Casey et al. International Journal of Emergency Medicine 2012, 5:28 http://www.intjem.com/content/5/1/28 countries, the burden of disease resulting from these events has been largely under-reported in the emergency medicine literature [4,5]. Moreover, the lack of consistent reporting of injuries leads to significant underestimates of the morbidity and mortality in these settings [6]. Poor mechanisms for reporting combined with inability to af- ford medical evaluation after an injury are likely important contributors to this phenomenon. Few studies have been performed in low-income countries, in particular in sub- Saharan Africa, to characterize the mechanisms of injury as well as the types of injury sustained in these events. Early data on the epidemiology of injury in East Africa, specifically in Tanzania, are just emerging, and the full scope of the problem is not yet well understood [7]. Effective injury prevention, patient care and rehabilita- tion all require a prior understanding of injury epidemi- ology in order to develop an effective response. Establishing hospital-based data collection systems, as recommended in the World Health Organization (WHO) injury surveillance guidelines, may contribute to a fuller understanding of injuries in low-income coun- tries [8,9]. Additionally, there has been a recommenda- tion for emergency care research, including hospital chart review, to begin to address the paucity of epide- miologic injury data in these settings [4]. This study evaluates the magnitude and scope of injury-related dis- orders in the population presenting to a large consultant and referral hospital emergency department in northern Tanzania. Methods Study design We performed a retrospective chart review of patients presenting with traumatic injuries to the Kilimanjaro Christian Medical Centre (KCMC) Casualty Department using established recommendations for data collection from medical records [10]. This study received Duke In- stitutional Review Board exemption from full review, KCMC Ethics Committee approval and exemption from review by the Tanzania National Institute of Medical Research. Setting Tanzania is situated in the East African region, bordered in the north by Kenya, in the west by Uganda, the Democratic Republic of Congo, Rwanda and Burundi, and to the south, by Zambia, Malawi and Mozambique. Currently 4 consultant specialty referral hospitals and 17 regional hospitals on the mainland serve a population of over 37 million people. Emergency departments in this region are typically referred to as casualty departments and are staffed by physicians, referred to as registrars, who have completed 5 years of medical school and have undergone a 1-year internship program. Until 2010, Page 2 of 7 when the first emergency medicine residency-training program was initiated at Muhimbili Hospital in Dar es Salaam, no formal emergency medicine physician train- ing was available in Tanzania. KCMC, located in Moshi, Tanzania, is the third largest hospital in the country, with 500 inpatient beds, and serves as the referral hospital for northeastern Tanzania. The KCMC Emergency Department has six beds and one large resuscitation room containing two additional beds. Over 17,000 patients are evaluated annually in this setting. The facility is staffed by four nurses per shift. Three registrar physicians provide care during the day, and an intern covers the department overnight. During the period of this study the physicians staffing the emer- gency department had no specialty emergency medicine or critical care training. There is no established prehospital system in the re- gion. There are ambulances available for inter-facility transfer to this large referral hospital. However, this is reserved for the most severely injured patients. The ma- jority of patients arrive via public transportation, private auto, motorcycle or taxi, and infrequently by police. Selection of patient records The emergency department maintains a logbook of every patient presenting for care. All patients presenting to the department with a chief complaint of injury, as defined by the International Classification of Disease 9th revision (ICD-9): External Causes of Injury E800-E999, were sub- ject to chart review. Patient records initially identified in the emergency department logbook were excluded from the subsequent analysis if the complete medical record could not be located for review. Data collection Data abstraction of the complete medical record was performed using a standardized data collection form, based on recommendations by the WHO injury surveil- lance guidelines (Additional file 1) [8]. A second inde- pendent abstractor reviewed a convenience sample of 15 percent of the patient charts in order to assess the inter- rater reliability of our data collection tool. Patient demographics were obtained from the emer- gency department logbook and verified against the complete medical record to ensure that the appropriate chart was reviewed. Mechanism of injury, location of in- juries by organ system, type of injuries, disposition and outcomes of patients were then documented after review of the emergency department log book and the complete medical record. Only injuries related to the initial trauma were recorded in the data collection forms, while compli- cations secondary to hospitalization or return visits were not included for analysis. If an injury was suspected based on the emergency department logbook documentation,