Epidemiology of injuries, outcomes, and hospital resource utilisation at a tertiary teaching hospital in Lusaka, Zambia

Abstract

Injuries represent a global public health threat and that threat is disproportionally felt especially in low and middle income countries (LMICs) that experience 90% of global mortality from injury. Few LMICs have robust datasets describing patient injuries and injury care. Objective: To develop a hospital-based trauma registry in an urban hospital in Lusaka, Zambia to assess patterns of injury, transport methods and duration, injury severity, outcomes and hospital resource utilisation. Methods: From September 2011 to February 2012, all injured patients presenting to the Surgical Emergency Centre at University Teaching Hospital (UTH) were prospectively enrolled in an observational study to describe the epidemiology and the circumstances of injury of patients presenting to UTH, a 1400 bed urban hospital which is the primary trauma centre for Lusaka. Data on injured patients were collected by trained staff 24 h/day including: circumstances of trauma, transport method and time, injury type and location, vital signs on arrival, and disposition. Additional data regarding length of stay, HIV testing, operative procedures, use of blood products, and 30-day vital status were recorded for admitted patients. Results: A total of 3498 patients were enrolled in the trauma registry. Patients were primarily male (71.8%), young (median age 24 years), and the majority arrived by private vehicle (51.8%) or public transport (37.1%). The most common reported mechanisms of injury were falls (26.3%), road traffic accidents (25.6%) and assault (20.0%). Hospital resource utilisation data were available for 863 of the 1769 (48.7%) admitted patients. Of these, 661 (76.6%) had X-rays, 468 (57.5%) had a surgical procedure performed, 390 (45.2%) underwent HIV testing, and 50 (5.8%) received blood products. The case fatality rate was 3%. Conclusion: Limited dataset trauma registries can capture important epidemiologic data that can characterise injury care, identify patterns of injury, and inform hospital-based intervention strategies in Zambia.