Objectives: Toward the establishment of an injury surveillance system in Uganda, the first step was to initiate hospital-based trauma registries that generate relevant and timely data on the causes, severity, morbidity, mortality, and outcomes of injuries at Mulago and Kawolo hospitals. This would help establish injury patterns and priorities in these hospital populations. The registries are based on a minimal data set and a new injury severity instrument, the Kampala Trauma Score (KTS). The usefulness of the registry and the qualities of the KTS are presented.
Methods: The Accident and Emergency Department of Mulago, an urban 1,500-bed, tertiary hospital, and the Casualty Unit of Kawolo, a 100-bed district-level hospital. Trained staff in the hospitals used a one-page, 19-item registry form to collect data on demographic, injury incident, and outcome data. The registry describes injuries based on cause, frequency, and severity. The inter-rater reliability and the predictive validity of the KTS were evaluated. Registry subjects include all injured persons that come to the above hospitals.
Results: Results are based on the first 5,210 records. Gender distribution was 27.7% female and 71.3% male. The younger than 5 years old category was 7.4%, whereas 3.9% were older than 55 years old. Admitted patients composed 37.3% of cases, and three of four injuries were unintentional. The KTS is highly predictive of need for admission or death (adults, Az = 0.95 ± 0.01; children, Az = 0.89 ± 0.01).
Conclusion: A trauma registry and injury severity measurement are both possible and useful in sub-Saharan Africa. This minimal data set and the KTS are recommended for investigators with similar resource constraints.
Two-thirds of injury deaths occur in the developing world, where they are now a recognized public health problem. 1,2 Infectious diseases remain the greatest killer of children 5 years old and younger; however, injury is a leading cause of disability and death among older children and adults. 3 A recent review of injury mortality in Africa ranks this mechanism third behind diarrhea and malaria. 4 Injury data for Uganda is fragmented, scanty, and tends to rely heavily on incomplete police and health facility records.
A USAID funded, health facility-based, burden of disease study in Uganda ranked injury in the top six causes of mortality in half of the districts. 5 Road traffic injuries alone account for 30% of all surgical emergency admissions to Mulago Hospital (Andrews and Kobusingye, unpublished data). According to the Transport Research Laboratories, UK, Uganda ranked sixth with 63.6 deaths per 10,000 vehicles per year (Jacobs and Palmer, unpublished data, 1996). Injuries caused by falls, especially at the extremes of age, and assault are also prevalent. 4 As elsewhere in Africa, burns in the home carry a high mortality and cause serious deformities in survivors. 6 This fragmentary data indicate that injury is a major problem in Uganda and warrants systematic investigation.
Effective prevention, acute care, and rehabilitation activities, are all dependent on the understanding of injury epidemiology, from surveillance and other types of research. 7-9 Forming a system of relevant data collection is vital to define the nature and extent of the problem, to identify risk factors, and to set priorities for intervention. 10,11