Estimating the health burden of road traffic injuries in Malawi using an individual-based model

Manning Smith, Robert; Cambiano, Valentina; Colbourn, Tim; Collins, Joseph H.; Graham, Matthew; Jewell, Britta; Li Lin, Ines; Mangal, Tara D.; Manthalu, Gerald; Mfutso-Bengo, Joseph; Mnjowe, Emmanuel; Mohan, Sakshi; Ng’ambi, Wingston; Phillips, Andrew N.; Revill, Paul; She, Bingling; Sundet, Mads; Tamuri, Asif; Twea, Pakwanja D.; Hallet, Timothy B.

doi:10.1186/s40621-022-00386-6

Injury Epidemiology

Table 3 A list of the injuries modelled in the road traffic injuries model, with the AIS score associated with the injury and DALY weight used to represent the health burden of that injury, the treatment plans designed to treat the injury and the source of information used to determine whether this treatment should be included

From: Estimating the health burden of road traffic injuries in Malawi using an individual-based model

Injury	AIS score	Disability weight	Treatment	Recovery time	Source for use of treatment
‘Unspecified’ skull fracture	2	0.195	Heal with time or major surgery for depressed skull fracture	42 days with surgery, 49 otherwise	Eaton et al. (2017)
Basilar skull fracture	3	0.149	Heal with time	49 days	Assumed
Subarachnoid hematoma	3	0.214	Heal with time or major surgery (craniotomy)	42 days with surgery otherwise permanent	Eaton et al. (2017), Lavy et al. (2007)
Brain contusion	3	0.174	Heal with time or major surgery (craniotomy)	42 days with surgery otherwise permanent	Eaton et al. (2017), Lavy et al. (2007)
Intraventricular haemorrhage	3	0.174	Heal with time or major surgery (craniotomy)	42 days with surgery otherwise permanent	Eaton et al. (2017), Lavy et al. (2007)
Subgaleal hematoma	3	0.174	Heal with time or major surgery (craniotomy)	42 days with surgery otherwise permanent	Eaton et al. (2017), Lavy et al. (2007)
Epidural hematoma	4	0.185	Heal with time or major surgery (craniotomy)	42 days with surgery otherwise permanent	Eaton et al. (2017), Lavy et al. (2007)
Subdural hematoma	4	0.21	Heal with time or major surgery (craniotomy)	42 days with surgery otherwise permanent	Eaton et al. (2017), Lavy et al. (2007)
Diffuse axonal injury/midline shift	5	0.239	Heal with time or major surgery (craniotomy)	42 days with surgery otherwise permanent	Eaton et al. (2017), Lavy et al. (2007)
Laceration to the head	1	0.1	Suture kit, tetanus vaccine	7 days	Malawian treatment guidelines
Burn to the head	4	0.455	Cetrimide 15% + chlorhexidine 1.5% solution, Paraffin dressing, ringer's lactate (Hartmann's solution), tetanus vaccine	28 days with treatment otherwise permanent	Malawian treatment guidelines
Facial fracture (nasal/unspecified)	1	0.067	Minor surgery	49 days	Mkandawire et al. (2008)
Facial fracture (mandible/zygomatic)	2	0.067	Minor surgery	49 days	Mkandawire et al. (2008)
Soft tissue injury to face	1	0.1	Minor surgery	7 days	Mkandawire et al. (2008)
Laceration to the face	1	0.1	Suture kit, tetanus vaccine	7 days	Malawian treatment guidelines
Burn to the face	4	0.455	Cetrimide 15% + chlorhexidine 1.5% solution, Paraffin dressing, ringer's lactate (Hartmann's solution), tetanus vaccine	28 days with treatment otherwise permanent	Malawian treatment guidelines
Eye injury	1	0.054	Minor surgery	7 days	Mkandawire et al. (2008)
Soft tissue injury in neck (vertebral artery laceration)	2	0.1	Major surgery	42 days	Lavy et al. (2007)
Soft tissue injury in neck (pharynx contusion)	3	0.1	Major surgery	42 days	Lavy et al. (2007)
Sternomastoid m. haemorrhage/Haemorrhage, supraclavicular triangle/Haemorrhage, posterior triangle/Anterior vertebral vessel haemorrhage/Neck muscle haemorrhage	1	0.1	Major surgery	7 days	Lavy et al. (2007)
Hematoma in carotid sheath/Carotid sheath haemorrhage	3	0.1	Major surgery	14 days	Lavy et al. (2007)
Atlanto-occipital subluxation	2	0.187	Heal with time or minor surgery	42 days	Mkandawire et al. (2008)
Atlanto-axial subluxation	3	0.187	Heal with time or minor surgery	42 days	Mkandawire et al. (2008)
Laceration to the neck	1	0.1	Suture kit, tetanus vaccine	7 days	Malawian treatment guidelines
Burn to the neck	3	0.135	Cetrimide 15% + chlorhexidine 1.5% solution, Paraffin dressing, ringer's lactate (Hartmann's solution), tetanus vaccine	28 days with treatment otherwise permanent	Malawian treatment guidelines
Fractured rib(s)	2	0.187	Heal with time	35 days	Assumed
Flail chest	4	0.211	Major surgery	365 days	Bach (2004)
Chest wall bruises/haematoma	1	0.143	Heal with time	14 days	Assumed
Haemothorax	3	0.143	Thoracoscopy	7 days if treated surgically, otherwise 14 days	Paediatric handbook for Malawi
Lung contusion	3	0.205	Thoracoscopy	42 days with surgery, otherwise 84 days	Paediatric handbook for Malawi
Diaphragm rupture	3	0.205	Thoracoscopy	42 days with surgery, otherwise 84 days	Paediatric handbook for Malawi
Chest wall lacerations/avulsions	1	0.143	Thoracoscopy	14 days	Paediatric handbook for Malawi
Surgical emphysema	2	0.164	Heal with time	14 days	Assumed
Closed pneumothorax/open pneumothorax	3	0.164	Thoracoscopy	14 days	Paediatric handbook for Malawi
Laceration to the thorax	1	0.1	Suture kit, tetanus vaccine	7 days	Malawian treatment guidelines
Burn to the thorax	3	0.135	Cetrimide 15% + chlorhexidine 1.5% solution, Paraffin dressing, ringer's lactate (Hartmann's solution), tetanus vaccine	28 days with treatment otherwise permanent	Malawian treatment guidelines
Injury to stomach/intestines/colon	2	0.182	Laparotomy	90 days	Lavy et al. (2007), Katundu et al. (2018)
Injury to spleen/Urinary bladder/Liver/Urethra/Diaphragm	3	0.182	Laparotomy	90 days	Lavy et al. (2007), Katundu et al. (2018)
Injury to kidney	4	0.182	Laparotomy	90 days	Lavy et al. (2007), Katundu et al. (2018)
Laceration to the abdomen	1	0.1	Suture kit, tetanus vaccine	7 days	Malawian treatment guidelines
Burn to the abdomen	3	0.135	Cetrimide 15% + chlorhexidine 1.5% solution, Paraffin dressing, ringer's lactate (Hartmann's solution), tetanus vaccine	28 days with treatment otherwise permanent	Malawian treatment guidelines
Fracture vertebrae	2	0.111	Heal with time	63 days	Assumed
Spinal cord injury at neck level without treatment	3, 4, 5, 6	0.748	No treatment provided	Permanent	Eaton et al. (2019)
Spinal cord injury below neck level without treatment	3, 4, 5	0.623	No treatment provided	Permanent	Eaton et al. (2019)
Fracture to Clavicle, scapula, humerus	2	0.035	Fracture casting	49 days with treatment, 70 without	Thomas et al. (2021)
Fracture to Hand/wrist short term with or without treatment	2	0.01	Fracture casting	49 days with treatment, 70 without	Thomas et al. (2021)
Fracture to Hand/wrist long term without treatment	2	0.014	Fracture casting	49 days with treatment, 70 without	Thomas et al. (2021)
Fracture to Radius/ulna short term with or without treatment	2	0.028	Fracture casting	49 days with treatment, 70 without	Thomas et al. (2021)
Fracture to Radius/ulna long term without treatment	2	0.043	Fracture casting	49 days with treatment, 70 without	Thomas et al. (2021)
Shoulder dislocation	2	0.062	Minor surgery or given sling	84 days	Thomas et al. (2021)
Amputated finger	2	0.005	Major surgery	Permanent	Grudziak et al. (2019)
Unilateral arm amputation with treatment	2	0.039	Major surgery	Permanent	Grudziak et al. (2019)
Unilateral arm amputation without treatment	2	0.118	Major surgery	Permanent	Grudziak et al. (2019)
Thumb amputation	2	0.011	Major surgery	Permanent	Grudziak et al. (2019)
Bilateral arm amputation with treatment	3	0.123	Major surgery	Permanent	Grudziak et al. (2019)
Bilateral arm amputation without treatment	3	0.383	Major surgery	Permanent	Grudziak et al. (2019)
Laceration to the upper extremity	1	0.1	Suture kit, tetanus vaccine	7 days	Malawian treatment guidelines
Burn to the upper extremity	3	0.135	Cetrimide 15% + chlorhexidine 1.5% solution, Paraffin dressing, ringer's lactate (Hartmann's solution), tetanus vaccine	28 days with treatment otherwise permanent	Malawian treatment guidelines
Foot fracture short term with or without treatment	1	0.026	Heal with time, open reduction, external fixation, internal fixation	63 days with treatment	Chagomerana et al. (2017)
Foot fracture long term without treatment	1	0.026	Heal with time, open reduction, external fixation, internal fixation	Permanent	Chagomerana et al. (2017)
Open fracture of the foot	3	0.126	Ceftriaxone, Cetrimide 15% + chlorhexidine 1.5% solution, paraffin gauze, suture kit, Metronidazole	213 days with treatment, 240 days without	Schade et al. (2020)
Fracture to patella, tibia, fibula, ankle, short term without treatment	2	0.05	Skeletal traction, open reduction, external fixation, internal fixation, fracture casting	63 days with treatment, 70 days without	Chagomerana et al. (2017)
Fracture to patella, tibia, fibula, ankle, long term without treatment	2	0.055	Skeletal traction, open reduction, external fixation, internal fixation, fracture casting	Permanent	Chagomerana et al. (2017)
Open fracture of the patella, tibia, fibula, ankle	3	0.15	Ceftriaxone, Cetrimide 15% + chlorhexidine 1.5% solution, paraffin gauze, suture kit, Metronidazole	213 days	Schade et al. (2020)
Hip fracture short term with or without treatment	3	0.258	Major surgery	270 days	Lavy et al. (2007)
Hip fracture long term with treatment	3	0.058	Major surgery	Permanent	Lavy et al. (2007)
Hip fracture long term without treatment	3	0.402	Major surgery	Permanent	Lavy et al. (2007)
Pelvis fracture, short term	3	0.279	Major surgery	70 days	Lavy et al. (2007)
Pelvis fracture, long term	3	0.182	Major surgery	Permanent	Lavy et al. (2007)
Open fracture of the pelvis	3	0.379	Ceftriaxone, Cetrimide 15% + chlorhexidine 1.5% solution, paraffin gauze, suture kit, Metronidazole	213 days	Schade et al. (2020)
Femur fracture, short term with or without treatment	3	0.111	Skeletal traction, open reduction, external fixation, internal fixation, fracture casting	120 days	Chagomerana et al. (2017)
Femur fracture, long term without treatment	3	0.042	Skeletal traction, open reduction, external fixation, internal fixation, fracture casting	Permanent	Chagomerana et al. (2017)
Open fracture of the femur	3	0.211	Ceftriaxone, Cetrimide 15% + chlorhexidine 1.5% solution, paraffin gauze, suture kit, Metronidazole	213 days	Schade et al. (2020)
Dislocated hip	2	0.016	Skeletal traction, open reduction, external fixation, fracture casting	270 days	Chagomerana et al. (2017)
Dislocated Knee	2	0.113	fracture casting	49 days	Chagomerana et al. (2017)
Amputation of toes	2	0.006	Major surgery	Permanent	Grudziak et al. (2019)
Unilateral leg amputation with treatment	3	0.039	Major surgery	Permanent	Grudziak et al. (2019)
Unilateral leg amputation without treatment	3	0.173	Major surgery	Permanent	Grudziak et al. (2019)
Bilateral leg amputation with treatment	4	0.088	Major surgery	Permanent	Grudziak et al. (2019)
Bilateral leg amputation without treatment	4	0.443	Major surgery	Permanent	Grudziak et al. (2019)
Laceration to the lower extremity	1	0.1	Suture kit, tetanus vaccine	7 days	Malawian treatment guidelines
Burn to the lower extremity	3	0.135	Cetrimide 15% + chlorhexidine 1.5% solution, Paraffin dressing, ringer's lactate (Hartmann's solution), tetanus vaccine	28 days with treatment otherwise permanent	Malawian treatment guidelines

AIS scores were found using the R package ‘InjurySeverityScore’ which converted ICD-9 codes to their corresponding AIS scores, and DALY weights were taken from the GBD study and Gabbe et al. (2016). The sources for the treatment plans modelled are given within the table

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