Patterns and outcomes of patients with abdominal trauma on operative management from northern Tanzania: a prospective single centre observational study

Abstract

Background The abdomen is one of the most commonly injured regions in trauma patients. Abdominal injury surgeries are common in Tanzania and in many parts of the world. This study aimed to determine the relationships among the causes, characteristics, patterns and outcomes of abdominal injury patients undergoing operations at Kilimanjaro Christian Medical Centre. Methods A prospective observational study was performed over a period of 1 year from August 2016 to August 2017. A case was defined as a trauma patient with abdominal injuries admitted to the general surgery department and undergoing an operation. We assessed injury types, patterns, aetiologies and outcomes within 30 days. The outcomes were post-operative complications and mortality. Multivariate logistic regression was used to explore the association between factors associated with morbidity and mortality. Results Out of 136 patients, 115 (84.6%) were male, with a male-to-female ratio of 5.5:1. The most affected patients were in the age range of 21–40 years old, which accounted for 67 patients (49.3%), with a median age (IQR) of 31.5 (21.3–44.8) years. A majority (99 patients; 72.8%) had blunt abdominal injury, with a blunt-to-penetrating ratio of 2.7:1. The most common cause of injury was road traffic accidents (RTAs; 73 patients; 53.7%). Commonly injured organs in blunt and penetrating injuries were, respectively, the spleen (33 patients; 91.7%) and small bowel (12 patients; 46.1%). Most patients (89; 65.4%) had associated extra-abdominal injuries. Post-operative complications were observed in 57 patients (41.9%), and the mortality rate was 18 patients (13.2%). In the univariate analysis, the following were significantly associated with mortality: associated extra-abdominal injury (odds ratio (OR): 4.9; P -value< 0.039); head injury (OR: 4.4; P -value < 0.005); pelvic injury (OR: 3.9; P -value< 0.043); length of hospital stay (LOS) ≥ 7 days (OR: 4.2; P -value < 0.022); severe injury on the New Injury Severity Score (NISS) (OR: 21.7; P -value < 0.003); time > 6 h from injury to admission (OR: 4.4; P -value < 0.025); systolic BP < 90 (OR: 3.5; P -value < 0.015); and anaemia (OR: 4.7; P -value< 0.006). After adjustment, the following significantly predicted mortality: severe injury on the NISS (17 patients; 25.8%; adjusted odds ratio (aOR): 15.5, 95% CI: 1.5–160, P -value < 0.02) and time > 6 h from injury to admission (15 patients; 19.2%; aOR: 4.3, 95% CI: 1.0–18.9, P -value < 0.05). Conclusion Blunt abdominal injury was common and mostly associated with RTAs. Associated extra-abdominal injury, injury to the head or pelvis, LOS ≥ 7 days, systolic BP < 90 and anaemia were a...

Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study

“…In our study the proportion of liver injuries within abdominal region was 33% and is similar to other studies from India which reported 23-35% of all the abdominal injuries [19][20][21]. However, this is lower than the proportion of 42-52% reported from studies from Africa and Italy [4,22]. In India, blunt abdominal trauma due to RTI is the commonest mechanism of injury except in the state of Jammu and Kashmir (a con ict zone) which has a higher proportion of penetrating abdominal trauma [20].…”

“…Demographics and Liver trauma Pro le (Table 1) (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)]. Univariate analysis showed no difference between these two cohorts in their age and GCS ( Table 2).…”

“…In one patient SBP was not recordable.As per the WSES grades of injury, of who underwent OM; 26 (20.3%) were Grade 1, 32 (33.3%) were Grade 2, 11 (15.9%) Grade 3 and 37 (49.3%) Grade 4. The operative management cohort differed from the nonoperative cohort signi cantly in their mean SBP 99(26.2%) vs. 111(21.0%), proportion of penetrating injury 21.7% vs. 4.4%, heart rate 103 (2.4) vs. 97 (18.5)] & ISS 14(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) vs. 17…”

Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study

“…In our study the proportion of liver injuries within abdominal region was 33% and is similar to other studies from India which reported 23-35% of all the abdominal injuries [18][19][20]. However, this is lower than the proportion of 42-52% reported from studies from Africa and Italy [4,21]. In India, blunt abdominal trauma due to RTI is the commonest mechanism of injury except in the state of Jammu and Kashmir (a con ict zone) which has a higher proportion of penetrating abdominal trauma [19].…”

Epidemiology and outcomes of injuries among trauma patients in Ethiopia: A 5 -years retrospective Analysis

“…Road traffic accident was the commonest types of injury (47.3%) followed by inter-personnel violence (30.1%) which is comparable with findings of Sub-Saharan African countries and WHO reports 1,20,21,25,26 . In this study, lower extremity injury is the most common types of injury unlike other studies conducted in Africa which was head injury [5][6][7][8]22,27,28 .…”