Trauma admissions in the Southern Highlands of Papua New Guinea

Background: Trauma is a common cause of surgical admission in Papua New Guinea (PNG) but to date there has been no study of the whole trauma burden in provincial hospitals. Methods: A 1-year retrospective study was made of all surgical admissions to the provincial hospital at Mendi. Results: Trauma was the third commonest reason for hospital admission and accounted for 43% of all surgical cases. The common causes of injury were tribal fights (24%), domestic violence (14.3%), assault (16.7%), road accidents (14%) and domestic accidents (25.1%), which comprised falls, penetrating wounds and bites. Males accounted for two-thirds of cases, and 19% were children below the age of 16. Only eight of 454 patients died (1.8%), because most trauma deaths occur before the patient reaches hospital. There were only 37 multiple injuries and only five patients had an injury severity score of greater than 16. The average inpatient stay for trauma admissions was 10.6 days. Conclusions: The cost of trauma in Mendi is difficult to calculate, but is enormous. In addition to 11% of the recurrent hospital expenditure (over US$1.1 million, excluding pharmaceuticals), the community costs include loss of earnings and productivity, as well as permanent disability. The social disruption caused by tribal fights results in cessation of the local economy, burning of aid posts, schools and homes and destruction of gardens for subsistence farming. Those who reach hospital alive tend to have single injuries and survive.