Informing prehospital care planning using pilot trauma registry data in Yaoundé, Cameroon

Obieze Chiemeka Nwanna-Nzewunwa, Marquise Kouo Ngamby, Elinor Shetter, Georges Alain Etoundi Mballa, Isabelle Feldhaus, Martin Ekeke Monono, Adnan A. Hyder, Rochelle Dicker, Kent A Stevens, Catherine Juillard

Research output: Contribution to journalArticle

Abstract

Introduction: About 54% of deaths in low- and middle-income countries (LMICs) are attributable to lack of prehospital care. The single largest contributor to the disability-adjusted life years due to poor prehospital care is injury. Despite having disproportionately high injury burdens, most LMIC trauma systems have little prehospital organization. An understanding of existing prehospital care patterns in LMICs is warranted as a precursor to strengthening prehospital systems. Methods: In this retrospective pilot study, we collected demographic and injury characteristics, therapeutic itinerary, and transport data of patients that were captured by the trauma registry at the Central Hospital of Yaoundé (CHY) from April 15, 2009 to October 15, 2009. Bivariate and multivariate regression analyses were used to explore relationships between care-seeking behavior, method of transport, and predictor variables. Results: The mean age was 30.2 years (95% CI [29.7, 30.7]) and 73% were male. Therapeutic itinerary was available for 97.5% of patients (N = 2855). Nearly 18.7% of patients sought care elsewhere before CHY and 82% of such visits were at district hospitals or health clinics. Moderately (OR 1.336, p = 0.009) and severely (OR 1.605, p = 0.007) injured patients were more likely to seek care elsewhere before CHY and were less likely to be discharged home after their emergency ward visit as opposed to being admitted to the hospital for further treatment (OR 0.462, p < 0.001). Commercial vehicles provided most prehospital transport (65%), while police or ambulance transported few injured patients (7%). Conclusions: Possible areas for prehospital trauma care strengthening include training lay commercial vehicle drivers in trauma care and formalizing triage, referral, and communication protocols for prehospital care to optimize timely transfer and care while minimizing secondary injury to patients.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalEuropean Journal of Trauma and Emergency Surgery
DOIs
StateAccepted/In press - Mar 10 2018

Fingerprint

Cameroon
Registries
Wounds and Injuries
Ambulances
Quality-Adjusted Life Years
District Hospitals
Triage
Police
Hospital Emergency Service
Patient Care
Therapeutics
Referral and Consultation
Multivariate Analysis
Retrospective Studies
Communication
Regression Analysis
Demography
Organizations
Health

Keywords

  • Cameroon
  • Injury
  • Prehospital care
  • Surveillance
  • Trauma system

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Nwanna-Nzewunwa, O. C., Kouo Ngamby, M., Shetter, E., Etoundi Mballa, G. A., Feldhaus, I., Monono, M. E., ... Juillard, C. (Accepted/In press). Informing prehospital care planning using pilot trauma registry data in Yaoundé, Cameroon. European Journal of Trauma and Emergency Surgery, 1-8. https://doi.org/10.1007/s00068-018-0939-2

Informing prehospital care planning using pilot trauma registry data in Yaoundé, Cameroon. / Nwanna-Nzewunwa, Obieze Chiemeka; Kouo Ngamby, Marquise; Shetter, Elinor; Etoundi Mballa, Georges Alain; Feldhaus, Isabelle; Monono, Martin Ekeke; Hyder, Adnan A.; Dicker, Rochelle; Stevens, Kent A; Juillard, Catherine.

In: European Journal of Trauma and Emergency Surgery, 10.03.2018, p. 1-8.

Research output: Contribution to journalArticle

Nwanna-Nzewunwa, OC, Kouo Ngamby, M, Shetter, E, Etoundi Mballa, GA, Feldhaus, I, Monono, ME, Hyder, AA, Dicker, R, Stevens, KA & Juillard, C 2018, 'Informing prehospital care planning using pilot trauma registry data in Yaoundé, Cameroon', European Journal of Trauma and Emergency Surgery, pp. 1-8. https://doi.org/10.1007/s00068-018-0939-2
Nwanna-Nzewunwa, Obieze Chiemeka ; Kouo Ngamby, Marquise ; Shetter, Elinor ; Etoundi Mballa, Georges Alain ; Feldhaus, Isabelle ; Monono, Martin Ekeke ; Hyder, Adnan A. ; Dicker, Rochelle ; Stevens, Kent A ; Juillard, Catherine. / Informing prehospital care planning using pilot trauma registry data in Yaoundé, Cameroon. In: European Journal of Trauma and Emergency Surgery. 2018 ; pp. 1-8.
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AU - Kouo Ngamby, Marquise

AU - Shetter, Elinor

AU - Etoundi Mballa, Georges Alain

AU - Feldhaus, Isabelle

AU - Monono, Martin Ekeke

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N2 - Introduction: About 54% of deaths in low- and middle-income countries (LMICs) are attributable to lack of prehospital care. The single largest contributor to the disability-adjusted life years due to poor prehospital care is injury. Despite having disproportionately high injury burdens, most LMIC trauma systems have little prehospital organization. An understanding of existing prehospital care patterns in LMICs is warranted as a precursor to strengthening prehospital systems. Methods: In this retrospective pilot study, we collected demographic and injury characteristics, therapeutic itinerary, and transport data of patients that were captured by the trauma registry at the Central Hospital of Yaoundé (CHY) from April 15, 2009 to October 15, 2009. Bivariate and multivariate regression analyses were used to explore relationships between care-seeking behavior, method of transport, and predictor variables. Results: The mean age was 30.2 years (95% CI [29.7, 30.7]) and 73% were male. Therapeutic itinerary was available for 97.5% of patients (N = 2855). Nearly 18.7% of patients sought care elsewhere before CHY and 82% of such visits were at district hospitals or health clinics. Moderately (OR 1.336, p = 0.009) and severely (OR 1.605, p = 0.007) injured patients were more likely to seek care elsewhere before CHY and were less likely to be discharged home after their emergency ward visit as opposed to being admitted to the hospital for further treatment (OR 0.462, p < 0.001). Commercial vehicles provided most prehospital transport (65%), while police or ambulance transported few injured patients (7%). Conclusions: Possible areas for prehospital trauma care strengthening include training lay commercial vehicle drivers in trauma care and formalizing triage, referral, and communication protocols for prehospital care to optimize timely transfer and care while minimizing secondary injury to patients.

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