Injuries in Bolivia: Initial Trauma Registry Results from Five Hospitals in Santa Cruz de la Sierra
Marissa A Boeck, J Esteban Foianini, Adil H Haider, Samuel D South, German Toledo, Jose C Camacho, Oscar M Gutiérrez, Lorena Jauregui, Pablo Mercado
Big data, Bolivia, Burden of disease, Developing world, Health system strengthening, Injury prevention, Public health, Quality improvement, Trauma registry
Citation Information :
Boeck MA, Foianini JE, Haider AH, South SD, Toledo G, Camacho JC, Gutiérrez OM, Jauregui L, Mercado P. Injuries in Bolivia: Initial Trauma Registry Results from Five Hospitals in Santa Cruz de la Sierra. Panam J Trauma Crit Care Emerg Surg 2018; 7 (3):209-218.
Aim: Trauma is a leading cause of global deaths. Many resource-limited settings, like Bolivia, lack data on injury mechanisms and outcomes, restricting targeted initiatives for prevention and quality improvement. We reviewed initial results from five hospital-based trauma registries in Santa Cruz de la Sierra to explore injury characteristics in this Bolivian region.
Materials and methods: From October 2015 until May 2016 emergency department (ED) staff gathered trauma patient information, including personal and injury demographics, prehospital facts, and hospital disposition, with subsequent transfer into an online platform.
Results: The registry captured N = 3,220 patients, of which 64% were male aged 21 years (IQR 6, 37). Hospital transport occurred via private car (37%), taxi (23%), or ambulance (15%), with many presenting on the day of injury (74%) within four hours (52%). Most injuries occurred at home (38%) or in the street (29%), were blunt (64%), and resulted from falls (43%), road traffic incidents (13%), or dog bites (8%). Common classifiable injuries (N = 2,874) included head/face/extremity contusions (43%), extremity fractures (12%), arm/hand penetrating injuries
Conclusion: These data suggest trauma patients at registry hospitals frequently are not hospitalized and many injuries are preventable. A more complete trauma representation within the city requires data quality improvement, program expansion, and supplementary data source inclusion. Results will inform health system resource planning and preventative strategies, enabling evidence-based interventions that reduce injury morbidity and mortality in Bolivia.
Clinical significance: These results qualify the injury burden in this Bolivian region, serving as the basis for future interventions to improve injured patient outcomes, and reduce morbidity and mortality.
Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev. 2016 Feb;22(1):3-18.
Injuries and violence: the facts. Geneva: World Health Organization, 2010.
Nwomeh BC, Lowell W, Kable R, Haley K, Ameh EA. History and development of trauma registry: lessons from developed to developing countries. World J Emerg Surg. 2006;1:32.
O'Reilly GM, Joshipura M, Cameron PA, Gruen R. Trauma registries in developing countries: a review of the published experience. Injury. 2013 Jun;44(6):713-21.
Essential Surgery. In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, editors. Disease Control Priorities 3. Vol. 1. Third edition ed. Washington D.C.: World Bank; 2015.
Bolivia: The World Bank Group; 2016 [cited 2018]. Available from: http://data.worldbank.org/country/bolivia.
Health in the Americas, 2012 Edition: Country Volume - Bolivia. Pan American Health Organization, 2012.
Santa Cruz Bolivia: Instituto Nacional de Estadistica; 2015. Available from: http://www.ine.gob.bo/pdf/Bo_Es_Na/ santa_cruz_web.swf.
Kirshner JD. City profile: Santa Cruz de la Sierra. Cities. 2013 Apr;31:544-52. PubMed PMID: WOS:000317246900053. English.
Santa Cruz de la Sierra: Google Maps; 2018 [cited 2018]. Available from: https://www.google.com/maps/@-17.8062054,-63.1783151,13z/data=!3m1!4b1!4m2!6m1!1s18rJXpQuCWdSc09jMj9ltpud8DMw?hl=en&authuser=1.
Plan Territorial de Desarrollo Integral (PTDI): Santa Cruz de la Sierra 2016-2020. Bolivia: Gobierno Autónomo Municipal, 2016.
Health Systems Profile: Bolivia, Monitoring and Analysis Health Systems Change/Reform. Washington D.C.: Pan American Health Organization, World Health Organization, 2007.
Norma Nacional de Caracterización de Hospitals de Segundo Nivel de Atencion. Bolivia: Ministerio de Salud y Deportes, 2014 Contract No.: 285.
Bolivia Washington DC: Pan American Health Organization; 2017 [cited 2018 May 30]. Available from: https://www.paho. org/salud-en-las-americas-2017; p. 3974.
Anuario Estadístico 2016. Bolivia: Instituto Nacional de Estadistica, 2017.
Boeck MA, Blair KJ, Foianini JE, Perry HB, Mata LV, Aboutanos MB, et al. Implementation of a Hospital-based Trauma Registry in Santa Cruz de la Sierra, Bolivia: Methodology, Preliminary Results, and Lessons learned. Ivatury RR, editor. Panamerican Journal of Trauma, Critical Care & Emergency Surgery [Internet]. Jaypee Brothers Medical Publishing; 2016;5(2):101-112.
Reportes de violencia contra la mujer: 60% de casos son en 2 distritos. Bolivia: El Día; 2017.
Estadísticas Sociales: Hechos de Tránsito Bolivia: Instituto Nacional de Estadística; 2018 [cited 2018 May 31st]. Available from: https://www.ine.gob.bo/index.php/seguridadciudadana/ introduccion-4.