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

Autor: Hendry R. Sawe, Upendo George, Erasto Sylvanus, Ellen J. Weber, Amour S. Mohamed, Juma A. Mfinanga, Nanyori J. Lucumay
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
Referral
lcsh:Special situations and conditions
World Health Organization
Tertiary referral hospital
Tanzania
Tertiary Care Centers
Young Adult
03 medical and health sciences
0302 clinical medicine
Interquartile range
Urban Health Services
Humans
Medicine
Prospective Studies
Initial stabilization
030212 general & internal medicine
Referral and Consultation
Case report form
Aged
biology
business.industry
lcsh:RC952-1245
Head injury
lcsh:Medical emergencies. Critical care. Intensive care. First aid
030208 emergency & critical care medicine
lcsh:RC86-88.9
Emergency department
Middle Aged
Trauma patients
biology.organism_classification
medicine.disease
Pre-referral
Practice Guidelines as Topic
Emergency medicine
Emergency Medicine
Wounds and Injuries
Female
Observational study
Guideline Adherence
Emergency care
Emergency Service
Hospital
business
Research Article
Zdroj: BMC Emergency Medicine, Vol 19, Iss 1, Pp 1-6 (2019)
BMC Emergency Medicine
ISSN: 1471-227X
DOI: 10.1186/s12873-019-0237-2
Popis: 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.
Databáze: OpenAIRE
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