Piloting a Trauma Registry in Northwestern Pakistan
[Thesis]
Tanoli, Omaid
Razek, Tarek
McGill University (Canada)
2018
66 p.
M.Sc.
McGill University (Canada)
2018
Introduction. Injuries are one of the leading causes of morbidity and mortality worldwide accounting for 5.8 million deaths, 32% more fatalities than tuberculosis, malaria, and HIV combined. In Pakistan, the burden of injury is significant, being the eleventh leading cause of premature death, fifth leading cause of healthy years of life lost, and the second leading cause of disability. Trauma registries have been shown to be superior to other forms of injury surveillance such as population based surveillance or administrative data. Most of the published literature documenting the state of trauma care in Pakistan is based off of population based surveillance data. A pilot trauma registry was implemented in Khyber Pakhtunkhwa, Pakistan, to accurately describe the epidemiology of injury in the region. Methods. The trauma registry was piloted at the Lady Reading Hospital (LRH) in Peshawar, Pakistan. The LRH remains the main tertiary referral center for the entire province of Khyber Pakhtunkhwa as well as bordering regions of Afghanistan. The trauma registry used was a twenty-five data point registry developed by the Centre for Global Surgery, McGill University Health Centre. Pilot implementation was carried out for five consecutive days. Results. A total of 267 patients were included in the pilot registry over the 5-day pilot study. 32.21% of patients arrived via ambulance, while 31.46% arrived via private vehicle, 29.21% used public transport, and 6.37% came on foot. Motor vehicle collisions made up 45.69% of trauma patients, while falls and gunshots caused 23.97% and 5.62% of injuries, respectively. Of the motor vehicle collisions, 45.1% of patients were pedestrians struck by a moving vehicle. Moreover, no patient involved in a car accident was wearing a seatbelt at the time of injury and only 4 patients involved in a motorbike accident were wearing a helmet. 50.56% of patients were treated and send home, 45.32% required admission for further treatment including possible surgeries, 2.25% were taken directly to the operating theatre, and 1.87% of patients died in the trauma bay. Conclusion. Despite providing a 5-day snapshot, the pilot registry was effective in delineating the epidemiology of injury in the region. Areas where public health policy is required to reduce the staggering number of trauma patients include helmet and seatbelt law enforcement, pedestrian safety, and pre-hospital trauma systems. This pilot registry provides compelling evidence for the implementation of a sustainable trauma registry in the region.