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Direct Transfer to a Tertiary Care Hospital After Traumatic Injury is Associated with a Survival Benefit in a Resource-Limited Setting

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Abstract

Introduction

Trauma is a leading cause of morbidity and mortality worldwide, and patients in low- and middle-income countries are disproportionately affected. Organized trauma systems, including appropriate transfer to a higher level of care, improve trauma outcomes. We sought to evaluate the relationship between transfer status and trauma mortality in Malawi.

Methods

We performed a retrospective analysis of trauma patients admitted to Kamuzu Central Hospital (KCH), a trauma center in Lilongwe, Malawi, between January 1, 2013, and May 30, 2018. Transfer status was categorized as direct if a patient arrives at KCH from the injury scene and indirect if a patient comes to KCH from another health care facility. We used logistic regression modeling to evaluate the relationship between transfer status and in-hospital mortality.

Results

A total of 8369 patients were included in the study. The mean age was 34.6 years (SD 15.8), and 81% of patients were male. The most common mechanism of injury was motor vehicle collision. Injury severity did not significantly differ between the two groups. Crude mortality was 4.8% for indirect and 2.6% for direct transfers. After adjusting for relevant covariates, odds ratio of mortality was 2.12 (1.49–3.02, p < 0.001) for indirect versus direct transfers.

Conclusion

Trauma patients indirectly transferred to a trauma center have nearly double the risk of mortality compared to direct transfers. Trauma outcome improvement efforts must focus on strengthening prehospital care, improving district hospital capacity, and developing protocols for early assessment, treatment, and transfer of trauma patients to a trauma center.

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Acknowledgments

We would like to thank Dr. Gift Mulima and Dr. Chifundo Kajombo for their assistance with this study.

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Authors and Affiliations

  1. Department of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, USA

    Avital Yohann, Laura N. Purcell, Jared Gallaher & Anthony Charles

  2. Kamuzu Central Hospital, Lilongwe, Malawi

    Linda Kayange & Anthony Charles

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  1. Avital Yohann
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  2. Linda Kayange
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  3. Laura N. Purcell
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  4. Jared Gallaher
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  5. Anthony Charles
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Correspondence to Anthony Charles.

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Yohann, A., Kayange, L., Purcell, L.N. et al. Direct Transfer to a Tertiary Care Hospital After Traumatic Injury is Associated with a Survival Benefit in a Resource-Limited Setting. World J Surg 46, 504–511 (2022). https://doi.org/10.1007/s00268-021-06415-7

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  • DOI: https://doi.org/10.1007/s00268-021-06415-7

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