Patterns and Predictors of Timely Presentation and Outcomes of Polytrauma Patients Referred to the Emergency Department of a Tertiary Hospital in Tanzania

Elishah N Premji; Said S Kilindimo; Hendry R Sawe; Amne O Yussuf; Alphonce N Simbila; Hussein K Manji; Juma A Mfinanga; Ellen J Weber

doi:10.1155/2022/9611602

Patterns and Predictors of Timely Presentation and Outcomes of Polytrauma Patients Referred to the Emergency Department of a Tertiary Hospital in Tanzania

Emerg Med Int. 2022 Nov 4:2022:9611602. doi: 10.1155/2022/9611602. eCollection 2022.

Authors

Elishah N Premji¹, Said S Kilindimo^{1

2}, Hendry R Sawe^{1

2}, Amne O Yussuf¹, Alphonce N Simbila¹, Hussein K Manji¹, Juma A Mfinanga^{1

2}, Ellen J Weber^{2

3}

Affiliations

¹ Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.
² Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
³ Department of Emergency Medicine, University of California, San Francisco, CA, USA.

Abstract

Background: Polytrauma patients require special facilities to care for their injuries. In HICs, these patients are rapidly transferred from the scene or the first-health facility directly to a trauma center. However, in many LMICs, prehospital systems do not exist and there are long delays between arrivals at the first-health facility and the trauma center. We aimed to quantify the delay and determine the predictors of mortality among polytrauma patients. Methodology. We consecutively enrolled adult polytrauma patients (≥18 years) with ISS >15 referred to the Emergency Medicine Department of Muhimbili National Hospital, a major trauma center in Tanzania between August 2019 and January 2020. Based on a pilot study, the arrival of >6 hours after injury was considered a delay. The outcome of interest was factors associated with delayed presentation and the association of timeliness with 7-day mortality.

Results: We enrolled 120 (4.5%) referred polytrauma adult patients. The median age was 30 years (IQR 25-39) and the ISS was 29 (IQR 24-34). The majority (85%) were males. While the median time from injury to first-health facility was 40 minutes (IQR 33-50), the median time from injury to arrival at EMD-MNH, was 377 minutes (IQR 314-469). Delayed presentation was noted in more than half (54.2%) of participants, with the odds of dying being 1.4 times higher in the delayed group (95% CI 0.3-5.6). Having a GCS <8 (AOR 16.3 (95% CI 3.1-86.3), hypoxia <92% (AOR 8.3 (95% CI 1.4-50.9), and hypotension <90 mmHg (R 7.3 (95% CI 1.6-33.6) were all independent predictors of mortality.

Conclusion: The majority of polytrauma patients arrive at the tertiary facilities delayed for more than 6 hours and a distance of more than 8 km between facilities is associated with delay. Hypotension, hypoxia, and GCS of less than 8 are independent predictors of poor outcome. In the interim, there is a need to expedite the transfer of polytrauma patients to trauma care capable centers.