; Johan Svensson, PhD; Vassil Manchev, MD; Karl A. Franklin, MD, PhD; Damian L. Clarke, MD

doi:10.1097/AS9.0000000000000210

Annals of Surgery Open (Dec 2022)

In-Hospital Mortality Following Traumatic Injury in South Africa

Erik Storm, MD,
Michelle Smith, MD,
Victor Kong, MD,
Grant L. Laing, MD,
John L. Bruce, MD,
Wanda Bekker, MD,
Johan Svensson, PhD,
Vassil Manchev, MD,
Karl A. Franklin, MD, PhD,
Damian L. Clarke, MD

Affiliations

Erik Storm, MD: From the * Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
Michelle Smith, MD: † Department of Surgery, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Victor Kong, MD: ‡ Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
Grant L. Laing, MD: † Department of Surgery, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
John L. Bruce, MD: † Department of Surgery, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Wanda Bekker, MD: † Department of Surgery, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Johan Svensson, PhD: From the * Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
Vassil Manchev, MD: † Department of Surgery, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Karl A. Franklin, MD, PhD: From the * Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
Damian L. Clarke, MD: † Department of Surgery, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa

DOI: https://doi.org/10.1097/AS9.0000000000000210
Journal volume & issue: Vol. 3, no. 4
p. e210

Abstract

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Objectives:. Trauma is a leading cause of death worldwide and in South Africa. We aimed to quantify the in-hospital trauma mortality rate in Pietermaritzburg, South Africa. Background:. The in-hospital trauma mortality rate in South Africa remains unknown, and it is unclear whether deficits in hospital care are contributing to the high level of trauma-related mortality. Methods:. All patients hospitalized because of trauma at the Department of Surgery at Grey’s Hospital, Pietermaritzburg Metropolitan Trauma Service, were prospectively entered in an electronic database starting in 2013 and the data were retrospectively analyzed. The trauma service adheres to Advanced Trauma Life Support and the doctors have attended basic and advanced courses in trauma care. The primary outcome was in-hospital mortality. Results:. Of 9795 trauma admissions, 412 (4.2%) patients died during hospital care between January 2013 and January 2019. Forty-six percent died after road traffic accidents, 19% after gunshot wounds, 13% after stab wounds, and 10% after assaults. Sixteen percent were classified as avoidable deaths due to inappropriate care and resource limitations. Fifty percent died because of traumatic brain injury and 80% of them were unavoidable. Conclusions:. In conclusion, the in-hospital trauma mortality rate at a South African trauma center using systematic trauma care is lower than that reported from other trauma centers in the world during the past 20 years. Nevertheless, 16% of death cases were assessed as avoidable if there had been better access to intensive care, dialysis, advanced respiratory care, blood for transfusion, and improvements in surgery and medical care.

Published in Annals of Surgery Open

ISSN: 2691-3593 (Online)
Publisher: Wolters Kluwer Health
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://journals.lww.com/aosopen/pages/default.aspx

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