Casey et al. International Journal of Emergency Medicine 2012, 5:28 http://www.intjem.com/content/5/1/28 Page 6 of 7 Figure 3 Mechanism of traumatic injuries within age stratum, proportion. for prevention measures as well as potentially improving availability of medical services. Limited access to quali- fied specialists results in significant treatment delay and potentially higher morbidity and mortality, however the impact of improving pre-hospital or hospital level care services is still uncertain when compared to prevention mechanisms such as improved road safety regulations. One study in Trinidad where trauma life support courses (ATLS) were instituted for physicians and pre-hospital care providers indicated a significant reduction in mor- tality from injuries, suggesting educational programs directed towards existing medical care providers may be an effective, affordable mechanism for reducing morbid- ity and mortality from injuries [22]. Finally, our results demonstrate the significant impact injuries have in males between the second and fourth decade of life. In our study, men accounted for 72.7% of the patients presenting to the emergency department with injuries and 57.8% of patients were between the ages of 15 and 45 years. As injuries often result in significant mor- bidity with potential for long-term disability and inability to return to prior work activities, the impact on the indi- vidual and their family’s socioeconomic status can be sub- stantial [23,24]. Pre-injury socio-economic status of the patient has been suggested as a determinant of injury risk in developing countries previously. Future prospective studies in the Kilimanjaro region should include measures of the economic impact and burden of injury in the coun- try and underscore the need for measures focusing on in- jury prevention and emergency care. This study has several limitations, as it is a retrospect- ive chart review of the medical records which may con- tain missing, incomplete, or conflicting data. Moreover, there is inherent risk of either unreliable or biased data abstraction with this methodology. However, we mini- mized these effects by using strict definitions and pro- cesses for handling data points as previously described and assessed reliability of our data abstraction tool. The data abstractors were not blinded to the goals of our investigation. Additionally, KCMC is a referral hospital for the Kilimanjaro, Tanga, Arusha, and Manyara regions and Table 1 Mortality by Injury Location Location Head and neck Chest Back Abdomen and pelvis Extremity Spine N 353 125 24 62 575 14 Proportion* (95% CI) 36.5 (33.6, 39.6) 12.9 (11.0. 15.2) 2.5 (1.7, 3.7) 6.4 (5.0, 8.1) 59.5 (56.4, 62.6) 1.4 (0.9, 2.4) *Total > 100% as some patients with multiple injuries. 2.5 2.4 4.1 2.5 6.0 Male: female ratio 3.3 Number of deaths 25 Crude OR for mortality 5.76 (2.57, 12.92) 6 1 3 13 0 1.52 (0.61, 3.76) 1.24 (0.16, 9.44) 1.48 (0.44, 5.00) 0.43 (0.21, 0.87) –