Retrospective review of the patient cases at a major trauma center in Nairobi, Kenya and implications for emergency care development

Julie Saleeby; Justin G Myers; Karen Ekernas; Katherine Hunold; Ali Wangara; Alice Maingi; Peyton Wilson; Vincent Mutiso; Sarah Zamamiri; Daniel Bacon; Wes Davis; John Suder; Yash Agrawal; Ogar Ogar; Ian B K Martin; Stephen Dunlop

doi:10.1016/j.afjem.2019.05.002

Retrospective review of the patient cases at a major trauma center in Nairobi, Kenya and implications for emergency care development

Afr J Emerg Med. 2019 Sep;9(3):127-133. doi: 10.1016/j.afjem.2019.05.002. Epub 2019 Jul 2.

Authors

Julie Saleeby¹, Justin G Myers¹, Karen Ekernas², Katherine Hunold³, Ali Wangara⁴, Alice Maingi⁴, Peyton Wilson⁵, Vincent Mutiso⁶, Sarah Zamamiri⁷, Daniel Bacon⁸, Wes Davis⁹, John Suder⁸, Yash Agrawal⁸, Ogar Ogar⁸, Ian B K Martin¹⁰, Stephen Dunlop¹¹

Affiliations

¹ University of North Carolina at Chapel Hill, Department of Emergency Medicine, 101 Manning Dr, Chapel Hill, NC 27514, USA.
² St Joseph Hospital, Department of Emergency Department, 1375 19th Ave, Denver, CO 80218, USA.
³ The Ohio State University, Department of Emergency Medicine, 410 W 10th Ave, Columbus, OH 43210, USA.
⁴ Kenyatta National Hospital, Accident and Emergency Department, Hospital Road, Upper Hill, Nairobi 00202, Kenya.
⁵ University of North Carolina at Chapel Hill, Department of Pediatrics, 130 Mason Farm Rd, Chapel Hill, NC 27514, USA.
⁶ University of Nairobi School of Medicine, Department of Orthopedics, University Way, Nairobi, Kenya.
⁷ Nova Southeastern University, College of Osteopathic Medicine, 3200 S University Dr, Davie, FL 33328, USA.
⁸ University of North Carolina, School of Medicine, 321 S Columbia St, Chapel Hill, NC 27516, USA.
⁹ Edward Via College of Osteopathic Medicine - Carolinas Campus, 350 Howard St, Spartanburg, SC 29303, USA.
¹⁰ West Virginia University, Department of Emergency Medicine, 1 Medical Center Dr, Morgantown, WV 26506, USA.
¹¹ Hennepin County Medical Center, Department of Emergency Medicine, 701 Park Ave, Minneapolis, MN 55415, USA.

Abstract

Introduction: Low- and middle-income countries (LMICs) are continuing to experience a "triple burden" of disease - traumatic injury, non-communicable diseases (NCDs), and communicable disease with maternal and neonatal conditions (CD&Ms). The epidemiology of this triad is not well characterised and poses significant challenges to resource allocations, administration, and education of emergency care providers. The data collected in this study provide a comprehensive description of the emergency centre at Kenya's largest public tertiary care hospital.

Methods: This study is a retrospective chart review conducted at Kenyatta National Hospital of all patient encounters over a four-month period. Data were collected from financial and emergency centre triage records along with admission and mortality logbooks. Chief complaints and discharge diagnoses collected by specially trained research assistants were manually converted to standardised diagnoses using International Classification of Disease 10 (ICD-10) codes. ICD-10 codes were categorised into groups based on the ICD-10 classification system for presentation.

Results: A total of 23,941 patients presented to the emergency centre during the study period for an estimated annual census of 71,823. The majority of patients were aged 18-64 years (58%) with 50% of patients being male and only 3% of unknown sex. The majority of patients (61%) were treated in the emergency centre, observed, and discharged home. Admission was the next most common disposition (33%) followed by death (6%). Head injury was the overall most common diagnosis (11%) associated with admission.

Conclusions: Trends toward NCDs and traumatic diseases have been described by this study and merit further investigation in both the urban and rural setting. Specifically, the significance of head injury on healthcare cost, utilisation, and patient death and disability points to the growing need of additional resources at Kenyatta National Hospital for acute care. It further demonstrates the mounting impact of trauma in Kenya and throughout the developing world.

Keywords: Emergency medicine; Head injury; Kenya; Kenyatta National Hospital; Trauma; Triple burden of disease.