|Year : 2016 | Volume
| Issue : 1 | Page : 1-4
Injury epidemiology at a trauma center in Southwest Nigeria
Adetunji M Toluse1, Oluwatosin O Idowu1, Olorunfemi O Ogundele2, Adekunle O Egbewole1
1 Department of Orthopaedic Surgery and Trauma, Ondo State Trauma and Surgical Centre, Ondo, Nigeria
2 Department of Community Health, State Specialist Hospital, Ondo, Nigeria
|Date of Web Publication||8-Dec-2016|
Adetunji M Toluse
Department of Orthopaedic Surgery and Trauma, National Orthopaedic Hospital, P.M.B. 2009, Yaba, Lagos State
Source of Support: None, Conflict of Interest: None
Background: Trauma is a leading cause of emergency room visits in Nigeria and results in significant morbidity and mortality.
Aims: This study aimed to identify the demographics, pattern, and outcome of injuries in patients seen within a year.
Settings and Design: A prospective cross-sectional study design was employed of consecutive patients at a new Trauma Centre in Ondo State, Southwest Nigeria.
Patients and Methods: Convenient sampling of consecutive patients seen at the Accident and Emergency (A and E) Department over a 12-month period from February 2014 to January 2015 was done prospectively, and entered into a structured pro forma.
Statistical Analysis: Data collected were analyzed using Statistical Package for Social Sciences version 16. Simple frequency, Chi-square test, and Spearman correlation were done. Outcome measures were mortality and duration of hospital stay.
Results: A total of 657 patients that attended the A and E were recruited and analyzed. The mean age was 33 ± 16 years. Four hundred and fifty (68.5%) were young adults (age range 15-45). Five hundred and two (767.5%) were males. Trauma due to road traffic crash accounted for 68.5% of the injuries. Gunshot, fall from height, assault, burns, and occupational injuries accounted for the rest. The injury severity score (ISS) ranges were 1-9 (60.4%), 10-15 (15.1%), 16-24 (18.6%), and >25 (5.9). Five hundred and forty (82.2%) were discharged within 2 weeks of admission. Overall mortality was 11.0%. Spearman's correlation showed a relationship between the ISS and the duration of hospital stay (r = 0.261, P < 0.001). Likelihood Chi-square tests also showed association between ISS and mortality χ2 = 193.8, P < 0.001.
Conclusion: Road traffic accidents remain the leading cause of trauma in our country, especially among young adults. Preventive measures should be improved to reduce this scourge. Universal health insurance coverage should be embarked on to reduce the incidence of "discharge against medical advice."
Keywords: Duration of hospital stay, injury severity score, mortality, trauma
|How to cite this article:|
Toluse AM, Idowu OO, Ogundele OO, Egbewole AO. Injury epidemiology at a trauma center in Southwest Nigeria. Afr J Trauma 2016;5:1-4
| Introduction|| |
Trauma is the leading cause of emergency room visits in Nigeria. Between 1990 and 2013, numbers of deaths from noncommunicable diseases and injuries steadily increased. However, deaths from communicable diseases, maternal, neonatal, and nutritional causes decreased. Most global road traffic deaths occur in low- and middle-income countries because of growth in motorization. It is a significant public health problem and projected to be the fifth leading contributor to the global burden of disease by 2030.
| Patients and Methods|| |
The study was a prospective descriptive study conducted at the Accident and Emergency (A and E) Department of the Ondo State Trauma and Surgical Centre (OSTSC) over a 12-month period. The OSTSC is a new 60-bed purpose built trauma hospital along a major interstate highway and serves a population of about 3.4 million in Southwest Nigeria. It is operationally designed for rapid assessment and surgical management of the patients with acute injuries.
Convenient sampling of consecutive patients presenting at the A and E Department from February 2014 to January 2015 was done. Data were collected using a structured pro forma detailing biodata, etiology and mechanism of injury, injury severity score (ISS), outcome of treatment, and duration of hospital stay.
Data were analyzed using Statistical Package for Social Sciences version 16.0 (SPSS Inc. Chicago, USA). Descriptive analyses such as frequencies, mean, and standard deviation (SD) were done. Further analysis was done using Chi-square test of significance and Spearman's correlation. Results were presented in tables.
Ethical clearance for the study was obtained from the hospital's ethical committee and informed consent was obtained from the study participants.
| Results|| |
A total of 657 patients who attended the A and E were recruited in the study. The ages of the patients range from 1 month to 90 years with the mean age being 33 (SD ± 16) years. Four hundred and fifty (68.5%) were young adults (age range 15-45). Five hundred and two (76.4%) were males. Trauma due to road traffic accident (RTA) accounted for 68.5% of the injuries. Among this, 68.5% motorcycle RTA was the most common (37.4%) while motor vehicle RTA was responsible for 29.2%. Gunshot injuries, fall from height, assault, burns, and occupational injuries accounted for the rest [Table 1].
Among the victims of road crashes, only 3.3% used a form of protection (seatbelt/crash helmet) at the time of the accident. Three hundred and eighteen (48.4%) patients presented with varying severity of head injury in conjunction with other injuries sustained. The ISS distributions of the patients in ranges were 1-9 (60.4%), 10-15 (15.1%), 16-24 (18.6%), and ≥25 (5.9%). Three hundred and fifty-nine (54.6%) of the patients were brought to the hospital within minutes to few hours after the injury. Only 219 (33.4%) of the patients were transported to the hospital in standard ambulance. The rest were transported through substandard vehicles such as pickup vans, motor cars, and motorcycles to the facility by police officers or sympathizers. Five hundred and forty (82.2%) patients were discharged within 2 weeks of admission. Overall mortality was 11.0%. [Table 2] shows the duration of hospital stay and the percentage proportion.
|Table 2: Length of hospital stay of the patients and percentage proportion |
Click here to view
Spearman's correlation showed a relationship between the ISS and the duration of hospital stay (r = 0.261, P < 0.001). High ISS was associated with longer hospital stay. Likelihood Chi-square tests also showed an association between ISS and mortality χ2 = 193.8, P < 0.001. 87.5% of the overall mortality in the study population had severe injuries (ISS ≥ 16) [Table 3].
| Discussion|| |
Injuries have been reported to be a neglected epidemic in developing countries and accounting for more than five million deaths per year, roughly equal to the number of deaths from HIV/AIDS, malaria, and tuberculosis combined.,, Road traffic crashes accounted for 74.5% of injuries in our study. Thanni et al. reported a prevalence of 90.6% in their trauma series from Nigeria. Comparatively, these rates are high, in the light of 18-31% reported from Kenya, 19% from the Netherlands, and 20% from the West Indies. Males were more commonly affected. This, along with the mean age is similar to most studies.,,,
Motorcycles are a commonly used mode of transportation in developing countries. This will account for their significant contribution to road traffic injuries seen in our study. Similar findings have also been reported in other publications.,, Thanni et al. in their series reported overall mortality of 2% while Madubueze et al. reported overall mortality of 4.7%. The mortality rate in our study is relatively higher; however, it must be noted that 24.5% of the patients in our study presented with severe injuries (ISS > 15). Only 5% of patients in the study by Thanni et al. presented with severe injuries while the report by Madubueze et al. was silent on this. Another factor that may be account for this is the use of protection by the victims. Our study shows a dismal use of seatbelt or crash helmets (3.3%). Furthermore, the means of transportation to the hospital leaves much to be desired. Two-thirds of the patients did not receive any form of resuscitation at the scene of the accident before presentation in the hospital. Prehospital care of victims of road traffic crashes is an aspect of care that requires a lot of improvement in our environment.
Discharge against medical advice (DAMA) is a common problem worldwide; however, the prevalence is higher in developing countries. Reasons for these are multifactorial and include financial problems, lack of clinical improvement, and leaving to seek alternative/complementary medical care. The proportion of patients that DAMA after initial resuscitation in the A and E Department is similar to the report by Madubueze et al. Moore et al. reported mean index and total hospital length of stay after admission for traumatic injury in Canada to be 8.6 and 9.4 days, respectively. Our study has similar finding in 82.2% of the patients.
Thanni et al. and Kuwabara et al. in their trauma series reported ISS score of 1-9 as being most prevalent, similar to our finding. ISS is also commonly used as an anatomic scoring system to predict mortality from trauma. Our study showed association between the ISS and the length of hospital stay and mortality, similar to the report by Thanni et al. and Kuwabara et al.
| Conclusion|| |
RTAs remain the leading cause of trauma in our country, especially among young adults. Preventive measures should be improved to reduce this scourge in our community. Enforcement of compliance with road safety regulations should be improved. Universal health insurance coverage should be embarked on to reduce the incidence of "discharge against medical advice."
We gratefully acknowledge the contributions of the emergency room doctors and medical records staff of the study center with data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bun E. Road traffic accidents in Nigeria: A public health problem. Afrimedic J 2012;3:34-5.
Murray CJ, Lopez AD, Vos T, Naghavi M, Wang H, Lozano R. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the global burden of disease study 2013. Lancet 2015;385:117-71.
Herman J, Ameratunga S, Jackson R. Burden of road traffic injuries and related risk factors in low and middle-income pacific Island countries and territories: A systematic review of the scientific literature. Public Health 2012;12:479.
Gosselin RA, Spiegel DA, Coughlin R, Zirkle LG. Injuries: The neglected burden in developing countries. Bull World Health Organ 2009;87:246.
Debas HT, Gosselin RA, McCord C, Thind A. Disease Control Priorities in Developing Countries. 2 nd
ed. New York: Oxford University Press; 2006.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ, editors. Global Burden of Disease and Risk Factors. New York: The World Bank, Oxford University Press; 2006.
Thanni LO, Kehinde OA. Trauma at a Nigerian teaching hospital: Pattern and docu-mentation of presentation. Afr Health Sci 2006;6:104-7.
Saidi HS. Initial injury care in Nairobi, Kenya: A call for trauma care regionalisation. East Afr Med J 2003;80:480-3.
Oskam J, Kingma J, Klasen HJ. The Groningen trauma study. Injury patterns in a Dutch trauma centre. Eur J Emerg Med 1994;1:167-72.
Crandon I, Carpenter R, McDonald A. Admissions for trauma at the University Hospital of the West Indies. A prospective study. West Indian Med J 1994;43:117-20.
Madubueze CC, Chukwu CO, Omoke NI, Oyakhilome OP, Ozo C. Road traffic injuries as seen in a Nigerian teaching hospital. Int Orthop 2011;35:743-6.
Racioppi F, Eriksson L, Tingvall C, Villaveces A. Preventing Road Traffic Injury: A Public Health Perspective for Europe. Europe: The World Health Organization; 2004. Available from: http://www.euro.who.int/document/E82659.pdf
. [Last accessed on 2016 Feb 04].
Toluse AM, Ikem IC, Akinyoola AL, Esan O, Esan OT. Femoral diaphyseal fractures in adults: Pattern of presentation and outcome. Niger J Orthop Trauma 2013;12:62-5.
Nantulya VM, Reich MR. The neglected epidemic: Road traffic injuries in developing countries. BMJ 2002;324:1139-41.
Fadare JO, Babatunde OA, Olanrewaju T, Busari O. Discharge against medical advice: Experience from a rural Nigerian hospital. Ann Niger Med 2013;7:60.
Moore L, Stelfox HT, Turgeon AF, Nathens A, Bourgeois G, Lapointe J, et al.
Hospital length of stay after admission for traumatic injury in Canada: A multicenter cohort study. Ann Surg 2014;260:179-87.
Kuwabara K, Matsuda S, Imanaka Y, Fushimi K, Hashimoto H, Ishikawa KB, et al.
Injury severity score, resource use, and outcome for trauma patients within a Japanese administrative database. J Trauma 2010;68:463-70.
[Table 1], [Table 2], [Table 3]