Table 2.
Assessment and management of injured patients presenting to emergency unit (EU) of select Ghanaian district and regional hospitals before TIF introduction (N=2,067)
| District hospital (n=1,586) |
Regional hospital (n=481) |
|||||
|---|---|---|---|---|---|---|
| N | (%) | N | (%) | AOR | p-value | |
| Triage and monitoring | ||||||
|
| ||||||
| Mobility at EU arrival assessed | 1,328 | (84) | 479 | (99.6) | 0.02 | <0.001 |
| Respiratory rate at EU arrival assessed | 723 | (46) | 471 | (98) | 0.02 | <0.001 |
| Temperature at EU arrival assessed | 1,167 | (74) | 477 | (99.2) | 0.02 | <0.001 |
| Oxygen saturation level at EU assessed | 706 | (45) | 422 | (88) | 0.13 | 0.001 |
|
| ||||||
| Primary assessment and actions | ||||||
|
| ||||||
| Airway assessed | 1,128 | (71) | 378 | (79) | 0.78 | 0.865 |
| Chest examined | 889 | (56) | 395 | (82) | 0.32 | 0.377 |
| Intravenous line placed | 723 | (46) | 370 | (77) | 0.31 | 0.004 |
| External bleeding checked for and controlled | 826 | (52) | 401 | (83) | 0.21 | 0.254 |
| Intra-abdominal bleeding evaluateda | 350 | (22) | 397 | (83) | 0.06 | 0.024 |
| Pelvic fracture evaluated | 288 | (18) | 344 | (72) | 0.10 | 0.050 |
| All distal pulses checked | 349 | (22) | 350 | (73) | 0.12 | 0.129 |
| Fluid and/or blood requirement considered | 657 | (41) | 333 | (69) | 0.40 | 0.139 |
| Spine immobilized for RTI or fall victims (n=1,106 district, 347 regional)b | 65 | (6) | 185 | (53) | 0.06 | 0.003 |
| Splinting of fractures considered (n=224 district, 120 regional) | 140 | (63) | 64 | (53) | 1.53 | 0.399 |
| Physical examination findings recorded | 1,484 | (94) | 476 | (99) | 0.18 | 0.164 |
| Alcohol on breath assessedc | 291 | (18) | 140 | (29) | 0.61 | 0.364 |
| Total burn surface area estimated (n=32 district, 9 regional) | 18 | (56) | 3 | (33) | 7.41 | 0.142 |
| Tetanus considered for bites, burns, lacerations, and abrasions (n= 1,271 district, 383 regional) | 906 | (71) | 335 | (87) | 0.36 | 0.306 |
| Antibiotic considered (e.g., open fracture) | 1,271 | (80) | 437 | (91) | 0.38 | 0.411 |
| Analgesics considered | 1,529 | (96) | 443 | (92) | 2.35 | 0.009 |
|
| ||||||
| Documentation | ||||||
|
| ||||||
| Blood pressure | 926 | (58) | 451 | (94) | 0.10 | 0.001 |
| Heart rate | 955 | (60) | 474 | (99) | 0.02 | <0.001 |
| Important clinical data documentedd | 639 | (40) | 444 | (92) | 0.06 | <0.001 |
|
| ||||||
| Complications | ||||||
|
| ||||||
| Any complication | 4 | (0.3) | 20 | (4) | 0.06 | 0.044 |
| Mortality | 22 | (1) | 25 | (5) | 0.62 | 0.452 |
| Mortality among seriously injured (n=84 district; n=91 regional) | 13 | (15) | 21 | (23) | 0.55 | 0.386 |
Key performance indicators listed in the table represent elements of the Trauma Intake Form
EU– Emergency Unit; RTI – Road Traffic Injury; EHSP – Emergency Unit Health Service Provider; AOR – Adjusted Odds Ratio (adjusted for patient age and injury severity score, and hospital (cluster)).
p-values in bold denotes statistical significance.
Internal abdominal bleeding ruled out by any one of: abdominal exam, ultrasound, X Ray, computerized tomography;
Spine immobilization implies use of either cervical collar or backboard;
Assessed by smelling the patient’s breathe;
Important clinical data documented - all of the following: patient sex, patient age, mechanism of injury, intent of injury, heart rate at EU arrival, blood pressure at EU arrival, consciousness level at EU arrival, and injury type