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Establishing a Mass Casualty Threshold in a Resource-Limited Hospital Setting: A Retrospective Analysis of a Trauma
Tori Hester1, Selena J An1, Jotham Gondwe2
1Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Introduction:
Mass casualty incidents (MCIs) easily overwhelm hospitals in resource-limited settings. Unfortunately, limited data exists on this problem, and few hospitals are prepared to deal with these events. We hypothesized that excessive patient volume would be associated with worse outcomes at a tertiary hospital in Lilongwe, Malawi, and that these data would provide a foundation for targeted interventions and improvement.
Materials And Methods:
We retrospectively analyzed the Kamuzu Central Hospital Trauma Registry from 2010 to 2021. Using arrival data, we characterized patient co-arrival volume trends. We a priori set the mass casualty threshold at 2 standard deviations above the mean number of patient co-arrivals in 1 h. We performed bivariate and multivariable logistic regression analyses to investigate the relationship between mortality and the number of co-arrivals above the threshold.
Results:
A total of 161,383 patients were analyzed. The median age was 24 y, and 73.8% were male. Crude mortality was 2.4%. A total of 3007 patients (1.9%) presented above the mass casualty threshold of 11 patients. Mortality for this group was 4.2% compared to 2.4% for those below the threshold. Those who have an arrival status above the MCI threshold of 11 patient arrivals in 1 h have 1.70 (95% confidence interval: 1.36, 2.12, P value < 0.001) times the odds of mortality than patients below the MCI threshold when adjusting for sex, age, primary injury type, and arrival time.
Conclusions:
Overwhelming and sudden patient volume is associated with higher odds of mortality in a resource-limited setting. Our results will inform a mass casualty protocol to maximize efficient resource use in similar settings.
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