Diurnal variation in trauma mortality in sub-Saharan Africa: A proxy for health care system maturity
Diurnal variation in trauma mortality in sub-Saharan Africa: A proxy for health care system maturity
复制标题
DOI：
10.1016/j.injury.2019.11.006
复制
发表时间：
2020-01-01
影响因子：
2.5
通讯作者：
Charles, Anthony
中科院分区：
文献类型：
--
作者：
Gallaher, Jared R.;Varela, Carlos;Charles, Anthony
背景：在全球范围内，创伤是低收入国家发病率和死亡率的主要原因。然而，在这些环境中的创伤中心有有限的资源来管理复杂的创伤与最少的人员配置和诊断工具。这些限制可能会在夜间加剧。我们假设，有一个在夜间hours.Methods：我们进行了一项回顾性分析，记录在马拉维利隆圭的Kamuzu中心医院创伤登记处的所有患者的创伤相关死亡率增加，从2012年1月至2016年12月。夜间定义为18：00至5：59。死亡的病人被排除在外。采用改良的Poisson回归模型计算夜间就诊与死亡率之间的关系，并对重要的混杂因素进行了调整。白天的粗死亡率为0.8%，而夜间为1.4%（p < 0.001）。根据马拉维创伤评分（MTS）和转移状态评估的损伤严重程度进行调整后，夜间就诊与白天相比死亡的风险比为1.90（95%CI 1.48，2.42）。当按创伤年分层时，死亡风险比从2012年至2014年每年都在下降，但在2015年有所上升。2016年没有差异。结论：我们首次描述了撒哈拉以南非洲创伤相关死亡率的昼夜变化。与白天就诊的患者相比，夜间就诊的受伤患者的校正死亡风险比几乎是白天就诊患者的两倍，尽管存在年度差异。创伤相关死亡率的日变化是创伤系统成熟度的一个简单但重要的指标，应跟踪医疗保健系统的改进。(C)2019爱思唯尔有限公司版权所有。
Background: Globally, traumatic injury is a leading cause of morbidity and mortality in low-income countries. However, trauma centers in these environments have limited resources to manage complex trauma with minimal staffing and diagnostic tools. These limitations may be exacerbated at night. We hypothesized that there is an increase in trauma-associated mortality for patients presenting during nighttime hours.Methods: We conducted a retrospective analysis of all patients recorded in the Kamuzu Central Hospital trauma registry in Lilongwe, Malawi from January 2012 through December 2016. Nighttime was defined as 18:00 until 5:59. Patients brought in dead were excluded. A modified Poisson regression model was used to calculate the relationship between presentation at night and mortality, adjusted for significant confounders.Results: 74,500 patients were included. During the day, crude mortality was 0.8% compared to 1.4% at night (p < 0.001). The risk ratio of mortality following night time presentation compared to day was 1.90 (95% CI 1.48, 2.42) when adjusted for injury severity, assessed by the Malawi Trauma Score (MTS), and transfer status. When stratified by the year of traumatic injury, the risk ratio of death decreased each year from 2012-2014 but increased in 2015. There was no difference in 2016.Conclusions: We report the first description of diurnal variation in trauma-associated mortality in subSaharan Africa. Injured patients who presented at night had nearly twice the adjusted risk ratio of death compared to patients that presented during the daytime although there were yearly differences. Diurnal variation in trauma-associated mortality is a simple but important indicator of the maturity of a trauma system and should be tracked for health care system improvement. (C) 2019 Elsevier Ltd. All rights reserved.