Author(s)
Gilbert Niyigaba MD*
Gaelen Stanford-Moore, MD MPhil*
Gratien Tuyishimire MD
Jenny Yau
Amol Kulkrani MDS OMFS
Victor Nyabyenda MD
Isaie Ncogoza MD
David A. Shaye, MD MPH*co first-author
Affiliation(s)
University of California, San Francisco Department of Otolaryngology-Head & Neck Surgery, San Francisco, CA (Stanford-Moore) University of Rwanda, College of Medicine and Health Sciences, Department of ENT, Kigali, Rwanda (Niyigaba, Ncogoza), University Teaching Hospital of Kigali, Department of Surgery, Kigali, Rwanda (Tuyishimire, Kulkrani, Nyabyenda, Ncogoza, Shaye) Massachusetts Eye & Ear, Harvard Medical School, Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Boston, MA (Yau, Shaye);
Abstract:
Objective:
Craniomaxillofacial (CMF) trauma comprises a significant proportion of global surgical disease burden, disproportionally impacting low and middle-income countries where care is often delayed. We investigated reasons for delay in CMF trauma care and the effect on patient outcomes in Rwanda.
Methods
Prospective cohort study of all patients with a diagnosis of CMF trauma presenting to the University Teaching Hospital of Kigali between June 1, 2020 and October 1, 2020. Epidemiologic data was collected, and logistic regression analysis was undertaken to explore risk factors for delays in care and complications.
Results
54 patients (94.4% men) met criteria for inclusion. Mean age was 30 years (range 4 - 65 years). A majority of patients presented from a rural setting (63% n=34), the most common cause of trauma was motor vehicle accident (n=18, 33%), and the most common injury was mandibular fracture. 78% of patients had delayed treatment of their fracture after arrival to the hospital, 81% of these patients with delayed treatment experienced a complication (n=34, chi-squared p=0.03). Delay in treatment was associated with 4 times greater likelihood of complication (OR 4.25 (95% CI 1.08-16.70) p=0.038).
Conclusion
Delay in treatment of CMF traumatic injuries correlates with higher rates of post-operative complications. Delays most commonly resulted from lack of surgeon and/or operating room availability, or were related to transfers from rural districts. Expansion of the CMF trauma surgical workforce, increased operative capacity, and coordinated transfer care efforts may improve trauma care.