Implementation of a pediatric trauma registry at a national referral center in Kenya: Utility and concern for sustainability

• Published in: Injury Vol. 55; no. 6; p. 111531
• Main Authors: Bhatia, Manisha B., Keung, Connie H., Hogan, Jessica, Chepkemoi, Eunice, Li, Helen W., Rutto, Emmy J., Tenge, Robert, Kisorio, Joshua, Hunter-Squires, JoAnna L., Saula, Peter W.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-06-2024
• Subjects: Child; Child, Preschool; Female; Global surgery; Hospitals, Pediatric; Humans; Implementation science; Infant; Injury epidemiology; Kenya - epidemiology; Male; Outcomes; Pediatric trauma; Prospective Studies; Referral and Consultation - statistics & numerical data; Registries; Trauma Centers; Wounds and Injuries - epidemiology; Kenya; Pediatric trauma; Injury epidemiology; Outcomes; Global surgery; Implementation science
• DOI: 10.1016/j.injury.2024.111531
• EISSN: 1879-0267
• ISSN: 0020-1383

•Implementation science can be used to develop trauma registries for limited resource settings.•External funding can provide a jumpstart to development of a registry but can limit sustainability.•Understanding trauma mechanisms by age can help develop targeted interventions.
Pediatric trauma disproportionately affects low- and middle-income countries, particularly the pediatric trauma systems, are frequently limited. This study assessed the patterns of pediatric traumatic injuries and treatment at the only free-standing public children's hospital in East Africa as well as the implementation and sustainability of the trauma registry.
A prospective pediatric trauma registry was established at Shoe4Africa Children's Hospital (S4A) in Eldoret, Kenya. All trauma patients over a six-month period were enrolled. Descriptive analyses were completed via SAS 9.4 to uncover patterns of demographics, trauma mechanisms and injuries, as well as outcomes. Implementation was assessed using the RE-AIM framework.
The 425 patients had a median age of 5.14 years (IQR 2.4, 8.7). Average time to care was 267.5 min (IQR 134.0, 625.0). The most common pediatric trauma mechanisms were falls (32.7 %) and burns (17.7 %), but when stratified by age group, toddlers had a higher risk of sustaining injuries from burns and poisonings. Over half (56.2 %) required an operation during the hospitalization. Overall, implementation of the registry was limited by the clinical burden and inadequate personnel. Sustainability of the registry was limited by finances.
This is the first study to describe the trauma epidemiology from a Kenyan public pediatric hospital. Maintenance of the trauma registry failed due to cost. Streamlining global surgery efforts through implementation science may allow easier development of trauma registries to then identify modifiable risk factors to prevent trauma and long-term outcomes to understand associated disability.