Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2016; 7(5): 308-314
Published online May 18, 2016. doi: 10.5312/wjo.v7.i5.308
From Cape Town to Cambridge: Orthopaedic trauma in contrasting environments
John E Lawrence, Vikas Khanduja
John E Lawrence, Vikas Khanduja, Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
Author contributions: Lawrence JE and Khanduja V contributed equally to this work; Lawrence JE gathered the data, performed data analysis and drafted the manuscript; Khanduja V devised the study, assisted with data analysis and edited the manuscript.
Institutional review board statement: This study was approved by both Addenbrooke’s Hospital, Cambridge and New Somerset Hospital, Cape Town.
Informed consent statement: All patients gave verbal informed consent for their anonymised data to be used in this study.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: Extended dataset available from the corresponding author at vk279@cam.ac.uk.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vikas Khanduja, MA, MSc, FRCS, FRCS (Orth), Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge CB2 0QQ, United Kingdom. vk279@cam.ac.uk
Telephone: +44-1223-257093
Received: November 24, 2015
Peer-review started: November 25, 2015
First decision: December 28, 2015
Revised: January 6, 2016
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: May 18, 2016
Processing time: 167 Days and 17.8 Hours
Abstract

AIM: To compare the trauma experience gained by a trainee at a United Kingdom major trauma centre and a secondary level hospital in South Africa.

METHODS: A profile of inpatient trauma cases during a five-week period in Addenbrooke’s Hospital, Cambridge and Somerset Hospital, Cape Town was created. This was achieved by recording various parameters for each patient admitted including age, gender, injury, mechanism of injury and postal/area code. This, together with details of the departments themselves, allows a comparison of the amount and variety of orthopaedic trauma cases experienced by an individual trainee in each setting.

RESULTS: The trauma profiles differed significantly. Patients in Cape Town were younger and more likely to be male. In the young, injury in Cape Town was more likely to occur due to assault or being struck by a vehicle, whilst patients in Cambridge were more likely to be injured whilst in a vehicle or in high energy falls. In older patients, trauma at both centres was almost exclusively due to mechanical falls. In a given age group, injuries at the two centres were similar, however the majority of patients admitted to Addenbrooke’s were elderly, resulting in less variation in the overall injury profile.

CONCLUSION: The trauma profile of a major trauma centre in the United Kingdom is less varied than that of a South African secondary centre, with significantly fewer cases per surgeon. This suggests a more varied training experience in the developing world with a greater caseload.

Keywords: Comparative; Epidemiology; Developing world; Trauma; Training

Core tip: The caseload of a hospital directly impacts the training experience of a surgeon. Centres in the developing world are widely thought to offer a superior exposure to traumatic injury and consequently a rich training environment for the orthopaedic trainee. This study directly compares the caseload at two centres over a fixed period, and shows that the department in the developing world experienced greater volume and variation in trauma cases thereby offering a better experience for training in trauma.