Burden and Severity of Injuries at the Emergency Department of a Tertiary Hospital in Botswana- Princess Marina Hospital

Abstract

Purpose: Injuries constitute a leading and growing cause of emergency department (ED) visits in sub-Saharan Africa. Characteristics of ED injury patients have been well-described in many parts of the world; however, data remain scarce throughout Africa, Botswana included. We aimed to describe in detail injury-related ED visits at an urban public referral hospital in Botswana. Methodology: We conducted a retrospective chart review of all patients who presented to Princess Marina Hospital in Gaborone, Botswana, over a period of 4 randomly selected consecutive months. Demographic data, injury mechanism, type, severity and ED disposition were abstracted from the medical record into a Microsoft Access database designed for this study. Study variables were analyzed with summary statistics  for frequencies, percentages, means, medians and relationships using SPSS. Injury severity was calculated for each patient using the modified Kampala Trauma Score. Results:  6715 ED visits occurred during the study period, and 1709 (25.5%) were injury related. Of these, 63.9% were male, 24.7% <14 years old, 6.7% age 14-19, 49.1% 20-40, and 19.5% >40. 35.9% were due to falls, 23.6% assault and 18.8% road traffic crashes. 40.5% isolated soft tissue injuries, 34.7% isolated extremity injuries, 9.4% multiple injuries and 5.3% head and neck injuries. Kampala Trauma Score II (KTS) was available for 76% of patients. 1.7% scored ≤6, 5.9% 7-8, and 92.4% 9-10. For patients with KTS ≤6, 18% died in the ED, 82% were admitted and 0% discharged home. For KTS 7-8, 0% died, 93.5% were admitted, 6.5% were discharged home.  For KTS II 9-10, 0% died, 26% were admitted, 74% were discharged home. Unique Contribution to Theory, Practice and Policy: This study is among the first in Botswana to assess the burden of injuries using a validated injury severity scoring tool. Based on the study findings and applicability of the KTS II in our setting, we recommend that PMH ED incorporates and promotes a severity scoring system to help in planning and resource allocation. PMH ED receives many low acuity injuries therefore improving the availability of basic resources in local clinics may reduce overcrowding. Future studies should aim to involve multiple centers to get a true representation of injury burden in Botswana.