Risk factors and injury characteristics among trauma patients in the Gambia

This research focuses on injuries from all mechanisms, with particular focus on road traffic injuries in urban Gambia. Data from trauma registries established in two major trauma hospitals were used to address three aims: 1) examine the general characteristics of injured individuals and their injuries, and identify factors associated with discharge status from the hospital emergency room; 2) identify differences in road-user, collision, vehicle, and driver factors, among individuals hospitalized with a road traffic injury; and 3) examine personal, crash, and injury factors associated with transfer status among road traffic injured (RTI) patients, and identify limitations of the current trauma systems that might be improved for more efficient use of resources.

Data used for this dissertation were from trauma registries established in two major trauma hospitals in The Gambia: Edward Francis Small Teaching Hospital (EFSTH) and Serrekunda General Hospital (SGH). At intake, the treating physicians and nurses completed an accident and emergency ward survey form for injuries from all mechanisms. For admitted road traffic injured patients (admission more than 24 hours), the road traffic injured admission form is completed. Data about risk factors contributing to crashes and injuries were collected from the patients. At hospital discharge, treating physicians used a 19-item questionnaire to collect data on the discharge status and disability at discharge of road traffic injured patients.

Using the trauma registry data from March 1, 2014 to March 31, 2016, we found the leading mechanism of injury was road traffic. For place of occurrence, injuries mostly occur at home and on the road. Assault was higher among young females (19 to 44 years) than males. Males have increased odds for admission and disability due to road traffic injuries. We also found that among admitted road traffic injured patients, injuries to pedestrians, bicyclists, and motorcyclists were higher than other road users. Crashes involved risk factors at person, crash, and environment levels. Head/skull injuries were common, and concussions/brain injuries were higher among pedestrians, bicyclists, and motorcyclists than vehicle occupants. Finally, our results also suggest that vehicle occupants, and professionals/skilled personnel had increased odds of being transferred than directly admitted RTI patients. Fractures/dislocations, and concussions/brain injuries were frequent among transfers. Intravenous fluid was the most frequent treatment administered to patients transferred to the definitive-care hospitals.

This project shows that injuries, especially road traffic, create a large burden of injury in The Gambia and the many contributing factors. It also provides evidence that there are many opportunities to intervene at personal, crash, and environment levels. Additionally, creating trauma registries across the country as well as trauma response system will have a greater impact to reduce burden of road traffic crashes in The Gambia.