One hundred injured patients a day: multicenter emergency room surveillance of trauma in Pakistan

•This study presents injury burden coming to seven largest tertiary-care hospitals in Pakistan using standardized methods.•Each facility sees between 80-100 patients each day, a challenge for already frail public healthcare system in Pakistan.•Injuries in Pakistan are common among young males, an economically productive age group.•Injury patients may suffer from long-term sequelae of injury that burdens their families and society.•Major emergency departments in Pakistan lack of resources, infrastructure and skilled providers for emergency care.

ObjectivesInjuries increasingly contribute to the global burden of disease in low- and middle-income countries. This study presents results from a large-scale surveillance study on injury from several urban emergency departments (EDs) in Pakistan. The objective is to document the burden of injuries that present to the healthcare system in Pakistan and to test the feasibility of an ED-based injury and trauma surveillance system.Study designCross-sectional study conducted using active surveillance approach.MethodsThis study included EDs of seven tertiary care hospitals in Pakistan. The data were collected between November 2010 and March 2011. All patients presenting with injuries to the participating EDs were enrolled. The study was approved by the Institutional Review Boards of the Johns Hopkins School of Public Health, Aga Khan University, and all participating sites.ResultsThe study recorded 68,390 patients; 93.8% were from the public hospitals. There were seven male for every three female patients, and 50% were 20-39 years of age. About 69.3% were unintentional injuries. Among injuries with a known mechanism (19,102), 51.1% were road traffic injuries (RTIs) and 17.5% were falls. Female, patients aged 60 years or older, patients transferred by ambulance, patients who had RTIs, and patients with intentional injuries were more likely to be hospitalized.ConclusionThe study is the first to use standardized methods for regular collection of multiple ED data in Pakistan. It explored the pattern of injuries and the feasibility to develop and implement facility-based systems for injury and acute illness in countries like Pakistan.