The Characteristics and Outcomes of Trauma Admissions to an Adult General Surgery Ward in a Tertiary Teaching Hospital

Overview

Journal Afr J Emerg Med

Publisher Elsevier

Specialty Emergency Medicine

Date 2021 May 17

PMID 33996419

Citations 4

Authors

Alemayehu Ginbo Bedada

Margaret J Tarpley

John L Tarpley

Affiliations

Soon will be listed here.

Abstract

Background: Traumatic injuries are proportionally higher in low- and middle-income countries (LMICs) than high-income counties. Data on trauma epidemiology and patients' outcomes are limited in LMICs.

Methods: A retrospective review of medical records was performed for trauma admissions to the Princess Marina Hospital general surgical (GS) wards from August 2017 to July 2018. Data on demographics, mechanisms of injury, body parts injured, Revised Trauma Score, surgical procedures, hospital stay, and outcomes were analysed.

Results: During the study period, 2610 patients were admitted to GS wards, 1307 were emergency admissions. Trauma contributed 22.1% (576) of the total and 44.1% of the emergency admissions. Among the trauma admissions, 79.3% (457) were male. The median[(IQR)](range) age in years was 30[24-40](13-97). The main mechanisms of injury were interpersonal violence (IPV), 53.1% and road traffic crashes (RTCs), 23.1%. More females than males suffered animal bites (5.9% vs. 0.9%), and burns (8.4% vs. 4.2%), while more males than females were affected by IPV (57.8% vs. 35.3%) and self-harm (5.5% vs. 3.4%). Multiple body parts were injured in 6.6%, mainly by RTCs. Interpersonal violence (IPV) and RTCs resulted in significant numbers of head and neck injuries, 57.3% and 22.2% respectively. More females than males had multiple body-parts injury 34.5% vs. 18.5%. Revised Trauma Score (RTS) of ≤11 was recorded in IPV, 38.4% and RTCs, 33.6%. Surgical procedures were performed on 44.4% patients. The most common surgical procedures were laparotomy (27.8%), insertion of chest tube (27.8%), and craniotomy/burr hole(25.1%). Complications were recorded in 10.1% of the patients(58) including 39 deaths, 6.8% of the 576.

Conclusion: Trauma contributed significantly to the total GS and emergency admissions. The most common mechanism of injury was IPV with head and neck the most frequently injured body part. Further studies on IPV and trauma admissions involving paediatric and orthopaedic patients are warranted.

Citing Articles

Epidemiology of orthopedic injuries among inpatients admitted at a tertiary teaching and referral hospital in Kenya: a retrospective cross-sectional study.

Omondi M BMC Musculoskelet Disord. 2024; 25(1):670.

PMID: 39192255 PMC: 11348735. DOI: 10.1186/s12891-024-07793-4.

Effect of enforcement of the national referral guidelines on patterns of orthopedic admissions to Kenyatta National Hospital, Kenya: Pre-post intervention study.

Omondi M, Mwangi Chege J, Ongango H, Sitati F PLoS One. 2024; 19(8):e0290195.

PMID: 39137196 PMC: 11321550. DOI: 10.1371/journal.pone.0290195.

Perioperative mortality among trauma patients in Northwest Ethiopia: a prospective cohort study.

Endeshaw A, Dejen E, Zewdie B, Addisu B, Molla M, Kumie F Sci Rep. 2023; 13(1):22859.

PMID: 38129464 PMC: 10739862. DOI: 10.1038/s41598-023-50101-8.

Nurses and emergency nursing care in Botswana.

Mamalelala T, Dithole K, Maripe-Perera D Afr J Emerg Med. 2023; 13(2):68-71.

PMID: 36969480 PMC: 10030907. DOI: 10.1016/j.afjem.2023.03.002.

References

Mwandri M, Hardcastle T . Burden, Characteristics and Process of Care Among the Pediatric and Adult Trauma Patients in Botswana's Main Hospitals. World J Surg. 2018; 42(8):2321-2328. DOI: 10.1007/s00268-018-4528-7. View

Haagsma J, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany E . The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev. 2015; 22(1):3-18. PMC: 4752630. DOI: 10.1136/injuryprev-2015-041616. View

Haac B, Varela C, Geyer A, Cairns B, Charles A . The utility of the Kampala trauma score as a triage tool in a sub-Saharan African trauma cohort. World J Surg. 2014; 39(2):356-62. DOI: 10.1007/s00268-014-2830-6. View

Ali A, Willett K . What is the effect of the weather on trauma workload? A systematic review of the literature. Injury. 2015; 46(6):945-53. DOI: 10.1016/j.injury.2015.03.016. View

Hanche-Olsen T, Alemu L, Viste A, Wisborg T, Hansen K . Trauma care in Africa: a status report from Botswana, guided by the World Health Organization's "Guidelines for Essential Trauma Care". World J Surg. 2012; 36(10):2371-83. DOI: 10.1007/s00268-012-1659-0. View

Laing G, Skinner D, Bruce J, Aldous C, Oosthuizen G, Clarke D . Understanding the burden and outcome of trauma care drives a new trauma systems model. World J Surg. 2014; 38(7):1699-706. DOI: 10.1007/s00268-014-2448-8. View

Bommakanti K, Feldhaus I, Motwani G, Dicker R, Juillard C . Trauma registry implementation in low- and middle-income countries: challenges and opportunities. J Surg Res. 2018; 223:72-86. DOI: 10.1016/j.jss.2017.09.039. View

Solon J, Houlihan P, OBrien D, Connolly S, OToole D, McNamara D . A review of major trauma admissions to a tertiary adult referral hospital over a ten year period: fewer patients, similar survival. Surgeon. 2012; 10(6):334-8. DOI: 10.1016/j.surge.2011.08.006. View

Heim C, Bosisio F, Roth A, Bloch J, Borens O, Daniel R . Is trauma in Switzerland any different? epidemiology and patterns of injury in major trauma - a 5-year review from a Swiss trauma centre. Swiss Med Wkly. 2014; 144:w13958. DOI: 10.4414/smw.2014.13958. View

10.

Motsumi M, Mashalla Y, Sebego M, Ho-Foster A, Motshome P, Mokokwe L . Developing a trauma registry in a middle-income country - Botswana. Afr J Emerg Med. 2020; 10(Suppl 1):S29-S37. PMC: 7723909. DOI: 10.1016/j.afjem.2020.06.011. View

11.

Gabbe B, Cameron P, Finch C . Is the revised trauma score still useful?. ANZ J Surg. 2003; 73(11):944-8. DOI: 10.1046/j.1445-1433.2003.02833.x. View

12.

Gosselin R, Spiegel D, Coughlin R, Zirkle L . Injuries: the neglected burden in developing countries. Bull World Health Organ. 2009; 87(4):246-246a. PMC: 2672580. DOI: 10.2471/blt.08.052290. View

13.

Ugare G, Bassey I, Udosen J, Ndifon W, Ndoma-Egba R, Asuquo M . Trauma death in a resource constrained setting: mechanisms and contributory factors, the result of analysing 147 cases. Niger J Clin Pract. 2014; 17(4):397-402. DOI: 10.4103/1119-3077.133965. View

14.

Dutton R, Stansbury L, Leone S, Kramer E, Hess J, Scalea T . Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997-2008. J Trauma. 2010; 69(3):620-6. DOI: 10.1097/TA.0b013e3181bbfe2a. View

15.

Schuurman N, Cinnamon J, Walker B, Fawcett V, Nicol A, Hameed S . Intentional injury and violence in Cape Town, South Africa: an epidemiological analysis of trauma admissions data. Glob Health Action. 2015; 8:27016. PMC: 4468056. DOI: 10.3402/gha.v8.27016. View

16.

Solagberu B, Adekanye A, Ofoegbu C, Udoffa U, Abdur-Rahman L, Taiwo J . Epidemiology of trauma deaths. West Afr J Med. 2003; 22(2):177-81. DOI: 10.4314/wajm.v22i2.27944. View

17.

Ovadia P, Szewczyk D, Walker K, Abdullah F, Rabinovici R . Admission patterns of an urban level I trauma center. Am J Med Qual. 2000; 15(1):9-15. DOI: 10.1177/106286060001500103. View

18.

Leilei D, Pengpeng Y, Haagsma J, Ye J, Yuan W, Yuliang E . The burden of injury in China, 1990-2017: findings from the Global Burden of Disease Study 2017. Lancet Public Health. 2019; 4(9):e449-e461. PMC: 6739690. DOI: 10.1016/S2468-2667(19)30125-2. View

19.

Bundu I, Lowsby R, Vandy H, Kamara S, Jalloh A, Scott C . The burden of trauma presenting to the government referral hospital in Freetown, Sierra Leone: An observational study. Afr J Emerg Med. 2019; 9(Suppl):S9-S13. PMC: 6440925. DOI: 10.1016/j.afjem.2018.07.008. View

20.

Ekeke O, Okonta K . Trauma: a major cause of death among surgical inpatients of a Nigerian tertiary hospital. Pan Afr Med J. 2017; 28:6. PMC: 5681011. DOI: 10.11604/pamj.2017.28.6.10690. View