The burden of trauma at a district hospital in the Western Cape Province of South Africa

Ali A Zaidi; Julia Dixon; Kathryn Lupez; Shaheem De Vries; Lee A Wallis; Adit Ginde; Nee-Kofi Mould-Millman

doi:10.1016/j.afjem.2019.01.007

The burden of trauma at a district hospital in the Western Cape Province of South Africa

Afr J Emerg Med. 2019;9(Suppl):S14-S20. doi: 10.1016/j.afjem.2019.01.007. Epub 2019 Jan 19.

Authors

Ali A Zaidi¹, Julia Dixon², Kathryn Lupez³, Shaheem De Vries⁴, Lee A Wallis^{5

4}, Adit Ginde², Nee-Kofi Mould-Millman^{2

5}

Affiliations

¹ Indiana University, School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States.
² University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, United States.
³ Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC, United States.
⁴ Western Cape Government EMS, Bellville, Western Cape Province, South Africa.
⁵ University of Cape Town, Division of Emergency Medicine, Cape Town, Western Cape Province, South Africa.

Abstract

Background: Sub-Saharan Africa bears a disproportionate burden of mortality from trauma. District hospitals, although not trauma centres, play a critical role in the trauma care system by serving as frontline hospitals. However, the clinical characteristics of patients receiving trauma care in African district hospitals remains under-described and is a barrier to trauma care system development. We aim to describe the burden of trauma at district hospitals by analysing trauma patients at a prototypical district hospital emergency centre.

Methods: An observational study was conducted in August, 2014 at Wesfleur Hospital, a district facility in the Western Cape Province of South Africa. Data were manually collected from a paper registry for all patients visiting the emergency centre. Patients with trauma were selected for further analysis.

Results: Of 3299 total cases, 565 (17.1%) presented with trauma, of which 348 (61.6%) were male. Of the trauma patients, 256 (47.6%) were ages 18-34 and 298 (52.7%) presented on the weekend. Intentional injuries (assault, stab wounds, and gunshot wounds) represented 251 (44.4%) cases of trauma. There were 314 (55.6%) cases of injuries that were unintentional, including road traffic injuries. There were 144 (60%) intentionally injured patients that arrived overnight (7pm-7am). Patients with intentional injuries were three times more likely to be transferred (to higher levels of care) or admitted than patients with unintentional injuries.

Conclusion: This district hospital emergency centre, with a small complement of non-EM trained physicians and no trauma surgical services, cared for a high volume of trauma with over half presenting on weekends and overnight when personnel are limited. The high volume and rate of admission/ transfer of intentional injuries suggests the need for improving prehospital trauma triage and trauma referrals. The results suggest strengthening trauma care systems at and around this resource-limited district hospital in South Africa may help alleviate the high burden of post-trauma morbidity and mortality.

Keywords: Emergency medical services; Emergency medicine; Non-accidental injury; Trauma system; Unintentional injury.