Michael Lowery Wilson’s research while affiliated with Heidelberg University and other places

Objective Fall-related injuries are a global public health concern, and trauma registries aid in collecting data to develop measures to reduce their burden on individuals and communities. The aim of this review was to provide a comprehensive overview of the reporting of fall-related mortality in trauma registries and surveillance systems in sub-Saharan Africa. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched eight electronic databases, and studies set in countries of sub-Saharan Africa were included if the reported data originated from a trauma registry or surveillance system and contained a measurement of fall-related mortality. Results were synthesised in a descriptive manner. Results Of the 3574 records found, we included 21 studies in the analysis. Different definitions were inconsistently used in reporting fall-related mortality: studies reported either a percentage of fall deaths by total falls or of fall deaths by total deaths. Deaths due to falls by total falls ranged from 0.01% to 2.4% in studies with paediatric patient populations, and from 0.03% to 60% among studies not restricted to a specific age group. Reporting on other variables in relation to injury and trauma care was also inconsistent. Conclusions The findings of this review were heterogeneous, and variables were collected irregularly among trauma registries. This led to a broad range of results and made comparisons and deductions difficult. A more standardised data collection across registries would heighten the intercomparability of results from different studies and, therefore, facilitate usage in data-based efforts for implementing prevention and optimising care.

Background: We assessed the impact of rural trauma team development course (RTTDC) on clinical processes and patient outcomes of motorcycle-accident related neurological and/or musculoskeletal injuries in selected Ugandan hospitals. Methods: Trial design: Two arm, parallel, multiperiod, cluster randomized controlled trial. Participants: Trauma care frontliners, and patients aged 2-80 years at three intervention and three control Ugandan hospitals (1:1 allocation). Randomization: Hospitals were randomly allocated to intervention or control using permuted block sequences. Blinding: Patient-participants and outcome assessors were blind to allocation. Intervention arm: 500 trauma care frontliners received RTTDC; patients received standard care. Control arm: Patients received standard care without RTTDC for staff. Primary outcomes: Time from accident to admission and from referral to discharge. Secondary outcomes: 90 day mortality and morbidity related to neurological and/or musculoskeletal injuries. We followed the CONSORT guidelines for cluster randomized trials. Results: We analyzed 1003 participants (501 intervention, 502 control). The intervention arm had a shorter median prehospital time (1hr; IQR=0.50, 2.00) and referral to discharge interval (median 2hrs; IQR=1.25, 2.75) vs. [(2hrs; IQR=1.50, 4.00) mean difference 1.13hrs, p<0.0001 and (4hrs; IQR=2.50, 4.10), mean difference 1.39hrs, p<0.0001 in the control], respectively. The 90 day mortality was more than halved in the intervention (5%, 24/457) vs. (13%, 58/430) in the control arm (p<0.0001). Fewer participants in the intervention group had unfavorable Glasgow Outcome Scale scores (9%, 42/457) vs. (20%, 87/430), p<0.0001. No difference was found in musculoskeletal injury morbidity outcomes (p=0.567). Interpretation: Rural trauma team development training improved organizational time efficiency and clinical outcomes for neurological injuries without negatively impacting musculoskeletal injury morbidity outcomes.

Introduction The objective of this study was to examine the factors linked to all-cause mortality and morbidity from neurological and musculoskeletal injuries in motorcycle accidents. Methods The study was part of a two-armed, parallel, multi-period, cluster-randomized controlled trial of 1003 motorcycle crash victims. Morbidity was assessed using various scoring systems, and mixed effects regression models were employed for analysis. Results 90-day all-cause mortality was 9.2% (82/887). Factors associated with mortality included referral-to-discharge >1 hour [OR 4.215 (1.802-9.858), p =.001), Kampala Trauma Score (KTS) ≤6 [OR 7.696 (1.932-30.653), p =.004], GCS 9-12 [OR 3.432 (1.194-9.870), p =.022], GCS ≤8 [OR 6.919 (2.212-21.645), p =.001], intra-axial lesions [OR 78.647 (9.871-626.587), p <.001], extra-axial lesions [OR 11.933 (1.386-102.750), p =.024], skull fracture [OR 11.366, (1.197-107.977), p =.034], and decompressive craniotomy (DC) [OR 0.260 (.095-.706), p =.008). A proportion of 14.5% had unfavourable Glasgow Outcome Scale (1-3); associated factors included increasing age [OR 1.02, (1.013-1.045, p <.001], multiple injuries [OR 4.559 (1.185-17.531), p=.027], KTS 7-8 [OR 2.755 (1.285-5.906), p=.009], KTS ≤6 [OR 7.551 (2.815-20.255), p=.001], GCS 9-12 [OR 4.07 (1.901-8.719), p=.001], GCS ≤8 [OR 13.779 (5.643-33.645), p <.001], and DC [OR 0.149 (.075-.295), p <.001]. Factors associated with unfavourable patient-reported musculoskeletal outcomes included being married [OR 1.984 (1.322–2.976), p =.001], multiple injuries [OR 1.762, (1.001–3.100), p =.049], and enrolment after the onset of the COVID-19 pandemic [OR 2.095 (1.199–3.659), p=.009]. Conclusions The key determinants of mortality and adverse neurological and musculoskeletal injury outcomes observed in this study are essential for establishing core outcome sets in future research and predictive models. Summary of the Key Messages Existing Knowledge: Motorcycle crashes in low- and middle-income countries represent significant public health issues, exacerbated by low helmet usage and insufficient trauma care resources. Study Contributions: This MOTOR trial ancillary study investigated factors associated with all-cause mortality and morbidity from motorcycle crashes, emphasizing neurological and musculoskeletal injuries as critical targets for enhancing rural trauma care systems. Implications for Research, Practice, and Policy: Our findings indicate that the anatomical nature, multiplicity and severity of injuries, referral-dispatch intervals, operative interventions, and COVID-19-related social conditions significantly influence injury outcomes. These factors may serve as a foundational outcome set for benchmarking future clinical trials and trauma registries.

Background Injury-related mortality exhibits a significant social gradient, particularly in low-middle-income countries (LMICs), with approximately 4.5 million premature deaths annually. Objective This study explores prehospital and in-hospital barriers to timely injury care as perceived by frontline healthcare personnel in Uganda. Methods We utilized a mixed methods approach, gathering qualitative data from five hundred frontline workers including surgical residents, interns, and law enforcement professionals, alongside quantitative data from 1,003 trauma patients. Barriers were categorized into pre- and in-hospital trauma team-related, patient-related, and systemic healthcare challenges. Results From frontline workers, prehospital barriers included delays in emergency medical services activation (21.2%), ambulance arrival (19.3%), and transportation to hospitals (15.2%) whereas in-hospital barriers primarily involved supply shortages (28.3%), delays in identifying life-threatening injuries (27.3%), and insufficient critical care services (26.3%). Among the 1003 audited trauma patients, 41.5% (n=416) faced barriers during treatment. The most common barriers were delays in treatment decisions (n=232, 23.1%) and securing necessary supplies (n=180, 17.9%). Presence of a barrier correlated with higher odds of unfavourable Glasgow Outcome Scale scores compared to those without barriers [OR 1.750, 95% CI (1.497-2.047) vs. OR 0.556, 95% CI (0.436-0.708), p<0.001]. Moreover, the odds of mortality were higher for those whom a barrier was encountered compared to those where there was no barrier [OR 1.901, 95% CI (1.057-3.420) vs. OR 0.588, 95% CI (0.397-0.869), p<0.001]. Conclusions Our findings highlight the need for multifaceted targeted interventions, integrating frontline healthcare perspectives to improve trauma care delivery in LMICs which face both prehospital and in-hospital disparities to accessing injury care.

Background Intimate partner violence (IPV) during pregnancy is a global issue of public health importance. Due to the low rates of help-seeking in response to IPV, research on survivors’ help-seeking behaviors is scarce, particularly within low- and middle-income countries (LMICs). The present study provides a cross-national evidence of informal and formal help-seeking patterns among pregnant women experiencing IPV. Methods This study made use of population-based data from the Demographic and Health Surveys (DHS) Program from 54 LMICs, collected between 2005 and 2020 (N = 359,027). Applying bivariate and multivariable analyses, the present study examined IPV survivors’ help-seeking distributions and associations with individual, partner, family, and community factors. Results Only half of survivors sought help in response to IPV during pregnancy with wide regional and national variations, mainly from informal support networks (including family, neighbors, and friends), and rarely from formal institutions (including legal, socio-cultural, and medical services). Evidence shows that help-seeking behaviors were associated with IPV survivors’ age and educational attainment, survivors’ employment status and earnings compared to their partners, survivors’ consumption of mass media, intimate partner’s age and education, spouse’s alcohol consumption and controlling behaviors, survivors’ wealth index, place of residence, and health-seeking barriers, among others. Conclusion Practitioners are encouraged to consider the study’s outcomes when designing interventions and support for survivors seeking help in response to IPV during pregnancy. Strong advocacy and action are needed, including fostering survivors’ educational attainment, diminishing pregnant women’s social and financial dependencies on their intimate partners, promoting pre- and peri-natal health care, informing survivors about help, and increasing gender equality by engaging women and men equally within the whole community.

Background 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 rural trauma team training amongst medical trainees and traffic law enforcement professionals in Uganda. Methods Prospective multi-centre interrupted time series analysis of an interventional training based on the 4th edition of rural trauma team development course of the American College of Surgeons. Trauma related multiple choice questions (MCQs), and trauma non-technical skills were assessed 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). Results 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. Among the 434 medical trainees who completed the trauma-based MCQ assessment, the 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 promulgate 389 (77.8%), relevance to their educational 405 (81.0%), and work needs 399 (79.8%). Each of the course components was rated above 76.0% as being very relevant. There was an overall increment in median (IQR) trauma-nontechnical skills team performance scores from 12 (9-14) to 17 (15-20) after the training (p < 0.001), with police teams advancing from 9.5 (6.0-12.5) to 19.5 (17.0-21.5) (p < 0.001). Conclusion 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. Trial registration Retrospective registration (UIN: researchregistry9450).

Background Traumatic brain injuries (TBIs) are among the most challenging conditions to accurately diagnose in children, and many TBIs are underdiagnosed. Patients with maxillofacial injury may be at risk for TBI. The objective of this study was to analyse the association between maxillofacial injuries and TBI among paediatric patients. Analysis of the factors associated with the occurrence of TBI among paediatric patients with maxillofacial injuries was the secondary objective. Method This case-control study included 192 cases defined as paediatric patients with maxillofacial injuries and 192 controls defined as all paediatric patients with traumatic injuries to other body locations and with no maxillofacial injuries. The medical records of patients aged 0–18 years, who underwent treatment at a tertiary care hospital were screened. Patient demographic data, causes of trauma, and the presence, type, and severity of TBI were recorded. For the cases, the presence of facial fracture, type and severity of the maxillofacial injuries were recorded. The odds ratio was obtained to determine the association between maxillofacial injuries and TBI. Multiple logistic regression analysis was performed to study the associations of all the recorded study variables with the occurrence of TBI in patients with maxillofacial injuries. Results A statistically significant difference was seen between the cases and controls for TBI occurrence, with 53% of cases recording TBI, compared to 32% among controls, with an odds ratio of 2.5. Multiple logistic regression analysis with the presence/absence of TBI among the cases as the dependent variable revealed a significant association of road traffic accidents (RTA), longer duration of hospital stays, and dentoalveolar fracture with TBI. Conclusion Paediatric patients with maxillofacial injuries need to be screened for TBI, as the risk of occurrence of TBI is 2.5 times greater in these patients than in those with injuries involving other parts of the body. RTA and prolonged hospitalization are factors associated with TBI among paediatric patients with maxillofacial injuries. The presence of only dentoalveolar injuries decreases the likelihood of a TBI.

Intimate partner violence (IPV) within heterosexual relationships affects both men and women, yet an in-depth description of IPV against men in developing countries is still limited. This study explored community perceptions of male IPV victimization in an informal settlement in Nairobi, Kenya. We conducted 12 focus group discussions (FGDs) with 118 ever-married participants (59 men and 59 women), divided into 6 FGDs for each gender. We performed thematic analysis using NVivo software. This article presents three main themes that emerged during data analysis: (a) triggers, (b) manifestations, and (c) consequences/effects of IPV against men. Both male and female participants perceived male IPV victimization as a significant concern in the community. The poor living conditions, coupled with alcohol use, seemed to be major underlying factors, often forming the basis of spousal conflict. Emotional abuse, including denial of basic needs, acts of humiliation, and coercive control, were the most frequently cited forms of violence. The consequences of what was considered IPV against men affected victims and their families including the violent female spouses, children, and the society at large. These effects upset the health, economic, and social spheres of life with some retriggering male IPV, thus creating a vicious cycle of abuse. Notably and of concern, IPV against women was highlighted as a consequence of male victimization. Although we set out to explore community perceptions, study participants openly shared their experiences of male IPV perpetration and victimization. These findings underscore the importance of recognizing men as potential victims of IPV and contextualizing IPV prevention strategies targeting the urban poor with the goal of designing and implementing policies and interventions that address IPV holistically.

Background Strengthening capacity for rural trauma education is critical for sustainability of competent trauma care systems. Objective To examine the effect of rural trauma development course (RTTDC) training and coordination on clinical process and outcomes of motorcycle-attributable neurological injuries in low-income Uganda. Methods Multi-center, two-armed parallel, multiperiod, cluster randomized motorcycle trauma outcome registry (MOTOR) trial. Six trauma centers were randomized to intervention (RTTDC plus standard care n=3) and control (standard care alone, n=3) in equal allocation, using permuted block sequence codes. Patients and outcome assessors were blinded. A motorcycle trauma outcome registry was executed in parallel in collaboration with community traffic police. Rural trauma care frontliners including traffic law enforcement professionals, surgery residents and medical trainees received the intervention. Prehospital and referral-discharge time intervals were primary outcomes whereas all cause 90-day mortality and morbidity of neurological injuries were secondary, all measured as final values. Mixed effects regression models and two-sample Wilcoxon rank-sum test were performed in Stata 15.0 to document differences in outcomes at 95% CI, regarding p<.05 as statistically significant. Pan African Clinical Trial Registry (PACTR202308851460352): Ethical approval from Uganda National Council for Science and Technology (Ref: SS 5082). Results For the 1003 trial participants, both prehospital and referral-discharge intervals were shorter in the intervention group by 1.13hrs (95% CI: 0.96–1.39) and 1.39hrs (95% CI: 1.23–1.55), respectively (p < .0001). Of the 887 participants whose follow-up was complete, 85.5% (758) had a favourable outcome with Glasgow outcome scale of (4–5). The proportions of participants with favourable outcome were higher in the intervention group 90.8% (415/457) compared to controls 79.8% (343/430), p < .0001. The 90-day mortality was 9.2% (82/887). The mortality was lower in the intervention 5.2% (24/457) compared to the control group 13.5% (58/430), p < .0001. Conclusions Empowering rural health professionals through capacity training and coordinated trauma teams improved clinical process effectiveness and outcomes of time-dependent neurological injuries. These results could inform the design of future trauma teams in similar vulnerable rural environments.

Adolescent suicide is a major public health concern, particularly among adolescents who have endured Adverse Childhood Experiences (ACEs). Adolescents who have been exposed to multiple ACEs are as much as three times more likely to present with suicidality compared to the general adolescent population. Adolescents who have been exposed to multiple ACEs are also more likely to receive behavioral and mental health services in the community. It is therefore important to understand patterns of suicidality among this sub-population of adolescents in order to provide the best clinical care. The present study examined the temporal patterns of suicidality among adolescents who have been exposed to multiple ACEs and are receiving behavioral and mental health services in the community. Using Electronic Health Record (EHR) data from a community-based behavioral and mental health care organization, an exploratory survival analysis was conducted on time to suicidal thoughts and behaviors (STBs) after suicidality risk screen at intake. Average time from suicidality risk screen at intake to STB was 185 days (6.2 months). Youth who screened negative for suicidality risk at intake had a longer survival time than youth who screened positive for suicidality risk, and the survival distributions between the two groups was significant. Predictors of STBs were also examined, with gender being a significant predictor of an STB occurring during the follow-up period. These findings may be used to guide suicidality screening and clinical practice at community-based behavioral and mental health care organizations serving adolescents who have been exposed to multiple ACEs.