Risk Factors for Delayed Presentation Among Patients with Musculoskeletal Injuries in Malawi

被引:20
作者
Agarwal-Harding, Kiran J. [1 ,2 ]
Chokotho, Linda C. [1 ,3 ]
Mkandawire, Nyengo C. [1 ,4 ,5 ]
Martin, Claude, Jr. [1 ,6 ]
Losina, Elena [1 ,7 ]
Katz, Jeffrey N. [1 ,8 ,9 ]
机构
[1] Brigham & Womens Hosp, Dept Orthopaed Surg, Orthopaed & Arthrit Ctr Outcomes Res, 75 Francis St, Boston, MA 02115 USA
[2] Harvard Combined Orthopaed Residency Program, Boston, MA USA
[3] Beit Cure Int Hosp, Blantyre, Malawi
[4] Queen Elizabeth Cent Hosp, Dept Orthoped, Blantyre, Malawi
[5] Univ Malawi, Coll Med, Blantyre, Malawi
[6] AO Alliance Fdn, Davos, Switzerland
[7] Boston Univ, Sch Publ Hlth, Dept Biostat, Boston, MA USA
[8] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA
[9] Harvard TH Chan Sch Publ Hlth, Dept Environm Hlth, Boston, MA 02115 USA
基金
美国国家卫生研究院;
关键词
BURDEN; TRAUMA; CARE; EPIDEMIOLOGY; CHALLENGES; IMPAIRMENT; CAPACITY; DISEASE; ACCESS;
D O I
10.2106/JBJS.18.00516
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: The burden of injuries is high in low-income and middle-income countries such as Malawi, where access to musculoskeletal trauma care is limited. Delayed treatment can worsen trauma-related disability. Understanding risk factors for delayed hospital presentation will assist in guiding trauma system development. Methods: We examined the records of 1,380 pediatric and adult patients with fractures who presented to the orthopaedic clinics of 2 urban referral hospitals and 2 rural district hospitals in Malawi. We used multivariate Poisson regression to evaluate the association between presentation to a hospital >= 2 days after the injury (delayed presentation) and 11 covariates: age, sex, education level, occupation, season of injury, day of injury, injury mechanism, injury type or extremity of injury, referral status, hospital of presentation, and estimated travel time. Results: Twenty-eight percent of pediatric patients and 34% of adult patients presented late. In the pediatric cohort, fall (relative risk [RR], 1.40 [95% confidence interval (CI), 1.02 to 1.93]), sports injuries (RR, 1.65 [95% CI, 1.09 to 2.49]), tibial or fibular injuries (RR, 1.36 [95% CI, 1.05 to 1.77]), injury over the weekend (RR, 2.30 [95% CI, 1.88 to 2.80]), estimated travel time of >= 20 minutes (RR, 1.45 [95% CI, 1.16 to 1.81]), referral from another facility (RR, 1.46 [95% CI, 1.05 to 2.02]), and presentation to Kamuzu Central Hospital, Mangochi District Hospital, or Nkhata Bay District Hospital (RR, 1.34 [95% CI, 1.07 to 1.69]) independently increased the risk of delayed presentation. In the adult cohort, fall (RR, 1.85 [95% CI, 1.38 to 2.46]), injury over the weekend (RR, 1.80 [95% CI, 1.38 to 2.36]), estimated travel time >= 20 minutes (RR, 1.36 [95% CI, 1.03 to 1.80]), and presentation to Kamuzu Central Hospital (RR, 1.74 [95% CI, 1.30 to 2.33]) independently increased the risk of delayed presentation. Conclusions: Delayed presentation to the hospital after a musculoskeletal injury is common in Malawi. Interventions are needed to improve access to musculoskeletal trauma care, especially for pediatric patients with tibial or fibular injuries, all patients after falls, patients injured over the weekend, and patients living far from health facilities.
引用
收藏
页码:920 / 931
页数:12
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