title: Analysis of outpatient trauma referrals in a sub-Saharan African orthopedic center.
abstract: BACKGROUND
  The purpose of this study was to characterize the orthopedic trauma workload in the Bedford Orthopaedic Centre (BOC), an orthopedic referral hospital in rural South Africa.
  
  
  METHODS
  Demographic data, injury data, and information about initial management were collected for two 6-week periods during both 2008 and 2009 from patients seen in the BOC outpatient department. Two primary outcomes were evaluated: (1) the interval between the initial outside evaluation and the BOC consultation and (2) the presence of established infection at the time of consultation. Secondary outcomes included assessments of the initial management at the referring facility.
  
  
  RESULTS
  Most patients were adult men. Almost half were referred from within a radius of 10 km, but more than one-third came from facilities in excess of 50 km away. The most frequent mode of transport was ambulance followed by taxi-van. Fractures accounted for most of the injuries. Motor vehicle accidents and assaults were more prevalent among adults than among children, for whom falls accounted for a large proportion of injuries. Referral was delayed more than 72 h in 41.4% of patients. Established infections were identified in 12.2%. Deficiencies detected during prehospital care were common.
  
  
  CONCLUSIONS
  The burden of orthopedic trauma in this rural referral center is sufficient to justify the manpower and resources needed for a major orthopedic trauma center. Because most of the injuries were fractures, efforts should be aimed at improving fracture care. Differences in the mode of injury and in the anatomical sites involved between adults and children highlight the need for focused preventive measures. Reducing both delays in referral and deficiencies in initial management might well reduce the cost and complexity of the definitive treatment required.
authors.affiliation: Institute for Global Orthopaedics and Traumatology, Department of Orthopedic Surgery, San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110, USA. jergesen@orthosurg.ucsf.edu
authors.forename: Harry
authors.initials: H
authors.lastname: Jergesen
authors.forename: David
authors.initials: D
authors.lastname: Oloruntoba
authors.forename: Edward
authors.initials: E
authors.lastname: Aluede
authors.forename: Monica
authors.initials: M
authors.lastname: Grova
authors.forename: Jonathan
authors.initials: J
authors.lastname: Phillips
authors.forename: Amber
authors.initials: A
authors.lastname: Caldwell
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D002648:Child; D004632:Emergency Medical Services; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D004204:Joint Dislocations / Q000453:epidemiology*; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D017695:Soft Tissue Injuries / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data; D016526:Workload; D055815:Young Adult