ABSTRACT
BACKGROUND: In Sub-Saharan African countries, the incidence of traumatic brain injury (TBI) is estimated to be many folds higher than the global average and outcome is hugely impacted by access to healthcare services and quality of care. We conducted an analysis of the TBI registry data to determine the disparities and delays in treatment for patients presenting at a tertiary care hospital in Uganda and to identify factors predictive of delayed treatment initiation. METHODS: The study was conducted at the Mulago National Referral Hospital, Kampala. The study included all patients presenting to the emergency department (ED) with suspected or documented TBI. Early treatment was defined as first intervention within 4 hours of ED presentation-a cut-off determined using sensitivity analysis to injury severity. Descriptive statistics were generated and Pearson's χ2 test was used to assess the sample distribution between treatment time categories. Univariable and multivariable logistic regression models with <0.05 level of significance were used to derive the associations between patient characteristics and early intervention for TBI. RESULTS: Of 3944 patients, only 4.6% (n=182) received an intervention for TBI management within 1 hour of ED presentation, whereas 17.4% of patients (n=708) received some treatment within 4 hours of presentation. 19% of those with one or more serious injuries and 18% of those with moderate to severe head injury received care within 4 hours of arrival. Factors independently associated with early treatment included young age, severe head injury, and no known pre-existing conditions, whereas older or female patients had significantly less odds of receiving early treatment. DISCUSSION: With the increasing number of patients with TBI, ensuring early and appropriate management must be a priority for Ugandan hospitals. Delay in initiation of treatment may impact survival and functional outcome. Gender-related and age-related disparities in care should receive attention and targeted interventions. LEVEL OF EVIDENCE: Prognostic and epidemiological study; level II evidence.
ABSTRACT
Emergency medical services (EMS) is defined as the system that organizes all aspects of care provided to patients in the pre-hospital or out-of-hospital environment. Hence, EMS is a critical component of the health systems and is necessary to improve outcomes of injuries and other time-sensitive illnesses. Still there exists a substantial need for evidence to improve our understanding of the capacity of such systems as well as their strengths, weaknesses, and priority areas for improvement in low-resource environments. The aim was to develop a tool for assessment of the pre-hospital EMS system using the World Health Organization (WHO) health system framework. Relevant literature search and expert consultation helped identify variables describing system capacity, outputs, and goals of pre-hospital EMS. Those were organized according to the health systems framework, and a multipronged approach is proposed for data collection including use of qualitative and quantitative methods with triangulation of information from important stakeholders, direct observation, and policy document review. The resultant information is expected to provide a holistic picture of the pre-hospital emergency medical services and develop key recommendations for PEMS systems strengthening.
ABSTRACT
This study tests the hypothesis that most pedestrian collisions occur near victims' homes. Patients involved in automobile versus pedestrian collisions who presented to the emergency department at a Level I trauma center between January 2000 and December 2009 were included in the study. Patient demographics were obtained from the trauma registry. Home address was determined from hospital records, collision site was determined from the paramedic run sheet, and the shortest walking distance between the collision site and pedestrian residence was determined using Google Maps. We summarized distances for groups with the median and compared groups using the Kruskal-Wallis rank test. We identified 1917 pedestrian injury cases and identified both residence address and collision location for 1213 cases (63%). Forty-eight percent of the collisions were near home (within 1.1 km, 95% CI 45-51%). Median distance from residence to collision site was 1.4 km (interquartile range 0.3-7.4 km). For ages 0-17, the median distance 0.7 km, and 59% (95% CI 54-63%) of collisions occurred near home. For ages 65 and older, the median distance was 0.6 km and 65% (95% CI 55-73%) were injured near home. Distance did not differ by sex, race, ethnicity, or blood alcohol level. More severe injuries (Injury Severity Score ≥ 16) occurred further from home than less severe injuries (median 1.9 km vs. 1.3 km, p=.01). Patients with a hospital stay of 3 days or less were injured closer to home (median 1.3 km) than patients with a hospital stay of 4 days or more (median 1.8 km, p=.001). Twenty-two percent were injured within the same census tract as their home, 22% on the boundary of their home census tract, and 55% in a different census tract.
