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Johns Hopkins International Injury Research Unit

A World Health Organization Collaborating Center for Injuries, Violence and Accident Prevention

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Keyword: kent stevens

Road traffic injuries (RTIs) are a leading cause of death and disability in Africa. With a rate of 28.3 fatalities per 100,000 population, it’s the highest in the world. What’s more, the economic cost of RTIs on the continent is estimated to be 1-2% of the gross national product. Despite these high numbers, there is little data available on prevention and treatment strategies.  This is true for the central African country of Cameroon, where the number of road traffic deaths has been steadily increasing since the 1970s.

Recently, in an effort to examine road traffic injuries JH-IIRU team members published “Road Traffic Injuries in Yaoundé, Cameroon: A hospital-based pilot surveillance study,” in the journal Injury. The paper looked at patients injured in RTIs who sought care at the main referral hospital in Yaoundé to determine not only the characteristics of those injured but also to identify the associations between these characteristics and outcomes which could be used to improve treatment in Cameroon as well as  other low- and middle-income countries (LMICs). The study provides valuable information about RTIs which the team hopes can be used to improve emergency care in Cameroon and other LMICs and highlights the importance of RTI prevention.

The team included JH-IIRU associate director, Kent Stevens and director Adnan Hyder, and colleagues from WHO Africa, the Ministry of Public Health in Yaoundé, as well as the Department of Surgery at the University of California, San Francisco.  Catherine Juillard, currently in the Department of Surgery at Johns Hopkins Hospital, was a post-doctoral fellow in JH-IIRU when this study was conducted.

This study is part of the unit’s ongoing global work on trauma care.

Read more here

Injury severity scores are important and necessary tools for both evaluating care of the injured patient and establishing institutional quality and research practices. In high-income countries (HICs), several injury severity scores have been used to evaluate and study trauma patients; however, despite the fact that more than 90% of the estimated 5.8 million deaths each year caused by injury worldwide occur in low- and middle-income countries (LMICs), few scores have been validated for use in these countries.  The Kampala Trauma Score (KTS) is an injury severity score that was developed specifically for use in low-resource settings.

In the recently published paper, “Is the Kampala Trauma Score an Effective Predictor of Mortality in Low-Resource Settings? A Comparison of Multiple Trauma Severity Scores,” a group of researchers, including Johns Hopkins International Injury Research Unit’s (JH-IIRU) associate director, Kent Stevens and director, Adnan Hyder, compared five trauma severity scores against the ability of KTS to predict mortality of trauma patients in the Central Hospital of Yaounde, Cameroon.

The results suggest that there is potential for the adoption of KTS for injury surveillance and triage in resource-limited settings and that KTS is as effective as other scoring systems in predicting patient mortality. Because the system is simple to administer and record, this makes KTS a potentially valuable tool for low-resource settings, where many hospitals are understaffed and basic record-keeping and data collection is unreliable or incomplete.

To read more about the study, click here.

Recently, JH-IIRU director, Adnan Hyder and associate director, Kent Stevens, were invited to participate in surgical Grand Rounds at Virginia Commonwealth University (VCU) Medical Center.

While there, Dr. Stevens presented on care of the injured patient in the developing world, focusing on the Unit’s trauma care efforts in Kenya as part of the Bloomberg Philanthropies Global Road Safety Program.

There are four specific aims of the trauma care efforts in Kenya, 1) to understand and evaluate the transport systems in the country (both formal and informal); 2) to evaluate the existing emergency response system; 3) to explore the triage capabilities of participating hospitals/healthcare facilities;  and 4) to evaluate hospitals’ resources and infrastructure available for the injured patient.

In order to accomplish these goals, it is important to have multi-sector engagement including hospital administrators, practitioners and clinicians as well as the local and national governments and Ministries of Health. It’s equally important, Dr. Stevens said, to focus efforts on areas that will have the most impact.  

In order to be most effective, the Unit’s trauma care efforts are focusing training of both pre-hospital and in-hospital trauma care providers while also developing and implementing trauma registries,  and working to develop a dependable EMS communications system. The Unit is also advocating for increased stakeholder engagement in order to strengthen trauma care legislation in the country. Dr. Stevens is also developing a Trauma Care Quality Improvement Program and is o recommending continuing the trauma care evaluation using the Trauma Care System Profile (TSP) tool.

Improving the care of the injured patient in Kenya must be a multi-step approach that involves numerous organizations working in the country in an ongoing effort to ensure longevity of the program.

On October 10-11, JH-IIRU hosted two experts to discuss care of the injured patient in low- and middle-income countries. Hosted by associate director, Kent Stevens, the experts met with members of the JH-IIRU team.

Dr. Razzak is a long-time JH-IIRU collaborator and affiliated faculty member who is currently serving as the chairman of the Department of Emergency Medicine at Aga Khan University and Director of the WHO Collaborating Center in Emergency Medicine and Trauma at the Aga Khan University in Pakistan. Dr. Razzak is also part of the Aman Foundation, a non-profit trust located and operating in Pakistan. The foundation aims to make strategic interventions in the country to support development in the areas of healthcare, education and nutrition. Dr. Razzak is CEO of AmanHealth, which oversees the foundation’s emergency medical service, AmanAmbulance. This service consists of a strategically positioned network of 100 state-of-the-art ambulances, with doctors and emergency medical technicians (EMTs) on board to provide comprehensive, round-the-clock coverage to the city of Karachi.

Dr. Rizwan Naseer is the Director General of The Punjab Emergency Service (Rescue 1122), the largest emergency humanitarian service of Pakistan. Rescue 1122 was developed in response to the failure of repeated attempts to revitalize and modernize the old organizations mandated for emergency management. Because of the services performance during emergencies and disasters in recent years, Rescue 1122 has been designated a Disaster Response Force by the Provincial Disaster Management Authority (PDMA), Government of the Punjab.

The experts discussed the Bloomberg Philanthropies Global Road Safety Program, as well as trauma care efforts in Kenya and how to apply the work of JH-IIRU, the Aman Foundation and Rescue 1122 in the developing world.  

By all accounts, the meeting was very successful, and JH-IIRU looks forward to further collaborations with Dr. Razzak and Dr. Naseer.

JHH_ER
Dr. Kent Stevens, right, gives Drs Junaid Razzak (left) and Rizwan Naseer (center) a tour of the Hopkins ER

On October 9, 2013, JH-IIRU director, Adnan Hyder, associate director, Kent Stevens and faculty member, Amber Mehmood participated in the American College of Surgeons Annual Clinical Congress in Washington DC.

In the panel, “Developing, Implementing and Evaluating Trauma Care Systems: Experiences from Low- and Middle-Income Countries,” Dr. Stevens discussed the trauma care work in Kenya as part of the Bloomberg Philanthropies Global Road Safety Program, and Dr. Mehmood discussed Pakistan’s efforts in trauma care and management. Also participating in the panel was former JH-IIRU post doctoral fellow, Hadley Wesson, who discussed trauma surveillance work at the Red Cross Memorial Children’s Hospital in Cape Town, South Africa.

The panel, moderated by Dr. James Neifeld, a surgical oncologist at the Virginia Commonwealth University Department of Surgery and past JH-IIRU collaborator and  co-moderated by Dr. Hyder, focused on trauma care systems in low- and middle-income countries. The panel aimed to demonstrate that established interventions can make a significant impact on injury prevention and public health, while highlighting fundamental elements in strengthening the care of the injured patient, such as defining the epidemiology of trauma care injuries, implementing evidence-based trauma care interventions, and assessing the overall impact of these interventions.

This year marks the 100 year anniversary of the founding of the American College of Surgeons. The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The College currently has approximately 78,000 members, including more than 4,000 Fellows in other countries, making it the largest organization of surgeons in the world. There are presently more than 2,600 Associate Fellows.

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