Comparative epidemiology and outcomes among trauma patients transported by private and formal pre-hospital care modes in Kigali, Rwanda

INTRODUCTION: The burden of injuries is high in low- and middle-income countries where pre-hospital systems are being developed to improve acute injury care. This study compares the characteristics and outcomes between trauma patients transported by formal emergency medical services (EMS) and by private transport to the emergency department (ED) of the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda. METHODS: This retrospective cohort study analyzed a random sample of trauma patients presenting between 1 August 2015 and 30 July 2016. Descriptive analyses were performed, and differences in outcomes were assessed based on transport modalities via Pearson Chi-Squared or Fisher’s Exact tests. RESULTS: Of the 556 trauma patients analyzed, 87.1% were transported by private transport and the remainder by EMS. The median inpatient length of stay for private transport patients was 7 days (IQR:3-16 days), compared to 9.5 days for EMS patients (IQR:4-18 days) (p=0.301). More EMS-transported patients died in the ED (p=0.005), and more were admitted to the hospital. There was a higher mortality rate among patients admitted to the hospital who arrived by private transport, but the difference was not statistically significant. CONCLUSION: The higher ED death rate among EMS-transported patients and the higher in-hospital death rate among private transport patients suggest that major differences in the two groups may or may not be related to how trauma patients are brought to the ED.