Road traffic injuries in a Nigerian referral trauma center: Characteristics, correlates, and outcomes

Epidemiological Burden of Neurotrauma in Nigeria: A Systematic Review and Pooled Analysis of 45,763 Patients

OBJECTIVE

Neurotrauma is a significant cause of morbidity and mortality in Nigeria. We conducted this systematic review to generate nationally generalizable reference data for the country.

METHODS

Four research databases and gray literature sources were electronically searched. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions and Cochrane's risk of bias tools. Descriptive analysis, narrative synthesis, and statistical analysis (via paired t-tests and χ2 independence tests) were performed on relevant article metrics (α = 0.05).

RESULTS

We identified a cohort of 45,763 patients from 254 articles. The overall risk of bias was moderate to high. Most articles employed retrospective cohort study designs (37.4%) and were published during the last 2 decades (81.89%). The cohort's average age was 32.5 years (standard deviation, 20.2) with a gender split of ∼3 males per female. Almost 90% of subjects were diagnosed with traumatic brain injury, with road traffic accidents (68.6%) being the greatest cause. Altered consciousness (48.4%) was the most commonly reported clinical feature. Computed tomography (53.5%) was the most commonly used imaging modality, with skull (25.7%) and vertebral fracture (14.1%) being the most common radiological findings for traumatic brain injury and traumatic spinal injury, respectively. Two-thirds of patients were treated nonoperatively. Outcomes were favorable in 63.7% of traumatic brain injury patients, but in only 20.9% of traumatic spinal injury patients. Pressure sores, infection, and motor deficits were the most commonly reported complications in the latter.

CONCLUSIONS

This systematic review and pooled analysis demonstrate the significant burden of neurotrauma across Nigeria.

Trauma Care in Nigeria: Time for an Integrated Trauma System

Traumatic injuries are a global health problem. Most first world countries have developed comprehensive trauma systems to provide optimal care for injured patients. A trauma system is a coordinated effort in a defined geographic area that attempts to deliver trauma care to all injured patients and is usually integrated with the local public health system.

The majority of low and middle income countries (LMIC) do not have functional trauma systems. This study aims to critique the status of trauma care in Nigeria and make a case for a re-organisation towards an inclusive trauma system.

The methodology was a review of published articles and available grey literature to assess current practices in Nigeria within the various components of a trauma system, viz., injury prevention, pre-hospital care, acute care, and rehabilitation.

The conclusions from this review suggest that integrating existing major trauma centres (MTCs) with smaller local hospitals within a region into an inclusive, interconnected region-based trauma system is the cheapest and most efficient way to improve Nigeria's trauma care and significantly reduce trauma mortality rates.

Clinicoepidemiological profile of trauma patients admitting to the emergency department of a tertiary care hospital in eastern India

Context:

Trauma is an immediate cause of patients flowing to the emergency department of any hospital. Besides epidemiology, clinical profile and treatment strategy forms an important aspect to reflect the gap in the existing public sector health-care system and the requirement.

Aims:

To evaluate the clinicoepidemiological profile of trauma patients admitting to an apex trauma hospital in east India.

Settings and Design:

A prospective observational study was performed during the time period of December 2018 to July 2019 on trauma patients admitted to the Trauma and Emergency department.

Methods and Material:

Patient's demographic profile, injury type, mechanism, the vehicle involved in the accident, and transportation were recorded. Various trauma scores (clinical) and outcome measures were recorded.

Statistical Analysis Used:

Statistical analysis was done by R version 3.6.1.

Results:

Male: female ratio was 407:93 with the 21–30 age group predominantly. 2–6 PM was the most common time of injury and ambulance was the predominant mode of transport (58%). Road traffic injury (RTI) accounted for 75% victims; two-wheelers (68%) dominated over others. Thirty percent (drivers 18%, pillion riders 12%) were wearing helmet; 41% were wearing seat belts (drivers 34%, passenger 12%). Twenty-five percent of drivers consumed alcohol. The median ± Interquartile range of injury severity score (ISS), revised trauma and trauma score and injury severity score were 17 (11–26), 7.8 (4.1–7.8), and 98.41 (95.95–99.30), respectively. Extremity injury (54% fractures) and head injury (50%) were the frontrunners in the pattern of injury, with half of the victims were polytrauma (ISS > 15).

Conclusions:

The injury was prominently RTI and the trauma victims/patients were young male drivers on two wheelers. The focus should be directed to make use of safety measures among the youth.