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Endeshaw D, Delie AM, Adal O, Tareke AA, Bogale EK, Anagaw TF, Tiruneh MG, Fenta ET. Mortality and its predictors in abdominal injury across sub-Saharan Africa: systematic review and meta-analysis. BMC Emerg Med 2024; 24:57. [PMID: 38605305 PMCID: PMC11008034 DOI: 10.1186/s12873-024-00982-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Abdominal injuries exert a significant impact on global morbidity and mortality. The aggregation of mortality data and its determinants across different regions holds immense importance for designing informed healthcare strategies. Hence, this study assessed the pooled mortality rate and its predictors across sub-Saharan Africa. METHOD This meta-analysis employed a comprehensive search across multiple electronic databases including PubMed, Africa Index Medicus, Science Direct, and Hinari, complemented by a search of Google Scholar. Subsequently, data were extracted into an Excel format. The compiled dataset was then exported to STATA 17 statistical software for analysis. Utilizing the Dersimonian-Laird method, a random-effect model was employed to estimate the pooled mortality rate and its associated predictors. Heterogeneity was evaluated via the I2 test, while publication bias was assessed using a funnel plot along with Egger's, and Begg's tests. RESULT This meta-analysis, which includes 33 full-text studies, revealed a pooled mortality rate of 9.67% (95% CI; 7.81, 11.52) in patients with abdominal injuries across sub-Saharan Africa with substantial heterogeneity (I2 = 87.21%). This review also identified significant predictors of mortality. As a result, the presence of shock upon presentation demonstrated 6.19 times (95% CI; 3.70-10.38) higher odds of mortality, followed by ICU admission (AOR: 5.20, 95% CI; 2.38-11.38), blunt abdominal injury (AOR: 8.18, 95% CI; 4.97-13.45), post-operative complications (AOR: 8.17, 95% CI; 4.97-13.44), and the performance of damage control surgery (AOR: 4.62, 95% CI; 1.85-11.52). CONCLUSION Abdominal injury mortality is notably high in sub-Saharan Africa. Shock at presentation, ICU admission, blunt abdominal injury, postoperative complications, and use of damage control surgery predict mortality. Tailored strategies to address these predictors could significantly reduce deaths in the region.
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Affiliation(s)
- Destaw Endeshaw
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Amare Mebrat Delie
- Department of Public Health, College of medicine and health science, Injibara University, Injibara, Ethiopia
| | - Ousman Adal
- Department of emergency and critical care nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abiyu Abadi Tareke
- Amref Health in Africa, COVID-19 vaccine/EPI technical assistant at West Gondar zonal health department, Gondar, Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioral science department, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabel Anagaw
- Health Promotion and Behavioral science department, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of medicine and health science, Injibara University, Injibara, Ethiopia
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Hassankhani A, Amoukhteh M, Valizadeh P, Jannatdoust P, Eibschutz LS, Myers LA, Gholamrezanezhad A. Diagnostic utility of multidetector CT scan in penetrating diaphragmatic injuries: A systematic review and meta-analysis. Emerg Radiol 2023; 30:765-776. [PMID: 37792116 PMCID: PMC10695863 DOI: 10.1007/s10140-023-02174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
Penetrating diaphragmatic injuries pose diagnostic and management challenges. Computed tomography (CT) scans are valuable for stable patients, but concern exists for missed injuries and complications in nonoperatively managed cases. The objective of this study was to explore the diagnostic utility of multidetector CT scan (MDCT) in identifying diaphragmatic injuries resulting from penetrating trauma. A systematic review and meta-analysis were conducted, following established guidelines, by searching PubMed, Scopus, Web of Science, and Embase databases up to July 6, 2023. Eligible studies reporting MDCT's diagnostic accuracy in detecting penetrating diaphragmatic injuries were included. Relevant data elements were extracted and analyzed using STATA software. The study included 9 articles comprising 294 patients with confirmed penetrating diaphragmatic injuries through surgical procedures. MDCT's diagnostic performance revealed a pooled sensitivity of 74% (95% CI: 56%-87%) and a pooled specificity of 92% (95% CI: 79%-97%) (Fig. two), with significant heterogeneity in both sensitivity and specificity across the studies. The Fagan plot demonstrated that higher pre-test probabilities correlated with higher positive post-test probabilities for penetrating diaphragmatic injury diagnosis using MDCT, but even with negative results, there remained a small chance of having the injury, especially in cases with higher pre-test probabilities. This study highlights MDCT's effectiveness in detecting diaphragmatic injury from penetrating trauma, with moderate to high diagnostic accuracy. However, larger sample sizes, multicenter collaborations, and prospective designs are needed to address observed heterogeneity, enhancing understanding and consistency in MDCT's diagnostic capabilities in this context.
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Affiliation(s)
- Amir Hassankhani
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Melika Amoukhteh
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Parya Valizadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Jannatdoust
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Liesl S Eibschutz
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA
| | - Lee A Myers
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA.
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Pooria A, Pourya A, Gheini A. A Descriptive Study on the Usage of Exploratory Laparotomy for Trauma Patients. Open Access Emerg Med 2020; 12:255-260. [PMID: 33116961 PMCID: PMC7568626 DOI: 10.2147/oaem.s254024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Laparotomy is commonly indicated in patients presenting blunt or penetrating trauma. This cross-sectional study is designed to evaluate the frequency and the causes of laparotomy following abdominal trauma. Materials and Methods The data of 71 patients who underwent laparotomy as a result of abdominal trauma in Shohada Ashayer Hospital, Khorramabad were evaluated and a questionnaire was completed for each patient. All the data were analyzed statistically using SPSS. Results Of 71 patients, 61 underwent positive laparotomy whereas, negative laparotomy was performed in 10 patients. The results from this study showed that the most common organ of the injury was spleen (19.7%), followed by other solid organs. The small intestine (16.4%) was found more prone to injuries in penetrating trauma. Incidence of blunt trauma injury due to road accidents was the greatest 50.82% and 20% of penetrating traumas were the result of a firearm. Conclusion Abdominal trauma injury is common in our study population where spleen, small intestine and other solid organs are chiefly involved. Indications of laparotomy should be fully examined in order to avoid negative laparotomies and associated complications.
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Affiliation(s)
- Ali Pooria
- Department of Cardiology, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Afsoun Pourya
- Student of Research Committee, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Gheini
- Department of Cardiology, Lorestan University of Medical Sciences, Khorramabad, Iran
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Isolated Jejunal Perforation and Mesentery Injury following a Kick on the Abdomen of a College Student: A Case Report from a District Hospital in Northern Ghana. Case Rep Crit Care 2020. [DOI: 10.1155/2020/3063472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction. Isolated jejunal perforation from blunt abdominal trauma is an extremely rare intra-abdominal injury that poses a huge diagnostic challenge. Delay in diagnosis and initiation of treatment often leads to significant morbidity and mortality. Diagnosis particularly in resource-poor settings may be extremely challenging and often relies on a high index of suspicion. This is due to lack of adequate diagnostic facilities and human resource to deal with the condition with resulting high occurrence of adverse outcomes. Case Presentation. We report a case of isolated jejunal perforation with associated mesentery injury in a young college student who sustained a kick to his abdomen while playing soccer. This is an unusual presentation since most reported cases often resulted from motor vehicular accidents, bicycle handlebar, and fall from a height. We emphasized the role of critical level of suspicion with a good history and physical examination as the major source of diagnosis since diagnostic procedures, such as abdominal ultrasonography and computed tomography, are largely unavailable in most resource-constraint settings. Early surgical intervention following diagnosis leads to good recovery and reduced mortality. Conclusion. Sufficient vigilance and suspicions of small bowel perforation should always be considered after blunt trauma even when symptoms and physical findings are minimal and when diagnostic capacity is limited.
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Abstract
Background: Perioperative mortality rate (POMR) has been identified as an important measure of access to safe surgical and anesthesia care in global surgery. There has been limited study on this measure in rural Ghana. In order to identify areas for future quality improvement efforts, we aimed to assess the epidemiology of exploratory laparotomy and to investigate POMR as a benchmark quality measure. Methods: Surgical records were reviewed at a regional referral hospital in Eastern Region, Ghana to identify cases of exploratory laparotomy from July 2017 through June 2018. Patient demographics, health information, and outcomes data were collected. Logistic regression was used to identify predictors of perioperative mortality. Findings: The study included operations for 286 adult and 60 pediatric patients. Only 60% of patients were covered by National Health Insurance (NHI). The overall POMR was 11.5% (12.6% adults; 6.7% pediatric). Sixty percent of mortalities were referrals from outside hospitals and the mortality rate for referrals was 13.5%. Odds of mortality was 13 times greater with perforated peptic ulcer disease (OR = 13.1, p = 0.025) and 12 times greater with trauma (OR = 11.7, p = 0.042) when compared to the most common operation. Female sex (OR = 0.3, p = 0.016) and NHI (OR = 0.4, p = 0.031) were protective variables. Individuals 60 years and older (OR = 3.3, p = 0.016) had higher mortality. Conclusion: POMR can be an important outcome and quality indicator for rural populations. Interventions aimed at decreasing emergent hernia repair, preventing perforation of peptic ulcer disease, improving rural infrastructure for response to major trauma, and increasing NHI coverage may improve POMR in rural Ghana.
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Abri B, Shams Vahdati S, Paknezhad S, Sepehri Majd P, Bahrami M. Abdominal penetrating trauma and organ damage and its prognosis. JOURNAL OF ANALYTICAL RESEARCH IN CLINICAL MEDICINE 2016. [DOI: 10.15171/jarcm.2016.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Yucel M, Bas G, Ozpek A, Basak F, Sisik A, Acar A, Ozdemir BA, Yuksekdag S, Alimoglu O. The predictive value of physical examination in the decision of laparotomy in penetrating anterior abdominal stab injury. Int J Clin Exp Med 2015; 8:11085-11092. [PMID: 26379908 PMCID: PMC4565291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/02/2015] [Indexed: 06/05/2023]
Abstract
A selective conservative treatment for penetrating anterior abdominal stab injuries is an increasingly recognized approach. We analyzed patients who followed-up and treated for penetrating anterior abdominal stab injuries. The anterior region was defined as the area between the arcus costa at the top and the mid-axillary lines at the laterals and the inguinal ligaments and symphysis pubis at the bottom. An emergency laparotomy was performed on patients who were hemodynamically unstable or had symptoms of peritonitis or organ evisceration; the remaining patients were followed-up selectively and conservatively. A total of 175 patients with purely anterior abdominal injuries were included in the study. One hundred and sixty-five of the patients (94.29%) were males and 10 (5.71%) were females; the mean age of the cohort was 30.85 years (range: 14-69 years). While 16 patients (9%) were made an emergency laparotomy due to hemodynamic instability, peritonitis or evisceration, the remaining patients were hospitalized for observation. During the selective conservative follow-up, an early laparotomy was performed in 20 patients (12%), and a late laparotomy was performed in 13 patients (7%); the remaining 126 patients (72%) were discharged after non-operative follow-up. A laparotomy was performed on 49 patients (28%); the laparotomy was therapeutic for 42 patients (86%), non-therapeutic for 4 patients (8%), and negative for 3 patients (6%). A selective conservative approach based on physical examination and clinical follow-up in penetrating anterior abdominal stab injuries is an effective treatment approach.
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Affiliation(s)
- Metin Yucel
- Department of General Surgery, Umraniye Training and Research Hospital Istanbul, Turkey
| | - Gurhan Bas
- Department of General Surgery, Umraniye Training and Research Hospital Istanbul, Turkey
| | - Adnan Ozpek
- Department of General Surgery, Umraniye Training and Research Hospital Istanbul, Turkey
| | - Fatih Basak
- Department of General Surgery, Umraniye Training and Research Hospital Istanbul, Turkey
| | - Abdullah Sisik
- Department of General Surgery, Umraniye Training and Research Hospital Istanbul, Turkey
| | - Aylin Acar
- Department of General Surgery, Umraniye Training and Research Hospital Istanbul, Turkey
| | - Buket Altun Ozdemir
- Department of General Surgery, Umraniye Training and Research Hospital Istanbul, Turkey
| | - Sema Yuksekdag
- Department of General Surgery, Umraniye Training and Research Hospital Istanbul, Turkey
| | - Orhan Alimoglu
- Department of General Surgery, Umraniye Training and Research Hospital Istanbul, Turkey
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Okuş A, Sevinç B, Ay S, Arslan K, Karahan Ö, Eryılmaz MA. Conservative management of abdominal injuries. ULUSAL CERRAHI DERGISI 2013; 29:153-7. [PMID: 25931868 DOI: 10.5152/ucd.2013.2300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/25/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Non-operative management of abdominal injuries has recently become more common. Especially non-operative treatment of blunt abdominal trauma is gaining wide acceptance. In this study, the efficacy of non-operative treatment in abdominal trauma (blunt penetrating) is discussed. MATERIAL AND METHODS All patients who received treatment due to abdominal trauma from November 2008 to January 2013 were retrospectively analyzed. The demographic characteristics, type of injury, injured organ, type of treatment (operative vs. nonoperative) and mortality data were evaluated. RESULTS The study includes 115 patients treated for abdominal trauma in our department. The mechanism of trauma was stab wounds in 60%, blunt abdominal trauma in 23.5% and gunshot wounds in 16.5%. Forty-two patients (36.5%) were operated for hemodynamic instability and/or peritonitis on admission. The remaining 63.5% of patients (n=73) were treated nonoperatively, 10 of whom required laparotomy during follow-up. The remaining 63 patients were treated with non-operative management. The success rate for non-operative treatment was 86.3% and there was no difference in terms of the types of injuries. The mortality rate was 4.3% (n= 5) in the whole series, but there were no deaths among the patients who had received non-operative treatment. In the whole patient group 54.2% (n=63) were treated nonoperatively. CONCLUSION Nonoperative treatment in abdominal trauma is safe and effective. Patients with clinical stability and normal physical examination findings can be treated nonoperatively with close monitoring.
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Affiliation(s)
- Ahmet Okuş
- Department of General Surgery, Faculty of Medicine, Mevlana University, Konya, Turkey
| | - Barış Sevinç
- Department of General Surgery, Konya Teaching Hospital, Konya, Turkey
| | - Serden Ay
- Department of General Surgery, Konya Teaching Hospital, Konya, Turkey
| | - Kemal Arslan
- Department of General Surgery, Konya Teaching Hospital, Konya, Turkey
| | - Ömer Karahan
- Department of General Surgery, Konya Teaching Hospital, Konya, Turkey
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Lunevicius R, Schulte KM. Analytical review of 664 cases of penetrating buttock trauma. World J Emerg Surg 2011; 6:33. [PMID: 21995834 PMCID: PMC3205008 DOI: 10.1186/1749-7922-6-33] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 10/13/2011] [Indexed: 11/10/2022] Open
Abstract
A comprehensive review of data has not yet been provided as penetrating injury to the buttock is not a common condition accounting for 2-3% of all penetrating injuries. The aim of the study is to provide the as yet lacking analytical review of the literature on penetrating trauma to the buttock, with appraisal of characteristics, features, outcomes, and patterns of major injuries. Based on these results we will provide an algorithm. Using a set of terms we searched the databases Pub Med, EMBASE, Cochran, and CINAHL for articles published in English between 1970 and 2010. We analysed cumulative data from prospective and retrospective studies, and case reports. The literature search revealed 36 relevant articles containing data on 664 patients. There was no grade A evidence found. The injury population mostly consists of young males (95.4%) with a high proportion missile injury (75.9%). Bleeding was found to be the key problem which mostly occurs from internal injury and results in shock in 10%. Overall mortality is 2.9% with significant adverse impact of visceral or vascular injury and shock (P < 0.001). The major injury pattern significantly varies between shot and stab injury with small bowel, colon, or rectum injuries leading in shot wounds, whilst vascular injury leads in stab wounds (P < 0.01). Laparotomy was required in 26.9% of patients. Wound infection, sepsis or multiorgan failure, small bowel fistula, ileus, rebleeding, focal neurologic deficit, and urinary tract infection were the most common complications. Sharp differences in injury pattern endorse an algorithm for differential therapy of penetrating buttock trauma. In conclusion, penetrating buttock trauma should be regarded as a life-threatening injury with impact beyond the pelvis until proven otherwise.
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Affiliation(s)
- Raimundas Lunevicius
- Major Trauma Centre, King's College Hospital NHS Foundation Trust, King's Health Partners Academic Health Sciences Centre, Denmark Hill, London, SE5 9RS, UK.
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