Comparison of clinical characteristics, care and outcomes of trauma patients presenting during regular and off hours at emergency medicine department of Muhimbili national hospital

Abstract

Background: Trauma constitutes a significant public health burden, accounting for ten percent of all global deaths. World Health Organization estimates that mortality due to trauma is more than that caused by Tuberculosis, Malaria and HIV/AIDS combined. Disproportionately Low Income Countries (LIC) has higher trauma burden than Higher Income Countries (HIC) and relatively poor outcomes. Timing of presentation to the hospital such as regular work hours versus off hours have shown to impact outcomes in trauma in HIC. In Tanzania the timing of presentation in trauma has never been investigated. Aim: To compare proportion, clinical characteristics, care and outcomes of adult trauma patients (≥18 years) presenting to the emergency medicine department of Muhimbili national Hospital (EMD-MNH). Methods: This was a prospective comparative descriptive study of adult trauma patients (≥18years) presenting to EMD-MNH from July 2017 to December 2017. Structured questionnaires incorporated into online data capture software were used to document patients’ demographics, clinical characteristics, care received and outcomes. Primary outcomes were difference in clinical presentation and EMD care and secondary outcomes were mortality, length of hospital stay and disposition. Study data was summarized with descriptive statistics including mean, standard deviation, median and interquartile range. Student’s t test (t-test) was used for comparison of mean and descriptive categorical data was analyzed using Chi-square (x²) with SPSS version 21.0 Results: We enrolled 1395 (49%) patients from 2898 trauma patients who presented to the ED. Of those who were enrolled, 818 (58.6%) presented during off hours. The median age of presentation of those enrolled was 33 years (interquartile range 26-44 years) and overall 1069 (76.6%) were male. Overall 1261 (90.4%) had minor Injury Severity Score (ISS) and 98 (7.6%) had moderate ISS, while 36 (2.6%) had major ISS. Among those 36 (2.6%) who had major injury (ISS≥15), 3(0.5%) presented during regular hours versus 31(4.0%) during off-hours with (p < 0.001). Overall 40(2.9%) that had used alcohol, and the majority of these 35(4.3%) presented during off hours while 5(0.9%) of regular hours (p<0.000). Overall 24h mortality with 2(0.2%) presenting during off-hours and none during regular hours, p<0.235. Conclusion: Off-hour presentation was associated with high male proportion, major trauma and injuries associated with alcohol influence. Even though these factors did not seem to impact on the ED and 24h mortality, clinicians are to be keener due to higher acuity and severity of patients presenting in off-hours in LIC.