Browsing by Author "Wilson, Michael Lowery"

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    Effect of rural trauma team development on outcomes of motorcycle related injuries: a protocol for a multi-center cluster randomized controlled clinical trial (The MOTOR trial)
    (medRxiv preprint, 2023-12-09) Lule, Herman; Mugerwa, Micheal A.; SSebuufu, Robinson; Kyamanywa, Patrick; Bärnighausen, Till; Posti, Jussi P.; Wilson, Michael Lowery
    Injury is a global health concern whose mortality disproportionately impact low-income countries. Compelling evidence from high-income countries show that rural trauma team development courses (RTTDC) increase clinicians’ knowledge. There is a dearth of evidence from controlled clinical trials to demonstrate the effect of RTTDC on process and patient outcomes. We document a protocol for a multi-center cluster randomized controlled clinical trial which aims to examine the impact of RTTDC on process and patient outcomes of motorcycle-related injuries. This will be a two-armed parallel multiple period cluster randomized controlled clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We shall recruit regional referral hospitals and include road traffic injured patients, interns, medical trainees, and road traffic law enforcement professionals who serve as trauma care frontliners. Three hospitals will be cluster randomized to RTTDC (intervention group) and the remaining three to standard care (control group). The primary outcomes will be prehospital interval from accident scene to arrival at emergency department, and referral-exit interval from the time the referral decision is made to hospital exist in hours as a measure of process improvement. The secondary outcomes will be all cause mortality, and morbidity of neurological, and orthopedic injuries based on the Glasgow outcome scale and trauma outcome measure scores respectively at 90-days post injury. All outcomes will be measured as final values. We shall compare baseline characteristics and outcomes both at individual, and at cluster level as intervention versus control group. We shall use the mixed effects regression models in Stata 15.0 to report any absolute or relative differences along with 95% CIs. We shall perform subgroup analyses to control for confounding due to injury mechanisms and severity. In parallel to the trial, we shall establish a motorcycle trauma outcome registry (MOTOR) in consultation with community traffic police. Our results could inform the design, implementation, and scalability of future rural trauma teams and education programs.
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    Feasibility of rural trauma team development amongst medical trainees and traffic law enforcement professionals in a low-income country: a prospective multi-centre study of interrupted time series of interventional training
    (Research Square Preprints, 2023-10-05) Lule, Herman; Mugerwa, Michael; SSebuufu, Robinson; Kyamanywa, Patrick; Jussi, Posti. P; Wilson, Michael Lowery
    Research shows that trauma team formation could potentially improve effectiveness of injury care in rural settings. The aim of this study was to determine the feasibility of the use of rural medical trainees and road traffic law enforcement professionals in the formation of rural trauma teams in Uganda. Multi-center interrupted time series of interventional rural health professions education, using the American College of Surgeons’ 4th edition of rural trauma team development course model. Trauma related multiple choice questions (MCQs) were administered pre-and post-training between September 2019- August 2023. Acceptability of the training for promulgation to other rural regions and its relevance to participants’ work needs were evaluated on 5- and 3-point Likert scales respectively. The median MCQ scores (IQR) were compared before and after training at 95% CI, regarding p < 0.05 as statistically significant. Triangulation with open-ended questions was obtained. Time series regression models were applied to test for autocorrelation in performance using Stata 15.0. Ethical approval was obtained from Uganda National Council for Science and Technology (Ref: SS 5082). A total of 500 participants including: 66 (13.2%) traffic police officers, 30 (6.0%) intern doctors, 140 (28.0%) fifth year and 264 (52.8%) third-year medical students were trained. The overall median pre- and post-test scores were 60%, IQR (50–65) and 80%, IQR (70–85) respectively. Overall, the mean difference between pre- and post-test scores was statistically significant (z = 16.7%, P|z|=<0.0001). Most participants strongly agreed to promulgation 389 (77.8%), relevance to their educational 405 (81.0%), and work needs 399 (79.8%). All the course elements scored above 76.0% as being very relevant. This study demonstrates that rural trauma team development training had a positive effect on the test scores of course participants. The training is feasible, highly acceptable and regarded as relevant amongst medical trainees and traffic law enforcement professionals who provide first-aid to trauma patients in resource-limited settings. The findings could inform the design of future trauma teams in rural communities.
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    Injury characteristics, severity and thirty-day mortality of non-sexual assault related injuries in Uganda
    (SSRN - Elsevier, 2023-02-06) Asiimwe, Daniel; Abio, Anne; Subramanian, Sadhvi; Nelson, Kevin; Wilson, Michael Lowery; Kyamanywa, Patrick; Lule, Herman
    Non-sexual assault is increasingly becoming a global public health concern in the context of human rights advocacy. The objective of this study was to determine the injury characteristics, severity and factors associated with thirty-day mortality of non-sexual assault attributable injuries at two tertiary hospitals in Uganda. Prospective observational cohort study of 140 consecutive patients with history of non-sexual assault (Ethical clearance No.UG-REC023/2021-17). We used the Kampala Trauma Score (KTS II) to assess injury severity, coded as mild (9-10), moderate (7-8) or severe (≤6). The main outcome was mortality after 30 days from time of arrival at the trauma units. We analyzed data using Stata V.17.0 (StataCorp, TX, USA) at 95% confidence interval, regarding p<0.05 as statistically significant. Mean age was 29.98 years +/-12.76 SD. Males were the majority 77.4% (n=108). Mortality occurred in 5.7% (n=8) of patients. The Kampala Trauma Score was moderate in 20.7% (n=29), and severe in 35.0% (n=49) of the cases respectively. Factors significantly associated with mortality at 30 days were: a severe Kampala Trauma Score (OR = 100.79, 95% CI 4.88, 2080.57; P=0.003), pelvic injuries (OR = 112.80, 95% CI 1.02, 12434.31; p=0.049] and being accompanied by a relative [OR=0.004, 95%CI (<0.01,0.48)]. Severe injuries due to non-sexual assault occur in 35% of cases in Uganda and predominantly affect males. These injuries are associated with higher mortality of 57 per 1000 affected individuals