Variations in injury characteristics among paediatric patients following trauma: A retrospective descriptive analysis comparing pre-hospital and in-hospital deaths at Kamuzu Central Hospital, Lilongwe, Malawi

Background
Trauma is a major cause of paediatric mortality in sub-Saharan Africa. In the absence of pre-hospital care, injury mechanisms and causes of death are difficult to characterise. Injury characteristics of pre-hospital deaths (PHD) and in-hospital deaths (IHD) were compared.
Methods
Using our trauma surveillance database, a retrospective, descriptive analysis of children (< 18 years) presenting to Kmuzu Central Hospital in Lilongwe, Malawi, from 2008 to 2013 was performed. Patient and injury characteristics of pre-hospital and in-hospital deaths were compared with univariate and bivariate analysis.
Results
Of 30,462 paediatric trauma patients, presenting between 2008 and 2013, 170 and 173 resulted in PHD and IHD, respectively. In PHD and IHD patients, mean age was 7.3 ± 4.9 vs 5.2 ± 4.3 (P < 0.001), respectively. IHD patients were more likely transported by ambulance than PHD patients (51.2% vs 8.3%, respectively; P < 0.001). The primary mechanisms of injury for PHD were road traffic injuries (RTI) (45.8%) and drowning (22.0%), with head injury (46.7%) being the predominant cause of death. Burns were the leading mechanism of injury (61.8%) and cause of death (61.9%) in IHD, with a mean total body surface area involvement of 24.7% ± 16.0%.
Conclusions
RTI remains Malawi’s major driver of paediatric mortality. Most of these deaths attributed to head injury occur prior to hospitalisation; therefore the mortality burden is underestimated if accounting for IHD alone. Death among burn patients is likely due to under-resuscitation or sepsis. Improving pre-hospital care and head injury and burn management can improve injury-related paediatric mortality.