Elsevier

Injury

Volume 44, Issue 1, January 2013, Pages 139-143
Injury

Hospital-based injury data from level III institution in Cameroon: Retrospective analysis of the present registration system

https://doi.org/10.1016/j.injury.2011.10.026Get rights and content

Abstract

Background

Data on the epidemiology of trauma in Cameroon are scarce. Presently, hospital records are still used as a primary source of injury data. It has been shown that trauma registries could play a key role in providing basic data on trauma. Our goal is to review the present emergency ward records for completeness of data and provide an overview of injuries in the city of Limbe and the surrounding area in the Southwest Region of Cameroon prior to the institution of a formal registration system.

Methods

A retrospective review of Emergency Ward logs in Limbe Hospital was conducted over one year. Records for all patients over 15 years of age were reviewed for 14 data points considered to be essential to a basic trauma registry. Completeness of records was assessed and a descriptive analysis of patterns and trends of trauma was performed.

Results

Injury-related conditions represent 27% of all registered admissions in the casualty department. Information on age, sex and mechanism of injury was lacking in 22% of cases. Information on vital signs was present in 2% (respiratory rate) to 12% (blood pressure on admission) of records. Patient disposition (admission, transfer, discharge, or death) was available 42% of the time, whilst location of injury was found in 84% of records. Road traffic injury was the most frequently recorded mechanism (36%), with the type of vehicle specified in 54% and the type of collision in only 22% of cases. Intentional injuries were the second most frequent mechanism at 23%.

Conclusion

The frequency of trauma found in this context argues for further prevention and treatment efforts. The institution of a formal registration system will improve the completeness of data and lead to increased ability to evaluate the severity and subsequent public health implications of injury in this region.

Introduction

Injury is becoming one of the leading causes of death and disability in low-income countries, disproportionately affecting sub-Saharan Africa.1, 2 Management of injury in African settings is especially challenging due to limited resources and complex cultural contexts. Published epidemiological data on injuries are lacking in most African countries; to date, no such information is available from Cameroon. Without reliable data, strategies for the prevention and treatment of injuries remain extremely limited.

Ideally, community-based surveys (CBS) should be conducted to provide a comprehensive, population-based estimation of injury incidence and mortality.3 As the expense and time required to conduct CBSs can be prohibitive in a resource-limited setting, information from police reports, post-mortem records, and comprehensive analysis of hospital or pre-hospital records are often relied upon to give an improved understanding of incidence, mortality, and epidemiologic patterns of injury. In Cameroon, police inquiries are not systematically carried out; post-mortem analysis is considered a cultural taboo and is usually rejected by relatives of victims of injuries; and there is no pre-hospital transport and management system in our region. Given this scarcity of data sources, the best currently available resource is hospital-based information.

In settings where hospital records are used as a primary source of injury data, trauma registries can play a fundamental role in providing data on epidemiology of injury, as well as provide a tool for injury quality improvement.4, 5 Trauma registries have been shown to improve injury surveillance and serve as the fundamental tool of trauma care quality improvement, both in individual institutions and system-wide policy.6, 7, 8 In fact, trauma registries are a recommendation of the Essential Trauma Care project of the WHO, which is designed for implementation in low income countries.9

Despite the growing international consensus of the importance of trauma registries, formal trauma registries are a rarity in sub-Saharan Africa.5 Instead, retrospective review of administrative hospital records is often used to provide information about epidemiology of injury. Even in high-income settings, it has been shown that administrative data lack accuracy when compared to trauma registries from the same institution.10 In low- and middle-income countries, where other sources of injury data are rare, the inaccuracy of administrative data becomes even more relevant.

To date, there is very limited data on the incidence and pattern of injury in Cameroon. This study sought to analyse the available administrative data available from the emergency ward logs in a 200-bed regional hospital in Cameroon with respect to completeness and suitability to serve as an injury surveillance tool. The data available are also used to explore an overview of the epidemiological profile of injury in this institution.

Section snippets

Methods

This retrospective review was performed between July 1, 2007 and June 30, 2008 using hospital records from Limbe Regional Hospital in the city of Limbe, located in the Southwest Region of Cameroon. Limbe is a rapidly growing city, with an estimated 12-fold increase in population during the last 40 years, now approaching 100,000 people. Limbe Hospital is a 200-bed hospital in a semi-urban setting with an Emergency Department that is functional 24 h per day. No formal pre-hospital care system

Results

A total of 1713 injury cases were recorded over the one-year study period, representing 28% of the total number of emergency consultations in Limbe Hospital. After review of records for presence of age, sex, and injury mechanism variables, 368 patients (21%) were excluded from further analysis. Additionally, 34 (2%) patients were excluded because they attended another health institution prior to coming to Limbe regional hospital. Another 227 cases were patients below 15 years of age. Data from

Discussion

The contribution of injuries to mortality and disability is on the rise in sub-Saharan Africa due to the rapid growth of motorized transport and industrialization without any related increase in safety measures and education. Given the growing importance of injuries as a public health problem in sub-Saharan Africa and the limitation of resources available to institute formal surveillance programmes, the completeness of available hospital data needs to be examined as a potential source of

Conclusion

Despite limitations of the current hospital registration system, there is a strong indication that injuries are an important problem that is grossly underestimated in Cameroon. Institution of a formal trauma registry, as has been done in similar settings, is likely to improve the quality and completeness of injury surveillance data, both in terms of epidemiologic information and clinical parameters. Even if it does not improve the overall capture-rate of injury cases nor eliminate sources of

Source of funding

None.

Conflict of interest

No conflict of interest to disclose.

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