Acute traumatic coagulopathy among major trauma patients in an urban tertiary hospital in sub Saharan Africa

Abstract

BackgroundMortality from trauma remains a major public health issue as it is the leading cause of death in persons aged 5 to 44 years .Uncontrolled hemorrhage and coagulopathy is responsible for over 50% of all trauma related deaths within the first 48hrs of admission. Coagulation profiles are not routinely done among trauma patients in resource limited settings and there is a paucity of data on acute traumatic coagulopathy (ATC) in sub Saharan Africa. The study was conducted to evaluate the prothrombin time and partial thromboplastin time (PT/PTT) as predictors of mortality and morbidity among major trauma patients.MethodsA prospective cohort study was carried out, in which major trauma patients admitted in A&E department between December 2011 to April 2012 were recruited. Five (5) mls of venous blood was drawn from a convenient vein within 10 minutes of the patient’s arrival at A&E for analysis of PT/PTT. Patients were stratified into two groups by the presence/absence of coagulopathy then followed up for a 2 week period for morbidity and mortality.ResultsA total of 182 major trauma patients were recruited; 149 (81.9%) were males, the mean age was 29.5 years (SD 9.8). Prevalence of coagulopathy was 54% (98/182). The mean ISS for the ATC group was 36.9 and the non ATC group was 26.9 (p=0.001). Patients with ATC stayed longer in hospital 11.24 days than non ATC patients 8 days (p=0.001). ATC was strongly associated with ARI (p= 0.003). Mortality was more in the ATC group 29 deaths compared to 9 deaths in the non ATC group. PTT was a strong independent predictor of mortality.ConclusionA significant proportion of major trauma patients were coagulopathic. Initial coagulation profile is useful in predicting outcomes for major trauma patients.

Short Term Outcome of Haemorrhagic Shock in Trauma at Mulago Hospital, an Urban Tertiary Hospital in Sub Saharan Africa

“…RTIs still remain the leading cause of injuries (56.4%), a finding which is consistent with that of other trauma related studies [17,18]. There are observed associations between the mechanism of injury and the body region injured ( Table 2).…”

“…Of the patients who presented within 1 hour of injury, 61.1% were in grade IV shock. This late hospital presentation is also observed in other studies [17,18]. This is likely to be due to: a long distance from hospital; lack of an organised pre-hospital care system which would facilitate early transfer of patients to the hospital; and poor communication due to lack of toll free functional emergency numbers.…”

“…This is likely to be due to similarity in age distribution between survivors and nonsurvivors. Age as a factor is known to affect the outcome of traumatic haemorrhagic shock mainly in elderly patients who cannot mount an appropriate response to shock due to deficiency in catecholamine receptors [17].…”

Cortisol evaluation during the acute phase of traumatic brain injury—A prospective study

“…In Guinea, a study of 2829 victims of RTA during the year 2009 showed TBI to be present in 82% of cases with median age 27.1 years . In East Africa, a study from Uganda showed TBI to be the second reason for admission to an intensive care unit, with 1774 patients admitted over 7 years …”

Prevalence of derangement of coagulation profile in surgical patients and its outcome in India

“…According to a study by Mujuni et al ., the prevalence of deranged aPTT was found to be 37% in patients of major trauma, which is much higher than the findings of the present study. [ 7 ]…”