Evidence map›Paper›PMID 32100065›Full record

ArticleWorld journal of surgery2020

Secondary Overtriage of Trauma Patients to a Central Hospital in Malawi.

Rebecca G Maine, Chifundo Kajombo, Gift Mulima, Jennifer Kincaid, Laura Purcell, Jared R Gallaher, Trista D Reid, Anthony G Charles

Abstract read
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In one paragraph

Article in World journal of surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Guideline
  2. Pooled it
  3. Observational
  4. Review
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Rebecca G MaineDepartment of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, 27599, USA. rebecca.maine@gmail.com.ORCID 0000-0003-4327-8742
Chifundo KajomboDepartment of Surgery, Kamuzu Central Hospital, Box 149, Lilongwe, Malawi.
Gift MulimaDepartment of Surgery, Kamuzu Central Hospital, Box 149, Lilongwe, Malawi.
Jennifer KincaidDepartment of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Laura PurcellDepartment of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, 27599, USA.
Jared R GallaherDepartment of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, 27599, USA.
Trista D ReidDepartment of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, 27599, USA.
Anthony G CharlesDepartment of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, 27599, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionSecondary overtriage (OT) is the unnecessary transfer of injured patients between facilities. In low- and middle-income countries (LMICs), which shoulder the greatest burden of trauma globally, the impact of wasted resources on an overburdened system is high. This study determined the rate and associated characteristics of OT at a Malawian central hospital.

methodsA retrospective analysis of prospectively collected data from January 2012 through July 2017 was performed at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. Patients were considered OT if they were discharged alive within 48 h without undergoing a procedure, and were not severely injured or in shock on arrival. Factors evaluated for association with OT included patient demographics, injury characteristics, and transferring facility information.

resultsOf 80,915 KCH trauma patients, 15,422 (19.1%) transferred from another facility. Of these, 8703 (56.2%) were OT. OT patients were younger (median 15, IQR: 6-31 versus median 26, IQR: 11-38, p < 0.001). Patients with primary extremity injury (5308, 59.9%) were overtriaged more than those with head injury (1991, 51.8%) or torso trauma (1349, 50.8%), p < 0.001. The OT rate was lower at night (18.9% v 28.7%, p < 0.001) and similar on weekends (20.4% v 21.8%, p = 0.03). OT was highest for penetrating wounds, bites, and falls; burns were the lowest. In multivariable modeling, risk of OT was greatest for burns and soft tissue injuries.

conclusionsThe majority of trauma patients who transfer to KCH are overtriaged. Implementation of transfer criteria, trauma protocols, and interhospital communication can mitigate the strain of OT in resource-limited settings.

Indexed as

TriageAdolescentAdultChildFemaleHealth ResourcesHumansMalawiMaleMedical OverusePatient TransferRetrospective StudiesWounds and InjuriesYoung Adult

Identifiers

PMID32100065

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.