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
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 in...
Main Authors: | , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2019-02-01
|
Series: | BMC Emergency Medicine |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12873-019-0237-2 |
id |
doaj-ae810ee0b01943b0a4409a2a52fc21ef |
---|---|
record_format |
Article |
spelling |
doaj-ae810ee0b01943b0a4409a2a52fc21ef2020-11-25T02:11:43ZengBMCBMC Emergency Medicine1471-227X2019-02-011911610.1186/s12873-019-0237-2Pre-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 TanzaniaNanyori J. Lucumay0Hendry R. Sawe1Amour Mohamed2Erasto Sylvanus3Upendo George4Juma A. Mfinanga5Ellen J. Weber6Emergency Medicine Department, Muhimbili University of Health and Allied SciencesEmergency Medicine Department, Muhimbili University of Health and Allied SciencesEmergency Medicine Department, Muhimbili University of Health and Allied SciencesEmergency Medicine Department, Muhimbili University of Health and Allied SciencesEmergency Medicine Department, Muhimbili National HospitalEmergency Medicine Department, Muhimbili National HospitalEmergency Medicine Department, Muhimbili University of Health and Allied SciencesAbstract 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.http://link.springer.com/article/10.1186/s12873-019-0237-2Initial stabilizationTrauma patientsPre-referralEmergency care |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nanyori J. Lucumay Hendry R. Sawe Amour Mohamed Erasto Sylvanus Upendo George Juma A. Mfinanga Ellen J. Weber |
spellingShingle |
Nanyori J. Lucumay Hendry R. Sawe Amour Mohamed Erasto Sylvanus Upendo George Juma A. Mfinanga Ellen J. Weber 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 BMC Emergency Medicine Initial stabilization Trauma patients Pre-referral Emergency care |
author_facet |
Nanyori J. Lucumay Hendry R. Sawe Amour Mohamed Erasto Sylvanus Upendo George Juma A. Mfinanga Ellen J. Weber |
author_sort |
Nanyori J. Lucumay |
title |
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 |
title_short |
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 |
title_full |
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 |
title_fullStr |
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 |
title_full_unstemmed |
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 |
title_sort |
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 |
publisher |
BMC |
series |
BMC Emergency Medicine |
issn |
1471-227X |
publishDate |
2019-02-01 |
description |
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. |
topic |
Initial stabilization Trauma patients Pre-referral Emergency care |
url |
http://link.springer.com/article/10.1186/s12873-019-0237-2 |
work_keys_str_mv |
AT nanyorijlucumay prereferralstabilizationandcompliancewithwhoguidelinesfortraumacareamongadultpatientsreferredtoanurbanemergencydepartmentofatertiaryreferralhospitalintanzania AT hendryrsawe prereferralstabilizationandcompliancewithwhoguidelinesfortraumacareamongadultpatientsreferredtoanurbanemergencydepartmentofatertiaryreferralhospitalintanzania AT amourmohamed prereferralstabilizationandcompliancewithwhoguidelinesfortraumacareamongadultpatientsreferredtoanurbanemergencydepartmentofatertiaryreferralhospitalintanzania AT erastosylvanus prereferralstabilizationandcompliancewithwhoguidelinesfortraumacareamongadultpatientsreferredtoanurbanemergencydepartmentofatertiaryreferralhospitalintanzania AT upendogeorge prereferralstabilizationandcompliancewithwhoguidelinesfortraumacareamongadultpatientsreferredtoanurbanemergencydepartmentofatertiaryreferralhospitalintanzania AT jumaamfinanga prereferralstabilizationandcompliancewithwhoguidelinesfortraumacareamongadultpatientsreferredtoanurbanemergencydepartmentofatertiaryreferralhospitalintanzania AT ellenjweber prereferralstabilizationandcompliancewithwhoguidelinesfortraumacareamongadultpatientsreferredtoanurbanemergencydepartmentofatertiaryreferralhospitalintanzania |
_version_ |
1724913005204865024 |