Pattern and Outcomes of Injuries among Trauma Patients in Gedeo Zone, Dilla, South Ethiopia: A 5 Years Retrospective Analysis

Outcomes and Its Associated Factors among Patients with Abdominal Trauma Requiring Laparotomy at Asella Referral and Teaching Hospital, South Central Ethiopia: A Retrospective Cross-Sectional Study

Trauma is a serious public health problem, and abdominal injuries are among the leading causes of hospitalization after trauma. Therefore, this study aimed to determine the outcome of abdominal trauma and its predictors in patients who underwent laparotomy at Asella Referral and Teaching Hospital (ARTH), South Central Ethiopia. We conducted a retrospective institutional based cross-sectional study of patients who underwent laparotomy for abdominal trauma at ARTH from October 1, 2015, to September 30, 2020. Bivariate and multivariate logistic regressions were used to determine associations between independent factors and mortality due to abdominal trauma, and a P value of <0.05 indicated statistical significance. Out of 139 patients, 110 (79.1%) were males and 88 (63.3%) aged <30 years old, with a mean age of 29 ± 15.73 years. The most common mechanism of injury was penetrating trauma, which accounted for 94 (67.6%) patients. The mortality rate was 21 (15.1%). Factors such as blunt mechanism of injury (95% CI: AOR: 3.36, 1.24-9.09), SBP < 90 mmHg at presentation (95% CI: AOR = 9.37, 3.28-26.80), time >6 hours from trauma to admission (95% CI: AOR: 5.44, 1.78-16.63), unstable intraoperative patient condition (95% CI: AOR = 8.82, 3.05-25.52), and patients who need blood transfusion (95% CI: AOR: 6.63, 1.92-22.91) were significantly associated with mortality. The mortality rate of abdominal trauma patients who underwent laparotomy was high. Therefore, healthcare providers should provide priority for traumatic patients as prolonged waiting time to get healthcare results in poor outcomes for the patients.

Injury characteristics and mortality in an emergency department in Ethiopia: a single-center observational study

INTRODUCTION

An injury is described as any damage to the body that impairs health, and its severity can span from mild to life-threatening. On a global scale, injuries account for approximately 4.4 million deaths annually and are anticipated to become the seventh leading cause of death by 2030. In Ethiopia, injuries account for 7% of all deaths, with one of the world's highest rates of road traffic injuries. This study, undertaken at a primary trauma centre in the capital of Ethiopia, aimed to explore the characteristics of injured patients and emergency department mortality as the patient outcome. Understanding the patterns and outcomes of injuries helps to anticipate needs, prioritize patients, and allocate resources effectively.

METHODS

A retrospective single-center observational study utilised patient records from September 2020 to August 2021 at Addis Ababa Burn Emergency and Trauma Hospital, located in Ethiopia. A structured checklist facilitated the data collection. All patients arriving in the ED from September 2020 to August 2021 were eligible for the study while incomplete records (missing > 20% of wanted data elements) were excluded.

RESULT

Of the 3502 injured patients recorded during the study period, 317 were selected. The mean patient age was 30 years, with 78.5% being male. About 8% arrived the emergency department within an hour after the injury. Ambulances transported 38.8% of patients; 58.5% of these were referred from other facilities. The predominant mechanism of injury both in and outside Addis Ababa was pedestrian road traffic injuries (31.4% and 38%). The predominant injury type was fractures (33.8%). The mortality rate was 5%, of which half were pedestrian road traffic incidents.

CONCLUSION

Pedestrian road traffic injuries were the main cause of injury in and outside of Addis Ababa. A small proportion of patients arrived at the emergency department within the first hour after an injury event. A significant proportion of ambulance-transported patients were referred from other facilities rather than directly from the scene. The overall mortality rate was high, with pedestrian road traffic injury accounting for half of the proportion.

Pattern of admission, outcome and predictors of trauma patients visiting the surgical emergency department in comprehensive specialized hospital: a retrospective follow-up study

Background

Traumatic injuries represent a huge burden in the developing world, and a significant proportion has found in low-income and middle-income countries. However, the pattern, outcome and factors of injury varies from setup to setup and is less studied in public health problems.

Objective

To assess pattern of admission, outcome and its predictors among trauma patients visiting the surgical emergency department in a comprehensive specialized hospital.

Methods

A retrospective follow-up study was conducted, and data were taken from the medical records of patients from 2019 to 2021. A simple random sampling technique was used to get a sample size of 386 from injured patient charts. Data were entered into Epi-Data version 4.6 software and exported to STATA version 14.1 for analysis. The dependent variable was injured patient's outcome, which could be died or not died. The independent variables with P value less than 0.25 in the bi-variable regression analysis were considered for the multivariable regression. Adjusted odds ratio (AOR) with the 95% CI were used to declare statistical significance.

Result

About 13.99% of injured patients with (95% CI: 10, 17) had died during the study period. The leading cause of injury was assault (62.44%) followed by road traffic accidents (26.17%). Severe Glasgow Coma Scale (AOR 6.6; 95% CI: 2.6-16.4), length of hospital stay more than or equal to 7 days (AOR=2.8; 95% CI: 1.2-6.2), time of arrival in between 1 and 24 h (AOR=0.15; 95% CI: 0.06-0.37), and upper trunk injury (AOR=6.3; 95% CI: 1.3-28.5) were significantly associated with mortality.

Conclusion and recommendation

Mortality after traumatic injury was considerably high. Severe Glasgow Coma Scale, Length of hospital stay more than or equal to 7 days, time of arrival in between 1 and 24 h, and upper trunk injury were the associated factors for mortality. Priority should be given for injured patients with decreased levels of consciousness and upper trunk injury. The establishment of organized pre-hospital emergency services and provision of timely arrival is recommended. The authors recommend prospective follow-up study.

Review of a large trauma registry in Addis Ababa, Ethiopia: insights into prehospital care and provider training for trauma quality improvement

Background

Injury is a major cause of death and disability in Ethiopia. ALERT Hospital, one of only three designated trauma centers in the country, has employed a basic trauma registry since its inception in 2016; however, these data had not been used. In joint efforts with the Federal Ministry of Health, we aimed to understand patient injury characteristics and predictors of mortality, to inform priorities in resource and training investments.

Methods

Data from 12 816 consecutive patients in the first 3 years of the trauma registry were reviewed retrospectively. Modified Early Warning Score was used at triage to indicate injury severity (red=critically injured, green=minor injury). No physiologic data for calculating Injury Severity Scores or in-hospital intervention data were available. Triage groups were compared and multivariate logistic regression conducted to determine predictors of in-emergency department (ED) mortality.

Results

Most patients presented with minor injuries with 64.7% triaged as 'yellow' and 16.4% triaged as 'green', and most (75.9%) referred from another facility. Of those who were critically injured, only 31.0% arrived by ambulance. Most injuries were soft tissue (51.1%) and fractures (23.0%); when stratified by triage category, most critical ('red') patients had sustained head injuries (52.7%). Arrival by ambulance (OR 2.20, p=0.017) and head injury (OR 3.11, p<0.001) were independent predictors of death in the ED.

Conclusion

This study of injured patients presenting to an Ethiopian trauma center is one of the largest to date, highlighting the need for more accessible and streamlined prehospital trauma care. Opportunities for improvement include staff training in initial trauma management and implementation of a more comprehensive trauma registry containing physiologic, intervention, and outcomes data to support a robust quality improvement program. Efforts by the Federal Ministry of Health are ongoing to support these improvements in care.

Level of Evidence

Level 3, observational study.

Time to recovery and its predictors following traumatic injuries among injured victims in Dessie Comprehensive Specialized Hospital, North East of Ethiopia, 2022: a retrospective follow-up study

BACKGROUND

Injuries are an extremely important public health problem worldwide. Despite being largely preventable and despite government efforts, injuries continue to be a major public health issue. Thus, the study tends to evaluate the time to recovery and its predictors for traumatic injuries.

METHODS

A hospital-based retrospective follow-up study was used. A total of 329 medical charts were actually reviewed. Traumatic injury victims from January 1, 2018-December 31, 2022 were included, and a simple random sampling technique was utilized. The data was gathered by reviewing medical charts. Data was coded and entered into Epi-Data Manager version 4.6.0.4 statistical software and further analyzed using STATA version 17. Descriptive statistics were performed to see the frequency distribution of variables. A Kaplan-Meier survival estimate and log rank test were performed to plot the overall survival curve and compare the difference in recovery among predictor categories, respectively. A model fitness test was done by using the Cox-Snell residual test and Harrell's C concordance statistic. Finally, a Cox proportional hazard model was fitted to determine the effect of predictors on recovery time from traumatic injuries.

RESULTS

The median time to recovery of traumatic injuries was 5 days (IQR: 3-10 days), with an overall incidence density of 8.77 per 100 person-days of observation. In the multivariable cox proportional regression model, variables such as being male (AHR: 0.384, 95%CI: 0.190-0.776, P-value: 0.008), the Glasgow coma scale of 13-15 (AHR: 2.563, 95%CI: 1.070-6.139, P-value: 0.035), intentional injury (AHR: 1.934, 95%CI: 1.03-3.632, P-value: 0.040), mild traumatic brain injury (AHR: 2.708, 95%CI: 1.095-6.698, P-value: 0.031), and moderate traumatic brain injury (AHR: 2.253, 95%CI: (1.033-4.911, P-value: 0.041) were statistically significant variables.

CONCLUSIONS

The median recovery time for traumatically injured respondents was 5 days. Independent predictors such as the Glasgow coma scale, time taken for surgical management, intent of injury, and traumatic brain injury were statistically significant with time to recovery from trauma.

Treatment Outcome, Pattern of Injuries and Associated Factors Among Traumatic Patients Attending Emergency Department of Dessie City Government Hospitals, Northeast Ethiopia: A Cross-Sectional Study

Background

Traumatic injuries are a major cause of emergency room visits and hospital workload, and they are a global health concern. Therefore, this study aimed to assess the pattern of injuries, treatment outcomes, and associated factors among traumatic patients attending the emergency department of Dessie City Government Hospitals, Northeast Ethiopia.

Methods

An institutional-based retrospective cross-sectional study was conducted among 415 traumatic patients selected by using a systematic random sampling technique, from July 1, 2019, to June 30, 2022. Data were collected through document review. The data were presented with frequency tables and graphs. Data were entered using EPI data version 4.6 and exported to SPSS version 26 for analysis. Both bi-variable and multivariable logistic regression analyses were performed to analyze the relationship between the independent variable and the outcome variable. As a measure of association, the adjusted odds ratio was utilized, which has a 95% confidence level. Statistically significant variables were those with a p-value of less than 0.05.

Results

From 420 patient charts, 415 traumatic patients' charts were reviewed in this study, with a response rate of 98.8%. The prevalence of good treatment outcomes among traumatic patients was found to be 67% [95% CI: 62.2, 72.0]. In the final multivariable analysis, having comorbidity [AOR=, 0.31 95% CI: 0.16, 0.60], arriving within one hour [AOR=4.79, 95% CI: 2.10, 10.94], arriving two up to twenty-four hours [AOR=2.25, 95% CI: 1.34, 3.78] and being conscious at admission [AOR=1.82, 95% CI: 1.02, 3.26] had a significant association with a good treatment outcome among traumatic patients.

Conclusion

Trauma constitutes a major public health problem in our setting and contributes significantly to unacceptably high morbidity and mortality. Interventions should be targeted at urgent injury prevention and management strategies, along with the establishment of a pre-hospital emergency medical service system.

Self-Reported Fall-Related Injury and Its Associated Factors among Adults with Visual Impairment Attending St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background

Falls account for vast majority of fractures and are a significant reason for trauma related hospital admissions. The main aim of this study is to determine the prevalence of self-reported fall, related injuries, and associated factors among adult patients with visual impairment.

Methods

Hospital-based cross-sectional study was conducted from July to August 2021. Systematic random sampling technique was used. The data were entered into Epi-data version 3.1 and exported to SPPS version 26 for analysis. Frequency, mean, and percentage, were used to summarize the descriptive data. The association between the outcome variable and explanatory variables was assessed using binary and multivariate logistic regressions. The adjusted odds ratio was calculated, and variables with a p-value below 0.05 at the 95% confidence interval (CI) were considered statistically significant.

Result

A total of 487 study participants were involved in this study with a response rate of 93.83%. The mean age of the study participants was 52 ± 16.26 years. The overall prevalence of self-reported fall was 36.1 %. Being female, being older than 64 years of age, rural residence, fear of falling, and blind stage of visual impairment were significantly associated with falling.

Conclusion

The prevalence of self-reported fall was high among visually impaired individuals. Female sex, age more than 64 years, rural residence, fear of falling, and blind stage of visual impairment were significantly associated with falling. Reducing patients' chances of suffering from falling-related injuries and consequences requires raising awareness about the burden, danger, and effects of falling on persons who are visually impaired.

Spatial Distribution of Road Traffic Accident at Hawassa City Administration, Ethiopia

BACKGROUND

Globally, road traffic accidents (RTAs) are the leading killer of young people and are projected to be the 7th leading cause of death by 2030. This study is aimed at analyzing the spatial distribution of road traffic accident and identifying hotspot areas across Kebeles (smallest administrative division in Ethiopia) of Hawassa city administration in Ethiopia.

METHOD

Secondary data on daily traffic accident record from October 2013 to June 2018 was obtained from Hawassa city administration police department. The spatial clustering and hotspots identification were carried through Moran's I and Getis-Ord Gi* statistics. Data analysis was conducted using GeoDa 1.16.0.0 and ArcGIS 10.2 softwares.

RESULTS

Drivers within age group of 18-30 years, who were hired by private business owners and who had no driving license committed the highest number of traffic accidents. The majority of traffic accidents were caused due to careless driving, failure to give priority for pedestrian, high speed and driver failure to give priority for each other. In addition, about 82.01% of traffic accidents were recorded on asphalts road and 11.51% by gravel road. Spatial clustering of road traffic accidents for accidents occurred on gravel road and in sunny weather conditions found to be significant. Different hotspot areas were identified for gravel type of road and sunny weather condition.

CONCLUSION

The concerned government bodies involved in policymaking are recommended to give special attention to young driver who were hired by private business owners. Interventions to mitigate the occurrence of traffic accident would take in to account the identified hotspot areas.