1. Comparison of Trauma Patients Between Cameroon, West Africa and Spokane, WA
Timothy Bax, MD, FACS
Trauma Medical Director
Sacred Heart Medical Center
Spokane, WA

2. Disclosures
Nothing to disclose

3. Mbingo Baptist Hospital
400 Bed hospital including 70 bed surgical ward
10 Operating rooms
More than 10,000 operations per year
Surgical residency program established in 2006
5 year program certified by Loma Linda

4. PAACS Established in 1997 to train African physicians to be surgeons
13 training sites on the continent
Goal to train 100 surgeons by 2020

5. Kasumba Moses Born and raised in Kenya Medical school in Ukraine
General Practitioner in Kenya
PAACS resident from
2017 World Health Organization fellow in oncology

6. Trauma Database May 2013 through May 2017
All injured patients evaluated by the surgical team
2275 patients
40 data points including 2 week cell phone followup

7. Sacred Heart Medical Center
Tertiary care level 2 trauma Hospital in Spokane, WA
628 beds
32 operating rooms

8. Trauma registry All patients entered into a standard trauma registry
NTDB and TQIP compliant
Calendar years
4708 patients
More than 250 data points

9. Mechanism of Injury Cameroon Spokane p value Traffic accident 68% 35%
Fall
20%
56%
Burn 3% 2%
p=0.06
Blunt assault 4% ??
Stab wound
p=0.36
GSW 1%
p<
Drowning
0%(0)
p<0.0007

10. Traffic Accidents Cameroon Spokane p value Car 24% 73% p<0.00001
Motorcycle
72%
17%
Bus 3%
0%(0)
Taxi 1%
p<
Bicycle 9%

11. Role in Accident Cameroon Spokane p value Driver 37% 66% p<0.00001
Passenger
39%
19%
Pedestrian
23%
14%

12. Safety Issues Cameroon Spokane p value Seatbelt use 6% 53% p<0.01
Helmet use
12%
83%
Alcohol use confirmed or suspected 9%
10%
p<0.07

13. Initial Presentation Cameroon Spokane p value First SBP
>89, radial pulse
82%
98%
p<
50-89, femoral/carotid pulse
17% 2%
<50 1%
<1%
First respiratory rate
10-30
96%
93%
>30 4%
p=0.46
<10 3%
Mental Status (GCS)
Alert(14-15)
91%
89%
p<0.01
Responds to voice(10-13)
p=0.78
Responds to pain(7-9)
Unresponsive(3-6) 7%

14. Injuries Cameroon Spokane p value Significant fractures 82% 52%
Closed head injury
14%
73%
Neck 2% 4%
Chest
22%
Abdomen 3%
16%
Cut/laceration
11% 8%
LE dislocation 1%
UE dislocation
<1%
Burn
p<0.005

15. Fractures Cameroon Spokane p value Lower extremity 54% 17%
Upper extremity
15%
10%
Face 4% 7%
Skull 9%
Spine w/o paralysis 2% 5%
Spine w/ paralysis
<1%
Pelvis
Open fractures
32%
16%

16. Disposition from ER/OPD
Cameroon
Spokane
p value
Ward
95%
46%
p<
ICU 1%
14% OR 2% 7%
Died
<1%
p<0.02
Referred out
p<0.002
Home
31%

17. Disposition from ER/OPD
Cameroon
Spokane
p value
Ward
95%
66% 46%
p<
ICU 1%
21% 14% OR 2%
10% %
Died
<1%
1% %
p<0.0005
Referred out
p<
Home
31%

18. Missing Data Cameroon Spokane Total patients 2275 4708 Sex 18 2 Age 13
Alcohol use
249
Mode of arrival 40
1113
Accident/Assault/
Self-inflicted 35
2713
1st Respiratory rate 17
678
1st Blood pressure 45
330
Initial neuro status 22
119
Injury to arrival interval
2925

19. Conclusions
Cameroon would benefit from an organized system of patient transport similar to the Emergency Medical Services system in Eastern Washington.
Cameroon would benefit from a public health initiative to encourage helmet and seat belt use.
The high rate of motorcycle use for transportation in Cameroon leads to a different injury pattern compared to Eastern Washington.
Despite the significant differences in technology and resources available at Mbingo Baptist Hospital, once a patient arrives, the care is excellent with a high rate of discharge to home and low mortality rate.

20. Thanks Kasumba Moses PAACS resident Denise McCurdy, RN
Trauma nurse manager for SHMC
Ryan Bax
Whitworth student

21. 2010 Subsaharan Africa HIV 1 Million Typhoid 1.1 Million
Malaria Million
Surgically treatable conditions Million

22. Questions