Trauma Surveillance in Cape Town, South Africa An Analysis of 9236 Consecutive Trauma Center Admissions
Trauma Surveillance in Cape Town, South Africa An Analysis of 9236 Consecutive Trauma Center Admissions
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DOI：
10.1001/jamasurg.2013.5267
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发表时间：
2014-06-01
期刊：
影响因子：
16.9
通讯作者：
Hameed, S. Morad
中科院分区：
文献类型：
--
作者：
Nicol, Andrew;Knowlton, Lisa Marie;Hameed, S. Morad
创伤是世界范围内导致死亡和残疾的主要原因。在许多低收入和中等收入国家，正式的创伤监测策略尚未广泛实施。目的为了正式收集开普敦大学首席学术医院Groote Schuur医院的创伤数据，Groote Schuur医院是开普敦大学的I级创伤中心，也是世界上最大的创伤转诊医院之一。设计、设置和参与者这是一项关于Groote Schuur医院从2010年10月1日到2011年9月30日所有创伤住院的前瞻性研究。一个标准的入院表被开发了多学科的输入，并被用于临床和数据提取目的。数据分析分三部分进行：伤害的人口统计学，按地点划分的伤害风险，以及创伤服务的获得和成熟度。然后，使用地理信息科学来创建损伤“热点”的卫星图像，并跟踪转诊模式。最后，使用世界卫生组织创伤系统成熟度指数来评估创伤系统目前的广度。MAIN结果和测量创伤患者的人口学数据、大城市集水区的伤害分布、创伤转诊和患者在创伤系统内的流动模式。结果最小34点数据集获得了9236名患者的相关人口统计、地理、事件和临床数据。数据领域完成率变化很大。对损伤的人口统计学特征(年龄、性别和损伤机制)进行了分析。大多数暴力行为发生在40岁以下的男性(71.3%)(74.6%)。暴力人际伤害(占故意伤害的71.6%)和机动车伤害(占伤害总数的18.8%)发生率较高。伤害和酒精使用之间有很强的联系，至少30.1%的创伤住院患者与酒精有关。从系统的角度来看，这些数据表明了与包容性创伤系统的存在相一致的成熟的转诊模式。结论和相关性Groote Schuur医院实施伤害监测提高了对基于人口统计学和邻里关系的伤害风险的洞察，以及基于转诊模式的服务获得。这些信息将指导南非本已先进的创伤系统的进一步发展。
IMPORTANCE Trauma is a leading cause of death and disability worldwide. In many low-and middle-income countries, formal trauma surveillance strategies have not yet been widely implemented.OBJECTIVE To formalize injury data collection at Groote Schuur Hospital, the chief academic hospital of the University of Cape Town, a level I trauma center, and one of the largest trauma referral hospitals in the world.DESIGN, SETTING, AND PARTICIPANTS This was a prospective study of all trauma admissions from October 1, 2010, through September 30, 2011, at Groote Schuur Hospital. A standard admission form was developed with multidisciplinary input and was used for both clinical and data abstraction purposes. Analysis of data was performed in 3 parts: demographics of injury, injury risk by location, and access to and maturity of trauma services. Geographic information science was then used to create satellite imaging of injury "hot spots" and to track referral patterns. Finally, the World Health Organization trauma system maturity index was used to evaluate the current breadth of the trauma system in place.MAIN OUTCOMES AND MEASURES The demographics of trauma patients, the distribution of injury in a large metropolitan catchment, and the patterns of injury referral and patient movement within the trauma system.RESULTS The minimum 34-point data set captured relevant demographic, geographic, incident, and clinical data for 9236 patients. Data field completion rates were highly variable. An analysis of demographics of injury (age, sex, and mechanism of injury) was performed. Most violence occurred toward males (71.3%) who were younger than 40 years of age (74.6%). We demonstrated high rates of violent interpersonal injury (71.6% of intentional injury) and motor vehicle injury (18.8% of all injuries). There was a strong association between injury and alcohol use, with alcohol implicated in at least 30.1% of trauma admissions. From a systems standpoint, the data suggest a mature pattern of referral consistent with the presence of an inclusive trauma system.CONCLUSIONS AND RELEVANCE The implementation of injury surveillance at Groote Schuur Hospital improved insights about injury risk based on demographics and neighborhood as well as access to service based on patterns of referral. This information will guide further development of South Africa's already advanced trauma system.