Review of a large trauma registry in Addis Ababa, Ethiopia: Insights into prehospital care and provider training for trauma quality improvement

Abstract

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Background: Injury is a major cause of death and disability in Ethiopia. ALERT Trauma Center in Addis Ababa, among only 3 designated trauma centres in the country, has employed a basic trauma registry since its inception in 2016; however, these data had not been utilized. In joint efforts with the Federal Ministry of Health, we aimed to understand patient injury characteristics and predictors of mortality to inform priorities in resource and training investments.

Methods: Data from 12 816 consecutive patients in the first 3 years of the trauma registry were reviewed retrospectively. MEWS (Modified Early Warning Score) was used at triage to indicate injury severity (‘red’, critically injured; ‘green’, minor injury). Physiologic data for calculating injury severity scores and in-hospital intervention data were not available. Triage groups were compared, and multivariate logistic regression analysis was conducted to determine predictors of death in the emergency department.

Results: Most patients presented with minor injuries, with 64.7% triaged as ‘yellow’ and 16.4% triaged as ‘green’. Most patients (75.9%) were also referred in from another facility. Of those who were critically injured, only 31.0% arrived by ambulance. Most injuries were soft-tissue injuries (51.1%) and fractures (23.0%). Most ‘red’ patients had sustained head injuries (62.7%). Arrival by ambulance (odds ratio, 2.20; P=0.017) and head injury (odds ratio, 3.11; P<0.001) were independent predictors of death in the emergency department.

Conclusions: This study of injured patients presenting to an Ethiopian trauma centre is among the largest to date, highlighting the need for more accessible and streamlined prehospital trauma care. Opportunities for improvement include staff training in initial trauma management and implementation of a more comprehensive trauma registry containing physiologic, intervention, and outcomes data to support a robust quality improvement programme. Efforts by the Federal Ministry of Health are ongoing to support these improvements in care.