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Observational Study
. 2019 Feb 28;19(1):22.
doi: 10.1186/s12873-019-0237-2.

Pre-referral stabilization and compliance with WHO guidelines for trauma care among adult patients referred to an urban emergency department of a tertiary referral hospital in Tanzania

Nanyori J Lucumay  1 , Hendry R Sawe  2   3 , Amour Mohamed  1 , Erasto Sylvanus  1 , Upendo George  4 , Juma A Mfinanga  4 , Ellen J Weber  1   4
Affiliations
Observational Study

Pre-referral stabilization and compliance with WHO guidelines for trauma care among adult patients referred to an urban emergency department of a tertiary referral hospital in Tanzania

Nanyori J Lucumay et al. BMC Emerg Med. .

Abstract

Background: The outcomes of trauma are considered to be time dependent. Efficient and timely pre-referral stabilization of trauma patients has been shown to impact survival. Tanzania has no formal pre-hospital or trauma system. World Health Organisation has provided a set of standards for initial stabilization of trauma patients according to the level of the hospitals. We aimed to describe pre-referral stabilization provided to adult trauma patient referred to the national referral hospital and compliance with World Health Organisation guidelines.

Methods: This prospective observational cross-sectional study was conducted at the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH), between July 2017 and December 2017. Eligible patients were adults with head injury and extremity injury ≥18 years who were referred from a peripheral hospital and had a referral note. Research assistant enrolled patients using structured case report form clinical information, and initial stabilization received at the referring hospital. Primary outcome was the proportion of patients who had initial stabilization performed according to World Health Organisation recommendation.

Results: We enrolled 368 (29% of eligible patients), the median age was 34 years (Interquartile range 26-44 years), and 281 (76%) were male. Overall 69% of referred patients arrived at the EMD more than 24 h after injury. Of those enrolled, 50 (13.6%) patients had received at least one stabilization intervention prior to transfer to MNH. Among 206 patients with extremity injuries, splinting was inadequate or missing in all cases; No patients with head injury received cervical spine protection. Among patients referred from a health center, 26.9% received an initial stabilization, while stabilization procedures were administered to 13.2% of those from district hospitals, and 10% of those from regional hospitals.

Conclusions: In this urban public emergency department in Tanzania, majority of trauma patients were referred from lower health facilities after 24-h of injury. Most did not receive initial trauma stabilization as recommended by the World Health Organisation guidelines. Future studies should identify barriers to pre-referral stabilization of adult trauma patients.

Keywords: Emergency care; Initial stabilization; Pre-referral; Trauma patients.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical clearance was obtained from Muhimbili University of Health and Allied Sciences’ (MUHAS) Institutional Review Board and permission to collect data was obtained from relevant authorities of both MUHAS and MNH. Written informed consent was obtained from all patients who are conscious and from their proxy if the level of consciousness is altered.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Lozano R. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. 15 Dec 2012. 380. - PMC - PubMed
    1. Lashoher A, Schneider EB, Juillard C, Stevens K, Colantuoni E, Berry WR, et al. Implementation of the World Health Organization trauma care checklist program in 11 centers across multiple economic strata: effect on care process measures. World J Surg. 2016;31:954–62. - PubMed
    1. Mathers C, Fat DM, Boerma JT, World Health Organization, editors. The global burden of disease: 2004 update. Geneva: World Health Organization; 2008.
    1. Richard A. The Increasing Burden of Injuries in Developing Countries Direct and Indirect Consequences.
    1. Peden MM, McGee K, Krug E, World Health Organization . Editors. Injury: a leading cause of the global burden of disease, 2000. Geneva: Dept. of Injuries and Violence Prevention, Noncommunicable Diseases and Mental Health Cluster, World Health Organization; 2002. p. 50.

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