Profile of trauma related deaths among road traffic injured patients presenting to the emergency department of Muhimbili National Hospital, Dar Es Salaam-Tanzania

Abstract

BACKGROUND: Road traffic injuries carry a high mortality rate worldwide and, over 90% of these deaths occur in low and middle-income countries. Trauma related deaths in low and middle-income countries are related to lack of proper pre-hospital and emergency care, poor infrastructure, lack of trained human resources, inadequate equipment and lack of data. AIM: We aimed to describe the profile of trauma related deaths among road traffic injured patients presenting to the Emergency Medicine Department (EMD) of Muhimbili National Hospital Dar es salaam Tanzania. METHODS: This was a retrospective study of all patients involved in road traffic accident (RTA) presenting alive at EMD-MNH from July 2015 to July 2018. The data was retrieved from the trauma registry for all RTA and they were followed up via a phone contact, we enrolled those who had died within 90 days of current injury episode. A standardized case report form was used to record demographics, presenting clinical characteristics, management and outcomes. Data capture in online data Capture Software (RED Cap) was exported and Statistical Package for Social Science. Descriptive statistics are presented as frequency, percentages and 95% Confidence intervals, mean and median as appropriate. Injury Severity Score was provider calculated through a pre-programed system in electronic medical record. Univariate analysis was used to establish the causes associated with mortality, and a p value of <0.05 was considered significant. RESULTS: Total of 17,855 trauma patients were attended and out of these 7793 (43.6%) were RTI, and all of these RTI patients were traceable via a phone call and ward follow-up. Of those who were traceable, 153 (2%) of RTI patients died within 90 days post injury. 129 (84.3%) of all trauma related deaths were head and neck injuries. Despite this, only 6 (4.5%) of all head and neck injuries had neck collars. Total of 117 (76.5%) of all RTI patients with trauma related deaths were transferred to Muhimbili Orthopaedics Institute. Factors associated with mortality were age 55 years, GCS 12, head and neck injury pattern, admission to general wards and referral from other facilities. CONCLUSION: Road traffic injuries constitute a significant proportion of trauma patients presenting to EMD-MNH. Age, Glasgow Coma Scale, injury patterns, disposition and referral status predicted the fatal outcomes in most RTI- related deaths. Future studies should focus building fatal injury surveillance capacities to inform on deaths that occur at the scene