1
|
Pettke A, Stassen W, Laflamme L, Wallis LA, Hasselberg M. Changes in trauma-related emergency medical services during the COVID-19 lockdown in the Western Cape, South Africa. BMC Emerg Med 2023; 23:72. [PMID: 37370047 DOI: 10.1186/s12873-023-00840-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND To limit virus spread during the COVID pandemic, extensive measures were implemented around the world. In South Africa, these restrictions included alcohol and movement restrictions, factors previously linked to injury burden in the country. Consequently, reports from many countries, including South Africa, have shown a reduction in trauma presentations related to these restrictions. However, only few studies and none from Africa focus on the impact of the pandemic restrictions on the Emergency Medical System (EMS). METHODS We present a retrospective, observational longitudinal study including data from all ambulance transports of physical trauma cases collected during the period 2019-01-01 and 2021-02-28 from the Western Cape Government EMS in the Western Cape Province, South Africa (87,167 cases). Within this timeframe, the 35-days strictest lockdown level period was compared to a 35-days period prior to the lockdown and to the same 35-days period in 2019. Injury characteristics (intent, mechanism, and severity) and time were studied in detail. Ambulance transport volumes as well as ambulance response and on-scene time before and during the pandemic were compared. Significance between indicated periods was determined using Chi-square test. RESULTS During the strictest lockdown period, presentations of trauma cases declined by > 50%. Ambulance transport volumes decreased for all injury mechanisms and proportions changed. The share of assaults and traffic injuries decreased by 6% and 8%, respectively, while accidental injuries increased by 5%. The proportion of self-inflicted injuries increased by 5%. Studies of injury time showed an increased share of injuries during day shift and a reduction of total injury volume during the weekend during the lockdown. Median response- and on-scene time remained stable in the time-periods studied. CONCLUSION This is one of the first reports on the influence of COVID-19 related restrictions on EMS, and the first in South Africa. We report a decline in trauma related ambulance transport volumes in the Western Cape Province as well as changes in injury patterns, largely corresponding to previous findings from hospital settings in South Africa. The unchanged response and on-scene times indicate a well-functioning EMS despite pandemic challenges. More studies are needed, especially disaggregating the different restrictions.
Collapse
Affiliation(s)
- Aleksandra Pettke
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Institute for Social and Health Sciences, University of South Africa, Pretoria, South Africa
| | - Lee Alan Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Marie Hasselberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Tang OY, Uwamahoro C, González Marqués C, Beeman A, Odoom E, Ndebwanimana V, Uwamahoro D, Niyonsaba M, Nzabahimana A, Munyanziza S, Nshuti S, Jarmale S, Stephen AH, Aluisio AR. Trends in Neurotrauma Epidemiology, Management, and Outcomes during the COVID-19 Pandemic in Kigali, Rwanda. J Neurotrauma 2023; 40:536-546. [PMID: 36326212 PMCID: PMC9986007 DOI: 10.1089/neu.2022.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
National regulations to curb the coronavirus disease 2019 (COVID-19) transmission and health care resource reallocation may have impacted incidence and treatment for neurotrauma, including traumatic brain injury (TBI) and spinal trauma, but these trends have not been characterized in Sub-Saharan Africa. This study analyzes differences in epidemiology, management, and outcomes preceding and during the COVID-19 pandemic for neurotrauma patients in a Rwandan tertiary hospital. The study setting was the Centre Hospitalier Universitaire de Kigali (CHUK), Rwanda's national referral hospital. Adult injury patients presenting to the CHUK Emergency Department (ED) were prospectively enrolled from January 27, 2020 to June 28, 2020. Study personnel collected data on demographics, injury characteristics, serial neurological examinations, treatment, and outcomes. Differences in patients before (January 27, 2020 to March 21, 2020) and during (June 1, 2020 to June 28, 2020) the COVID-19 pandemic were assessed using chi-squared and Mann-Whitney U tests. The study population included 216 patients with neurotrauma (83.8% TBI, 8.3% spine trauma, and 7.9% with both). Mean age was 34.1 years (standard deviation [SD] = 12.5) and 77.8% were male. Patients predominantly experienced injury following a road traffic accident (RTA; 65.7%). Weekly volume for TBI (mean = 16.5 vs. 17.1, p = 0.819) and spine trauma (mean = 2.0 vs. 3.4, p = 0.086) was similar between study periods. During the pandemic, patients had lower Glasgow Coma Scale (GCS) scores (mean = 13.8 vs. 14.3, p = 0.068) and Kampala Trauma Scores (KTS; mean = 14.0 vs. 14.3, p = 0.097) on arrival, denoting higher injury severity, but these differences only approached significance. Patients treated during the pandemic period had higher occurrence of hemorrhage, contusion, or fracture on computed tomography (CT) imaging (47.1% vs. 26.7%, p = 0.003) and neurological decline (18.6% vs. 7.5%, p = 0.016). Hospitalizations also increased significantly during COVID-19 (54.6% vs. 39.9%, p = 0.048). Craniotomy rates doubled during the pandemic period (25.7% vs. 13.7%, p = 0.003), but mortality was unchanged (5.5% vs. 5.7%, p = 0.944). Neurotrauma volume remained unchanged at CHUK during the COVID-19 pandemic, but presenting patients had higher injury acuity and craniotomy rates. These findings may inform care during pandemic conditions in Rwanda and similar settings.
Collapse
Affiliation(s)
- Oliver Y Tang
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Chantal Uwamahoro
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | | | - Aly Beeman
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Enyonam Odoom
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Vincent Ndebwanimana
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Doris Uwamahoro
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Mediatrice Niyonsaba
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Apollinaire Nzabahimana
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Silas Munyanziza
- Department of Anesthesia, Emergency Medicine, and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Steven Nshuti
- Department of Neurosurgery, King Faisal Hospital, Kigali, Rwanda
| | - Spandana Jarmale
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Andrew H Stephen
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adam R Aluisio
- Division of Global Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
3
|
Beeman A, Gonzalez Marques C, Tang OY, Uwamahoro C, Jarmale S, Mutabazi Z, Ndebwanimana V, Uwamahoro D, Niyonsaba M, Stephen A, Aluisio AR. Factors associated with HIV testing among patients seeking emergent injury care in Kigali, Rwanda. Afr J Emerg Med 2022; 12:281-286. [PMID: 35782195 PMCID: PMC9240989 DOI: 10.1016/j.afjem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Emergency centres (ECs) can be important access points for HIV testing. In Rwanda, one in eight people with HIV are unaware of their infection status, which impedes epidemic control. This could be addressed via increased testing. This cross-sectional study evaluated factors associated with EC-based HIV testing among injured patients at the Centre Hospitalier Universitaire de Kigali (CHUK), in Kigali, Rwanda. Methods Adult injury patients were prospectively enrolled between January-June 2020. Trained study personnel collected data on demographics, injury aspects, treatments, HIV testing, and disposition. The primary outcome was the completion of EC-based HIV testing. Differences between those receiving and those not receiving testing were assessed. Regression models yielding adjusted odds ratios with associated 95% confidence intervals (CI) were calculated to quantify magnitudes of effect. Results Among 579 patients, the majority were under 45 years of age (78.1%) and male (74.4%). The most common mechanism of injury was road traffic accidents (50.3%). EC discharge occurred in 54.4% of cases. HIV testing was performed in 221 (38.2%) cases, of which 5.9% had a positive result. HIV testing was more likely among males (aOR=1.69, 95% CI: 1.02-2.78; p=0.04), cases transported by prehospital services (aOR=2.07, 95% CI: 1.28-3.35; p=0.003) and those receiving surgical consultation (aOR=3.13, 95% CI: 1.99-4.94; p<0.001). Cases with lower acuity were less likely to be tested (OR=0.70, 95% CI: 0.55-0.90; p=0.004), as were those discharged (OR=0.28, 95% CI: 0.18-0.43; p<0.001). Conclusion In the population studied, most patients did not undergo HIV testing. EC-based physician directed testing was more likely among male patients and patients with greater care needs. These results may inform approaches to increase EC-based testing services in Rwanda and other similar settings with high HIV burdens.
Collapse
Affiliation(s)
- Aly Beeman
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA,Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | | | - Oliver Y. Tang
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Chantal Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda,Corresponding author.
| | - Spandana Jarmale
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Zeta Mutabazi
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | - Vincent Ndebwanimana
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | - Doris Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, KN 4 Ave, Kigali, Rwanda
| | - Mediatrice Niyonsaba
- Rwanda Biomedical Center, Kigali, Rwanda,Service d'Aide Médicale Urgente (SAMU), Rwanda Ministry of Health, Kigali, Rwanda
| | - Andrew Stephen
- Department of Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Adam R. Aluisio
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA,Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, USA
| |
Collapse
|
4
|
Evaluating Post-Injury Functional Status among Patients Presenting for Emergency Care in Kigali, Rwanda. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite high injury-related morbidity, approaches for evaluating post-injury functional status after emergency care are poorly characterized in resource-limited settings. This study evaluated the feasibility of standardized disability assessments among patients presenting with significant trauma to the Centre Hospitalier Universitaire de Kigali ED in Rwanda from January–June 2020. The functional status at 28-days post-injury was assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2), the Katz Activities of Daily Living (ADL) Scale, and self-reported functional state. The primary outcome was a descriptive profile of the disability status at 28-days post-injury. The WHODAS 2.0, Katz ADL Scale and patients’ self-perceived functional status was compared using Kendall’s rank correlation coefficient. Twenty-four patients were included. The most common injury mechanism was road traffic accident (70.8%); 58.3% of patients had traumatic brain injury. The self-perception questionnaire and the Katz ADL scale were strongly correlated with the WHODAS 2.0 scale; however, self-perception was not well correlated with the ADL scale. Post-injury morbidity was high and morbidity assessment was feasible, with a strong correlation between patients’ self-perceived functional status and the WHODAS-2 scale. Structured post-injury assessments may serve to inform the development of rehabilitation services in Rwanda, although larger studies are needed to inform such initiatives.
Collapse
|