Unknown identity as a determinant of unfavourable outcomes among trauma patients at Mulago National Referral Hospital, a cohort study.

Abstract

Introduction: Trauma is one of the leading causes of morbidity and mortality worldwide with a disproportionate distribution in Low and Middle-Income countries (LMICs). Among trauma patients is a subset whose identity cannot be ascertained on admission, and these are referred to as ‘unknown’ patients. These patients occasionally receive delayed and inadequate care resulting in increased morbidity and mortality. Objective: Our objective was to assess unknown patient identity as a determinant of 48- hour outcomes among trauma patients at the Accident and Emergency Department (A&E) of Mulago National Referral Hospital (MNRH). Methodology: We consecutively recruited 163 trauma patients into the prospective cohort study. The outcome was categorized as favorable or unfavorable, depending on whether or not the patient’s vital signs improved or deteriorated during the first 48 hours of arrival into the hospital. Data were collected by observation and transfer from a patient’s file into a pretested questionnaire. We then summarized the data into proportions. Association was determined using modified Poisson regression method. Results: Trauma patients whose identity was unknown had approximately four times the risk of developing unfavorable outcomes at p-value 0.001 and 95% CI (1.859-12.891) compared to those whose identity was known given that other variables were kept constant. There were 144 males and 19 females in this study. The incidence of unfavorable outcome among unknown trauma patients was 3 per 1000 person-minutes of follow up, and the incidence of unfavorable outcome among the known trauma patients was 1.4 per 1000 person-minutes of follow up. Similarly, trauma patients whose Kampala trauma score (KTS) was ≤ 7 had two times the risk of developing unfavorable outcome compared to those whose KTS was > 7 at p-value 0.001 and 95%CI (1.438- 3.795). Conclusion: Unidentified trauma patients have a greater risk of developing unfavorable outcomes than their identified counterparts, mainly due to limited resources.