DEPARTMENT OF PUBLIC HEALTH MEDICINE

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ACADEMIC PROGRAMME: JOURNAL CLUB

2022

Trauma Surveillance in Cape Town, South Africa

An Analysis of 9236 Consecutive Trauma Center Admissions

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Presenter: Mirike de Beer

Authors: Andrew Nicol, MD; Lisa Marie Knowlton, MD, MPH; Nadine Schuurman, PhD; Richard Matzopoulos, BBusSci, MPhil; Eiman Zargaran, MD; Jonathan Cinnamon, MA; Vanessa Fawcett, MD, MPH; Tracey Taulu, RN, BSCN, MHS; S. Morad Hameed, MD, MPH

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Presenter

Dr Mirike de Beer - Medical Intern 2nd year

Studied: University of Pretoria

Completing internship @ SBAH - currently rotating through Family Medicine including public health.

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An Overview

1. Importance:

Trauma = leading cause of death and disability globally.

>90% in low- to middle income countries - Trauma systems not implemented

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Trauma system: a comprehensive public health approach to injury control and prevention.

1. Objective:

Sustainable strategy for trauma center–based injury surveillance that does not interrupt clinical flow, to analyze injury data and assess access to trauma services in Cape Town.

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1. Type of study:

Prospective study from all traumas admitted to Groote Schuur Hospital (GSH) during a 1 year period (Oct 2010-Sept 2011)

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Overview cont.

5. Design & Setting:

• Standard admission form - multidisciplinary team compiled
• Capture data based on 3 parts (demographics of injury, injury risk by location, and access to and maturity of trauma services.)
• Geographic information: hot spots & track referral patterns
• WHO: trauma system maturity index - evaluate current breadth of our trauma system

6. Conclusion & Relevance

This study helped to achieve insights about injury risk based on demographics and neighborhood as well as access to service based on patterns of referral.

Introduction

• Importance: Trauma leading cause of death - global burden

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• Injury-related deaths in SA: need for implementation of systems to optimize treatment and education to prevent death and complications

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• Surveillance of trauma patients through hospital-based registries is shown to be effective but is not widespread in low- and middle-income countries.

(Trauma registry: Database that document acute care delivered to patients hospitalised with injuries.) - Alternative?

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• Why GSH? Teaching hospital, Level 1 trauma centre based in the Western Cape, seeing up to 12000 casualties annually with 1 million more seen at hospitals close by

Method

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Injury Surveillance

Part 3: WHO trauma system maturity index tool

Tool - assess GSH

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Global standard - globally measure and compare the system currently in place

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Part 2: Report form

• Multi-disciplinary
• No exclusion criteria
• Captured data: demographics, injury mechanism and type, and geographic location of injury data.
• Completed on arrival by 1st Clinician

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Part 1: Needs assessment conducted

Surgeons, public health, administrators - feasibility and utility

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Method

Ethics and consent:

• Approval obtained institutional review boards at Simon Fraser University and GSH

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• Patient consent - not obtained - standard processes of care

Results

Keep in mind - Limitations

Field completion rates were low - inaccurate data

Results

Part 1: Form use & Field completion

34 data points - Completion rates variable

Feasibility and utilization?

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Results

Part 2 - Information gathered from the form

Geographic distribution

Location: 1. the street (48.6%), 2. at home (33.6%), and 3. at a bar (4.8%)

Modes of transportation: 1. ambulance (51.1%), 2. walking (18.2%), and 3. private vehicle (14.7%)

Townships:

• Khayelitsha
• Salt River
• Landsdowne
• Mitchell’s Plain

Results

Patient demographics

71.3% Males

Heavily distributed among age 18-40

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Injury mechanism

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Results

Regional Trauma system (Part 3)

WHO trauma system maturity index: Cape Town - strong trauma system.

• Accredited by professional bodies
• Governed by national agency
• Requires formal training to practice trauma
• Quality improvement - M&M

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GSH: Level I center, with specialized trauma care, processes for quality improvement, and strong commitments to education and research

Discussion

Trauma system implemented - decrease the injury risk and global burden of disease: Comprehensive public health approach - advances in injury prevention and constant improvements in the quality and coordination

• pre-hospital care,
• acute in-hospital trauma care
• rehabilitation

Created safer roads, work places, and societies. This comprehensive public health approach to injury control decreased injury risk

The development of trauma systems is dependent on injury data and continuous injury surveillance

Our challenge: Trauma registries costly and competing with other priorities

Addressed this - fill-out form

Discussion

What the data showed:

Prevalence

• young males
• high rates of assault
• association of alcohol and interpersonal violence
• traffic collisions

Insights

• pattern of presentation
• hospital and flow of patients to higher levels of care.

Essential to the development of inclusive systems of trauma care: Decrease odds mortality

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Geographic analyses demonstrate injury “hot spots”

Allow for targeted placement of injury prevention efforts.

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Discussion

Limitations:

Field completion rates were low

• frequent turnover of staff
• high clinical workloads
• Paper based
• Labor intensive

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Discussion

Improvements

• Who is prepared to fill in (Clinician?)
• Compliance - on-site trauma coordinator - ?Costly
• Include procedural data and outcomes, anatomic information for a better overview of burden
• tablet computer–based electronic application

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Discussion

Going forward

Designed a tablet computer–based electronic application

1. Gather relevant patient data
2. Calculate injury severity scores
3. Generate treatment plans
4. Review safety checklists, and
5. Communicate plans.

Uploaded - process (software)

Access to hotspots (mapping)

Hope: low-cost information technology tools can expand the benefits of injury surveillance and corresponding trauma system development to low-resource settings, starting within the hospitals of Cape Town’s trauma system.

Conclusions

The implementation of injury surveillance 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.

My Thoughts

Potential: Very impactful

Decrease workload - less labour intensive form - focussed

Education towards clinicians and physicians: Long run - decrease burden

Involvement of other public sectors

Expand the study on the reason for mechanism of injuries - where’s the gap in our system (assualt, traffic, alcohol, falls)

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Journal Topic and Date.

Thank You