A cohort of pediatric injury patients from a hospital-based trauma registry in Northern Tanzania

Elizabeth M Keating; Francis Sakita; Blandina T Mmbaga; Getrude Nkini; Ismail Amiri; Chermiqua Tsosie; Nora Fino; Melissa H Watt; Catherine A Staton

doi:10.1016/j.afjem.2022.04.008

A cohort of pediatric injury patients from a hospital-based trauma registry in Northern Tanzania

Afr J Emerg Med. 2022 Sep;12(3):208-215. doi: 10.1016/j.afjem.2022.04.008. Epub 2022 Jun 6.

Authors

Elizabeth M Keating¹, Francis Sakita^{2

3}, Blandina T Mmbaga^{2

3

4}, Getrude Nkini², Ismail Amiri², Chermiqua Tsosie⁵, Nora Fino⁶, Melissa H Watt^{7

8}, Catherine A Staton^{8

9

10}

Affiliations

¹ Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
² Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania.
³ Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania.
⁴ Kilimanjaro Clinical Research Institute, Box 2236, Moshi, Tanzania.
⁵ College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
⁶ Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
⁷ Department of Population Health Sciences, Salt Lake City, University of Utah, UT, USA.
⁸ Duke Global Health Institute, Duke University, Durham, NC, USA.
⁹ Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA.
¹⁰ Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Medical Center, Durham, NC, USA.

Abstract

Introduction: Pediatric injuries in low- and middle-income countries are a leading cause of morbidity and mortality worldwide. Implementing hospital-based trauma registries can reduce the knowledge gap in both hospital care and patient outcomes and lead to quality improvement initiatives. The goal of this study was to create a pediatric trauma registry to provide insight into the epidemiology, outcomes, and factors associated with poor outcomes in injured children.

Methods: This was a prospective observational study in which a pediatric trauma registry was implemented at a large zonal referral hospital in Northern Tanzania. Data included demographics, hospital-based care, and outcomes including morbidity and mortality. Data were input into REDCap© and analyzed using ANOVA and Chi-squared tests in SAS(Version 9.4)©.

Results: 365 patients were enrolled in the registry from November 2020 to October 2021. The majority were males (n=240, 65.8%). Most were children 0-5 years (41.7%, n=152), 34.5% (n=126) were 6-11 years, and 23.8% (n=87) were 12-17 years. The leading causes of pediatric injuries were falls (n=137, 37.5%) and road traffic injuries (n=125, 34.5%). The mortality rate was 8.2% (n=30). Of the in-hospital deaths, 43.3% were children with burn injuries who also had a higher odds of mortality than children with other injuries (OR 8.72, p<0.001). The factors associated with in-hospital mortality and morbidity were vital sign abnormalities, burn severity, abnormal Glasgow Coma Score, and ICU admission.

Conclusion: The mortality rate of injured children in our cohort was high, especially in children with burn injuries. In order to reduce morbidity and mortality, interventions should be prioritized that focus on pediatric injured patients that present with abnormal vital signs, altered mental status, and severe burns. These findings highlight the need for health system capacity building to improve outcomes of pediatric injury patients in Northern Tanzania.

Keywords: Global health; Pediatric injuries; Sub-Saharan Africa; Trauma registry.

Abstract

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