ArticleInjury2016
Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa.
Article in Injury, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Thefeasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: a systematic review.Trauma surgery & acute care open · 2020Pooled it
- Delays in seeking and reaching care for injured patients in four low-income and middle-income countries: a cohort study.BMJ global health · 2026Article
- Impact of Admission Route on In-Hospital Mortality in Patients with Traumatic Brain Injury: A Retrospective Observational Study of a Single Major Trauma Center in South Korea.Journal of clinical medicine · 2026Article
- Strategies and Recommendations to Improve Accessibility of Essential Surgery in Rural Settings in OECD Countries: A Scoping Review.World journal of surgery · 2025Article
- Mapping the processes and information flows of a prehospital emergency care system in Rwanda: a process mapping exercise.BMJ open · 2024Article
- Article
- Access to quality care after injury in Northern Malawi: results of a household survey.BMC health services research · 2024Article
- [Indicators to measure the performance of emergency trauma care].Revista medica del Instituto Mexicano del Seguro Social · 2023Review
- Delay in surgical treatment in low-income and middle-income countries: an editorial.Annals of medicine and surgery (2012) · 2023Article
- Analysis of Surgical Mortalities Using the Fishbone Model for Quality Improvement in Surgical Disciplines.World journal of surgery · 2022Article
- The Optimal Distribution of Surgery in Low- and Middle-Income Countries: A Proposed Matrix for Determining Country-Level Organization of Surgical Services - A Response to the Recent Commentaries.International journal of health policy and management · 2022Article
- Direct Transfer to a Tertiary Care Hospital After Traumatic Injury is Associated with a Survival Benefit in a Resource-Limited Setting.World journal of surgery · 2022Article
- Association of traumatic brain injury severity and time to definitive care in three low-middle-income European countries.Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention · 2022Article
- Epidemiology of prehospital trauma deaths in Malawi: A retrospective cohort study.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2021Article
- Association between volume resuscitation & mortality among injured patients at a tertiary care hospital in Kigali, Rwanda.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2021Article
- Association between traumatic brain injury (TBI) patterns and mortality: a retrospective case-control study.F1000Research · 2021Article
- A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes.International journal of emergency medicine · 2020Article
- Observational
- Delays in hospital admissions in patients with fractures across 18 low-income and middle-income countries (INORMUS): a prospective observational study.The Lancet. Global health · 2020Observational
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
introductionTraumatic injuries account for the greatest portion of global surgical burden particularly in low- and middle-income countries (LMICs). To assess effectiveness of a developing trauma system, we hypothesize that there are survival differences between direct and indirect transfer of trauma patients to a tertiary hospital in sub Saharan Africa.
methodsRetrospective analysis of 51,361 trauma patients within the Kamuzu Central Hospital (KCH) trauma registry from 2008 to 2012 was performed. Analysis of patient characteristics and logistic regression modelling for in-hospital mortality was performed. The primary study outcome is in hospital mortality in the direct and indirect transfer groups.
resultsThere were 50,059 trauma patients were included in this study. 6578 patients transferred from referring facilities and 43,481 patients transported from the scene. The indirect and direct transfer cohorts were similar in age and sex. The mechanism of injury for transferred patients was 78.1% blunt, 14.5% penetrating, and 7.4% other, whereas for the scene group it was 70.7% blunt, 24.0% penetrating, and 5.2% other. Median times to presentation were 13 (4-30) and 3 (1-14)h for transferred and scene patients, respectively. Mortality rate was 4.2% and 1.6% for indirect and direct transfer cohorts, respectively. A total of 8816 patients were admitted of which 3636 and 5963 were in the transfer and scene cohort, respectively. After logistic regression analysis, the adjusted in-hospital mortality odds ratio was 2.09 (1.24-3.54); P=0.006 for indirect transfer versus direct transfer cohort, after controlling for significant covariates.
conclusionsDirect transfer of trauma patients from the scene to the tertiary care centre is associated with a survival benefit. Our findings suggest that trauma education and efforts directed at regionalization of trauma care, strengthening pre-hospital care and timely transfer from district hospitals could mitigate trauma-related mortality in a resource-poor setting.
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