Patterns and outcomes of paediatric trauma at a tertiary teaching hospital in Kenya

Abstract

Introduction Trauma continues to be a major cause of morbidity and mortality especially in the paediatric population of low- and middle-income countries such as Kenya. The aim of this study was to establish the profile and outcomes of admitted paediatric trauma cases at the Aga Khan University Hospital, Nairobi. Methods This retrospective, descriptive study involved a 12-month chart review (January 2016–December 2016). A total of 218 records were identified of which 144 were reviewed. Results Most injuries were amongst boys (65.3%) and the very young (mean age 6), occurred in private residences (42.4% homes, 25.7% residential institutions), were typically caused by falls (56.3%) or penetrating trauma (13.2%), mostly resulted in extremity fractures (45.8% closed, 4.9% open) and burn or head injuries (in infants and small children), and got very little or no pre-hospital care (51.4% no care). Additionally, children with burns, brain injuries, or poly-trauma had the longest hospital stays and highest rates of mortality. A more detailed description of the patterns and outcomes seen are included in the study. Discussion Paediatric injuries remain a major public health problem and contribute a substantial proportion of all paediatric surgical admissions at the Aga Khan University Hospital in Nairobi. Based on the patterns and outcomes seen in this study, we therefore recommend for Nairobi (and possibly Kenya) to establish greater supervision and safety measures for children; targeting safety interventions at all children but particularly at boys, the very young, at home and in residential buildings; building pre-hospital emergency care that can accommodate children; and equipping paediatric trauma hospitals to especially handle bony fractures, burns, head injuries, and poly-traumas. A bespoke trauma registry would benefit the hospital, and likely the country as a whole.

Study of the characteristics and burden of pediatric trauma in low resource settings.

“…In agreement with many previously published studies, our study also shows male predilection for injuries, males 67.9 %( n=595) and females 32.1 %( n=276). 21,22,23 The present study revealed that 3-5 years age group is the most common victim of trauma,39%(n=340). 6-10.9 years 20.7%(n=2038) has been reported as the most frequently injured age group 10 A study conducted in India reported that 11-15 years comprised the most common age group involved in trauma.…”

“…This finding was supported by many previously published studies. 19,25,26,27 Unlike the previous studies 21,22,28 fall was not the most common injury mechanism, rather it was the second most common injury mechanism, 34.0 %( n=238). Vehicle related incidents are the most common injury mechanism in boys and fall is most common in girls.…”

Feet deformities and their close association with postural stability deficits in children aged 10–15 years

“…This assertion was also corroborated by others, e.g. Halawa et al [3], Heidenkeni et al [4], Ndung’u et al [5]. Overall assessment of morphological structure of the feet, and any attendant deformities in terms of their impact on postural stability, is therefore believed an essential and challenging research issue in many areas.…”

Guest Editorial: Introduction to the Trauma Special Issue

“…This aspect is addressed in four of the papers included in this special issue, ranging from low income to middle income countries. [3] , [5] , [6] , [7] …”

“…Ndung’u and co-authors examined this aspect in a Kenyan emergency centre attached to Aga Khan University, including children and younger adolescents (under 15 years of age). [6] They noted that paediatric injury was common in the younger child, around 6 years of age, due to domestic incidents and falls, while a smaller number had penetrating trauma. Admissions were predominantly for limb fractures, with only 4% of the total cohort resulting from intentional injury, very different from the adult population.…”