Trauma Surveillance in Cape Town, South Africa: An Analysis of 9236 Consecutive Trauma Center Admissions.
OBJECTIVE
Trauma is a leading cause of death and disability worldwide. In many low- and middle-income countries, formal trauma surveillance strategies have not yet been widely implemented.


OBJECTIVE
To formalize injury data collection at Groote Schuur Hospital, the chief academic hospital of the University of Cape Town, a level I trauma center, and one of the largest trauma referral hospitals in the world.


METHODS
This was a prospective study of all trauma admissions from October 1, 2010, through September 30, 2011, at Groote Schuur Hospital. A standard admission form was developed with multidisciplinary input and was used for both clinical and data abstraction purposes. Analysis of data was performed in 3 parts: demographics of injury, injury risk by location, and access to and maturity of trauma services. Geographic information science was then used to create satellite imaging of injury "hot spots" and to track referral patterns. Finally, the World Health Organization trauma system maturity index was used to evaluate the current breadth of the trauma system in place.


METHODS
The demographics of trauma patients, the distribution of injury in a large metropolitan catchment, and the patterns of injury referral and patient movement within the trauma system.


RESULTS
The minimum 34-point data set captured relevant demographic, geographic, incident, and clinical data for 9236 patients. Data field completion rates were highly variable. An analysis of demographics of injury (age, sex, and mechanism of injury) was performed. Most violence occurred toward males (71.3%) who were younger than 40 years of age (74.6%). We demonstrated high rates of violent interpersonal injury (71.6% of intentional injury) and motor vehicle injury (18.8% of all injuries). There was a strong association between injury and alcohol use, with alcohol implicated in at least 30.1% of trauma admissions. From a systems standpoint, the data suggest a mature pattern of referral consistent with the presence of an inclusive trauma system.


CONCLUSIONS
The implementation of injury surveillance at Groote Schuur Hospital improved insights about injury risk based on demographics and neighborhood as well as access to service based on patterns of referral. This information will guide further development of South Africa's already advanced trauma system.
Department of Surgery, University of Cape Town, Cape Town, South Africa.
Andrew
A
Nicol
Department of Surgery, University of British Columbia, Vancouver, Canada.
Lisa Marie
LM
Knowlton
Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada.
Nadine
N
Schuurman
Medical Research Council of South Africa, Cape Town.
Richard
R
Matzopoulos
Department of Surgery, University of British Columbia, Vancouver, Canada.
Eiman
E
Zargaran
Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada.
Jonathan
J
Cinnamon
Department of Surgery, University of Washington, Seattle.
Vanessa
V
Fawcett
Trauma Services, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Tracey
T
Taulu
Department of Surgery, University of British Columbia, Vancouver, Canada.
S Morad
SM
Hameed
D000293:Adolescent; D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012042:Registries; D013019:South Africa / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy*