Musculoskeletal Injuries and Outcomes Pre- and Post- Emergency Medicine Training Program.

Peter Mattson,Adam Aluisio,Michael Henry,Jeanne Nyinawankusi,Naz Karim,Ezechiel Nteziryayo,Adam Levine,Jean Byiringiro,Zeta Mutabazi,Noah Rosenberg

doi:10.5811/westjem.2019.7.41448

Abstract

IntroductionMusculoskeletal injuries (MSI) comprise a large portion of the trauma burden in low- and middle-income countries (LMIC). Rwanda recently launched its first emergency medicine training program (EMTP) at the University Teaching Hospital-Kigali (UTH-K), which may help to treat such injuries; yet no current epidemiological data is available on MSI in Rwanda.MethodsWe conducted this pre-post study during two data collection periods at the UTH-K from November 2012 to July 2016. Data collection for MSI is limited and thus is specific to fractures. We included all patients with open, closed, or mixed fractures, hereafter referred to as MSI. Gathered information included demographics and outcomes including death, traumatic complications, and length of hospital stay, before and after the implementation of the EMTP.ResultsWe collected data from 3609 patients. Of those records, 691 patients were treated for fractures, and 674 of them had sufficient EMTP data measured for inclusion in the analysis of results (279 from pre-EMTP and 375 from post-EMTP). Patient demographics demonstrate that a majority of MSI cases are male (71.6% male vs 28.4% female) and young (64.3% below 35 years of age). Among mechanisms of injury, major causes included road traffic accidents (48.1%), falls (34.2%), and assault (6.0%). There was also an observed association between EMTP and trends of the three primary outcomes: a reduction of death in the emergency department (ED) from those with MSI by 89.9%, from 2.51% to 0.25% (p = 0.0077); a reduction in traumatic complications for MSI patients by 71.7%, from 3.58% to 1.01% (p = 0.0211); and a reduction in duration of stay in the ED among those with MSI by 52.7% or 2.81 days on average, from 5.33 to 2.52 days (p = 0.0437).ConclusionThis study reveals the current epidemiology of MSI morbidity and mortality for a major Rwandan teaching hospital and the potential impacts of EM training implementation among those with MSI. Residency training programs such as EMTP appear capable of reducing mortality, complications, and ED length of stay among those with MSI caused by fractures. Such findings underscore the efficacy and importance of investments in educating the next generation of health professionals to combat prevalent MSI within their communities.

Highlights

Musculoskeletal injuries (MSI) comprise a large portion of the trauma burden in lowand middle-income countries (LMIC)
691 patients were treated for fractures, and 674 of them had sufficient emergency medicine training program (EMTP) data measured for inclusion in the analysis of results (279 from pre-EMTP and 375 from post-EMTP)
This study reveals the current epidemiology of MSI morbidity and mortality for a major Rwandan teaching hospital and the potential impacts of EM training implementation among those with MSI

Summary

Introduction

Musculoskeletal injuries (MSI) comprise a large portion of the trauma burden in lowand middle-income countries (LMIC). Musculoskeletal injuries (MSI) are a major cause of morbidity and mortality across the world that disproportionately affect those in low- and middle-income countries (LMIC), which often lack trained healthcare providers who can properly treat such conditions.[1,2] Approximately 90% of the five million annual deaths across the world due to injuries occur in LMICs such as Rwanda.[3,4] The literature lacks an updated fund of knowledge regarding the prevalence, etiology, and treatment for MSIs in Rwanda to supplement previous studies. These mortality figures do not paint a comprehensive picture of the burdens posed by MSIs and fractures in particular

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