Outcomes of stab wounds presenting to Kamuzu Central Hospital in Malawi

Abstract

Introduction
Injuries are a leading cause of morbidity and mortality worldwide, necessitating that we understand the local burden of injury to
improve injury-related trauma care and patient outcomes. The characteristics, outcomes, and risk factors for mortality following stab
wounds in Malawi are poorly delineated.
Methods
This is a retrospective, descriptive analysis of patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, with stab wounds
from February 2008 to May 2018. Univariate and bivariate analyses were performed to compare patient and injury characteristics based
on mortality. We performed Poisson multivariate regression to predict the factors that increase the relative risk of mortality.
Results
During the study, 32,297 patients presented with assault. Of those patients, 2,352 (7.3%) presented with stab wounds resulting in a
3.2% (n=74) overall mortality. The majority of wounds were to the head or cervical spine (n=1,043, 44.6%), while injuries to the chest
(n=319, 13.7%) were less frequent. We found an increased relative risk of mortality in patients who presented with an injury to the
chest (RR 3.95, 95% CI 1.79-8.72, p=0.001) and who were brought in by the police (RR 33.24, 95% CI 11.23–98.35, p<0.001).
Conclusion
In this study, stab wounds accounted for 7.3% of all assault cases, with a 3.2% mortality. Though the commonest site of stab was the
head, wounds to the chest conferred the highest relative risk of mortality. A multifaceted approach to reducing mortality is needed.
Incorporating training of first responders in basic life support, including the police, may reduce stab-related mortality.