COMPARATIVE ASSESSMENT OF IN-HOSPITAL TRAUMA MORTALITY AT A SOUTH AFRICAN TRAUMA CENTRE AND MATCHED PATIENTS TREATED IN THE UNITED STATES.

BACKGROUND: The unacceptably high rate of death and disability due to injury in sub-Saharan Africa is alarming. The objective of this work is to compare mortality rates between severely injured trauma patients at a high volume trauma centre in South Africa with matched patients in the United States.

METHOD: Clinical databases from the Groote Schuur Hospital (GSH) for patients treated in Cape Town, South Africa and the American College of Surgeon's National Trauma Databank (NTDB) for patients treated at large academic trauma centres in the US were used. Coarsened exact matching (CEM) identified the most comparable patient populations based on sex, age, intent, injury type, injury mechanism, Injury Severity Score, Glasgow Coma Score (GCS), and systolic blood pressure. Conditional logistic regression generated odds ratios for mortality among the entire sample and clinically relevant subgroups.

RESULTS: CEM matched 97.9% of the GSH patient sample, resulting in 3,206 matched-pairs between the GSH and NTDB cohorts. Conditional logistic regression revealed an odds ratio of mortality of 1.67 (95% CI: 1.10-2.52) for patients at GSH compared to matched patients from the NTDB. Subset analyses revealed significantly increased odds of mortality among patients with blunt injuries (OR 3.40, 95% CI: 1.68-6.88) and patients with a GCS of 8 or lower (OR 4.33, 95% CI:2.10-8.95). No statistically significant difference was identified among patients with penetrating injuries or with a GCS greater than 8 (p-value 0.90 and 0.39, respectively).

CONCLUSION: International comparisons of inter-hospital variation in risk adjusted outcomes following trauma can identify opportunities for quality improvement and have the potential to measure the impact of any corrective strategy implemented.