510 - The Effects of Time and Distance to Definitive Care on Morbidity and Mortality in Pediatric Injury Patients in Northern Tanzania

Poster Number: 510
Publication Number: 510.42

Background: Injury is the leading cause of death for youth aged 5-24 years with the majority of deaths occurring in low- and middle-income countries (LMICs). Despite this, there is a paucity of funding and research focused on reducing the burden of these deaths. Injuries require time-critical care, and delays lead to worse outcomes. Interventions directed at reaching appropriate care faster have the potential to improve pediatric injury-related outcomes in LMICs. Geographic information systems (GIS) is a valuable tool in the field of public health as it can spatially describe patient outcome measures and identify areas in which to target interventions.

Objective: This study uses GIS to map the facilities where pediatric injury patients in Northern Tanzania present first in order to see the effects of time and distance to definitive care at a tertiary hospital on morbidity and mortality.

Design/Methods: This was a retrospective, descriptive study using a pediatric injury registry including patients < 18 years of age at Kilimanjaro Christian Medical Center (KCMC), a tertiary referral hospital in Northern Tanzania. Data included demographics, referral center information, morbidity and in-hospital mortality. Morbidity was measured using the Pediatric Glasgow Outcome Score-Extended (GOS-E) score. Data was input into REDCap© and analyzed using chi-squared tests in SAS (Version 9.4). Distances between facilities and KCMC were determined using GoogleMaps. ArcGIS was used for GIS mapping.

Results: 828 patients were enrolled in the registry from November 2020 to September 2023. The majority were male (n=521, 63.5%). Most patients were between the ages of 6-11 years (n=297, 37.6%). Older patients had increased morbidity as compared to younger patients (p < 0.01). Patients treated at a health care facility prior to KCMC had higher morbidity that those who presented direct to KCMC (p < 0.01). The majority of patients came from a facility < 5 km from KCMC (N=363, 57.08%) and arrived to KCMC between 1-12 hours from time of injury (N=291, 45.68%). There was not a statistically significant association between time and distance to KCMC on in-hospital mortality or morbidity. Figure 1 shows distribution of referral centers and number of patients transferred to KCMC.

Conclusion(s): Pediatric injury in Northern Tanzania is associated with high morbidity and mortality. Although there were no statistically significant effects of time and distance to KCMC on morbidity and mortality, Figure 1 helps identify hotspots to target for future interventions to decrease time to definitive care and improve outcomes for pediatric injury patients.