Timing, Distribution and Predictors of Mortality Following a Road Traffic Injury in Northwest Ethiopia: A Hospital-Based Prospective Follow up Study

Abstract BackgroundRoad traffic injury-related mortality continues to increase from time to time globally, but its burden is more than three times higher in low-income countries. This discrepancy is mainly due to poor trauma care system both at the pre-hospital and in-hospital. The analysis of injury patterns and time to mortality is crucial for the development and improvement of trauma care systems. This study aimed to identify patterns of RTI , and predictors of mortality following a RTI. MethodsA prospective hospital-based follow up study was conducted among road traffic injury victims admitted to Gondar University Hospital between May 2019 and February 2020. The total follow-up time was 30 days. Injury severity was determined using revised trauma score (RTS). A Cox regression model was used to identify the time to death and predictors of mortality. Hazard ratios (HR), attributable risks (AR) and population attributable percent (PAR) were computed to estimate the effect size and public health impacts of road traffic injuries.ResultsA total of 454 victims were followed for 275,534 person-hours. There were 80 deaths with an overall incidence of 2.90 deaths per 10,000 person-hours of observation (95% CI: 2.77, 3.03). The significant predictors of time to death were being a driver (AHR=2.26; 95% CI: 1.09, 4.65, AR=14.8), accident at inter urban roads (AHR=1.98; 95% CI: 1.02, 3.82, AR=21%), hospital arrival time (AHR=0.41; 95% CI: .16, 0.63; AR= 3%), SBP on admission (AHR= 3.66; 95% CI: 2.14, 6.26; AR=57%), GCS of <8 (AHR= 7.39; 95% CI, 3.0819 17.74464;AR=75.7%), head injury with polytrauma (AHR= 2.32 (1.12774 4.79; AR=37%) and interaction of distance from hospital with pre-hospital care.ConclusionThis study demonstrated that trauma deaths follow the classical tri-modal pattern in low resource settings. Interventions on pre hospital care, and advancing the hospital trauma care system is required to reduce preventable deaths caused by road traffic injuries. We recommend further study that assess capability of primary hospitals in the area in providing primary trauma care.