International Emergency Medicine
Background: Musculoskeletal injuries (MSI) comprise a large portion of the trauma burden in low- and
middle-income countries (LMICs). Rwanda recently launched its first emergency medicine training program (EMTP) at the University Teaching Hospital-Kigali (UTH-K), which may help to treat such injuries, yet no current epidemiological data is available on MSI specifically in the country.
Methods: This pre-post study was conducted during two data collection periods at the UTH-K from >November 2012 to July 2016. All patients with open, closed, or mixed fractures were included. Gathered information included demographics and injury characteristics of patients along with MSI outcomes, including death, traumatic complications, and length of hospital stay, before and after the implementation of its EMTP.
Results: Data from 3,609 patients was collected. Of those records, 691 patients were treated for fractures; 674 of these patients had sufficient EMTP data measured for inclusion in the analysis of results (279 from pre-EMTP and 375 from post-EMTP). In addition to revealing patient demographics, there was an observed association between EMTP and three primary outcomes: a reduction of the death rate in the ED from those with MSI by 89.9%, from 2.51% to 0.253% (p=0.0077), a reduction in traumatic complications for MSI patients by 71.7%, from 3.58% to 1.01% (p=.0211), and a reduction in duration of stay in the ED among those with MSI by 52.7% or 2.81 days on average, from 5.33 to 2.52 days (p=.0437).
Conclusion: This study reveals the epidemiology of MSI for a major Rwandan teaching hospital, and the importance of trained emergency medicine physicians to treat MSI in one example of an LMIC setting. Residency training programs are capable of reducing mortality, complications, and ED length of stay among those with MSI and other complications following traumatic injuries. Such findings underscore the efficacy and importance of investments toward educating the next generation of health professionals to combat prevalent MSI within their communities.