Patterns of injury at an Ethiopian referral hospital: Using an institutional trauma registry to inform injury prevention and systems strengthening

Background: Data about injury patterns and clinical outcomes are essential to address the burden of injury in low- and middle-income countries. Institutional trauma registries (ITRs) are a key tool for collecting epidemiologic data about injury. This study uses ITR data to describe the demographics and patterns of injury of trauma patients in Addis Ababa, Ethiopia in order to identify opportunities for injury prevention, systems strengthening and further research. Methods: This is an analysis of prospectively collected data from a sustainable ITR at Menelik II Specialized Hospital, a public teaching hospital with trauma expertise. All patients presenting to the hospital with serious injuries requiring intervention or admission over a 13 month period were included. Univariable and bivariable analyses were performed for patient demographics and injury characteristics. Results: A total of 854 patients with serious injuries were treated during the study period. Median age was 33 years and 74% were male. The most common mechanisms of injury were road traffic injuries (RTI) (37%), falls (30%) and blunt assault (17%). Over half of RTI victims were pedestrians. Median delay in presentation was 2 h; 17% of patients presented over 6 h after injury. 58% of patients were referred from another hospital or a clinic, and referrals accounted for 84% of patients arriving by ambulance. Median emergency center length of stay was 2 h and 62% of patients were discharged from the emergency center. Conclusion: This study highlights the utility of institutional trauma registries in collecting crucial injury surveillance data. In Addis Ababa, road safety is an important target for injury prevention. Our findings suggest that the most severely injured patients may not be making it to the referral centers with the capacity to treat their injuries, thus efforts to improve prehospital care and triage are needed. African relevance: Injury is a public health priority in Africa. Institutional trauma registries play a crucial role in efforts to improve trauma care by describing injury epidemiology to identify targets for injury prevention and systems strengthening efforts. In our context, pedestrian safety is a key target for injury prevention. Improving prehospital care and developing referral networks are goals for systems strengthening

Injury patterns of patients presenting to a non-governmental hospital in Western Uganda

Introduction: Injury is a leading cause of morbidity and mortality globally and disproportionately affects low-income countries. While most injury data comes from tertiary care centers in urban settings, the purpose of this study was to describe the characteristics and severity of injury in rural Uganda and the associated treatment patterns and delays in care. Methods: This is a retrospective cohort study of a trauma registry that was implemented at Masindi-Kitara Medical Center (MKMC), a rural hospital in Western Uganda. Demographic information, injury characteristics, modified Kampala Trauma Scores (M-KTS), and treatment modalities over a 12 month period were retrospectively collected from paper-based registry forms completed for all injury patients presenting to MKMC. Results: A total of 350 patients were entered into the trauma registry. Most patients were male (71.2%) with a median age of 26.5 years. Motorcycle crashes were the most prevalent mechanism of injury (42.3%) with the majority being unhelmeted (83.3%). Soft tissue injury was the most common diagnosis (44.9%). Patients were frequently treated in the outpatient department and then discharged (54.8%). Patients requiring admission or transfer (M-KTS = 11.57 or 11.67) tended to have a lower M-KTS than discharged patients (M-KTS = 12.75). Analgesics (74.6%) and antibiotics (52.9%) were the most common treatments administered. For those patients requiring admission (29.4%), only one in-hospital death was documented. Thirty-nine percent of patients reported a delay in seeking care, most frequently due to lack of transportation (31.5%) with a median time of delay of 11 h. Conclusion: Road traffic injuries were the leading cause of injury in Masindi, with a high proportion of injuries associated with unhelmeted motorcycle crashes. Future opportunities to prevent injury and improve care may be seen through improved prehospital care, enforcement of helmet laws, increased access to neurosurgical services, and enactment of hospital quality improvement measures

Pattern of limb amputations in Liberia

Background: Amputation is one of the oldest known surgical procedures. It has been one of the modalities of applying judgment and treatment. Its method and indications has evolved over time. Modern amputation is regarded as a part of treatment rather than failure of treatment. Amputation is the removal of a limb or part of a limb through on or more bone. When through a joint is referred to as disarticulation. Data on the profile and pattern of amputation in Liberia will add to the body of knowledge. Aim and Objectives: Is to describe the pattern of limb of amputations in Liberia. Also to describe the anatomical variations of limb amputations in Liberia. Patients and Method: A retrospective study of all patients that underwent limb amputation surgeries in the John F Kennedy Memorial (JFK M), Hospital , Monrovia Liberia between January 2010 to December 2015. Results: 100 patients had limb amputations between 2010 and 2015. Males(73) to female(27) ratio were 2.4:1. The age range was 9 - 91 years. Mean age was 42.9 years. The indications for amputations were Trauma 24%, Diabetes 29%, Gangrene (6%), Chronic ulcer (25%), Tumour (5%). Below knee(47%), Above Knee(45%), Below elbow(2%), Above Elbow(2%), Knee Disarticulation(2%), and Big Toe Disarticulation(2%). Conclusion: The profile of Limb amputation in Liberia is not very different from what is obtaining in the region. However the limitations of histology and other investigative procedure have affected the accurate diagnosis of certain conditions like tumours

Plaies du tendon calcanéen par rayons de roue arrière de moto

Objectifs - Déterminer les aspects épidémiologiques et le mécanisme lésionnel, et évaluer les résultats du traitement des plaies du tendon calcanéen engendrées par les rayons de roue arrière de moto. Matériel et Méthodes - Il s'agissait d'une étude rétrospective concernant tous les patients traités pour une plaie du tendon calcanéen occasionnée par les rayons de roue arrière de moto entre Janvier 2014 et Décembre 2016. Résultats - Durant la période d'étude, trente-quatre patients totalisant 34 lésions ont été recensés. Il y avait (n=20; 59%) hommes et (n=14; 41%) femmes. L'âge moyen était de 12 ans (4 et 37 ans). Les élèves étaient les plus concernés (n=18; 53%). La section du tendon était totale (n= 22;65%) et partielle dans (n=12 ; 35%). Les lésions associées prédominantes étaient les fractures du calcanéum (n=14). Les complications postopératoires étaient infectieuses (n=14 ; 41%). La cicatrice était disgracieuse (n=10 ;29%). Au recul moyen de 17 mois, le résultat fonctionnel évalué selon le score de Mc Comis était excellent (n=16; 47%), bon (n=10 ; 29%), moyen (n=5 ;15%), et mauvais (n= 3;9%). Conclusion - Les plaies du tendon calcanéen par rayons de roue arrière de moto sont fréquentes. Elles ont concerné les enfants d'âge scolaire. La réparation définitive par suture en urgence est possible pour les plaies vues tôt. Les suites opératoires immédiates peuvent être émaillées de complications infectieuses. Mais l'évolution à moyen terme est favorable

Factors associated with unintentional injury among the paediatric age population in the hospitals of Amhara National Regional State, Ethiopia

Background:Childhood unintentional injuries cause nearly 875,000 deaths each year. The aim of this study was to assess the prevalence and factors associated with unintentional injury of children presenting to the hospitals of Amhara Regional State, Ethiopia.Methods:In a hospital-based, cross-sectional study undertaken in one month, from April 1 to 30th 2016,893 children less than 18 years of age were included. Data were collected using an interviewer- administered questionnaire. Training was given to all data collectors and supervisors. Data was entered into EPI info version 7 and then exported to SPSS version 20, for further analysis.Results:Unintentional injury caused 62% (554) of all injuries in attending children. Several factors affected the likelihood of injuries, namely the age of the child, age of the parents or guardians, sex of the child, and whether the child lived with the parents. Modifiable factors were the child's behaviour,awareness of danger, the child's level of educational, if the child's parent had received adequate injury counselling, and whether a child was left in the care of another child. The source of light in the house,and house floor material were also significant factors at p < 0.05.Conclusion:The prevalence of unintentional injury was high. Many of the factors associated with injuries are modifiable and safety issues for children need urgent attention

Aspects épidémio-cliniques des traumatismes graves de la main au Centre National Hospitalier Universitaire Hubert Koutoukou Maga de Cotonou, Bénin

Introduction : Les traumatismes graves de la main sont fréquents et peuvent ruiner l'espoir d'une vie active normale. Nous nous sommes proposés d'étudier leurs caractéristiques épidémio-cliniques dans notre pratique quotidienne. Matériel et méthodes : Il s'agit d'une étude rétrospective sur dossiers, réalisée à la Clinique Universitaire de Traumatologie-Orthopédie et de Chirurgie Réparatrice (CUTO-CR) du Centre National Hospitalier et Universitaire-Hubert Koutoukou Maga de Cotonou (CNHU-HKM) du 1er janvier 2011 au 31 décembre 2015. Résultats : Les traumatismes graves de la main représentaient 2,4% des hospitalisations en orthopédie-traumatologie avec une moyenne annuelle de 13,4 patients. L'âge moyen des traumatisés était de 32 ans (19-56 ans). Ils étaient majoritairement de sexe masculin (sex-ratio de 2,3) et des ouvriers (32,6%). Les accidents de travail étaient la principale circonstance traumatique (43,5%). Le délai moyen d'admission était de 3h 14 minutes. Le côté dominant était lésé dans 58,7% des cas, avec deux cas d'atteinte bilatérale. Les fractures (24 cas soit 32,9% de toutes les lésions) et les sections tendineuses (18 cas soit 24,6%) étaient les lésions les plus fréquentes. Ces lésions siégeaient principalement sur les 1er, 3ème et 5ème rayons et étaient associées majoritairement aux traumatismes crânio-facio-encéphaliques. Discussion : Les traumatismes graves de la main sont de plus en plus fréquents dans notre pratique quotidienne. Ils doivent bénéficier d'une prise en charge optimale dans des centres qui leurs sont dédiés, afin d'en réduire les complications et séquelles

Epidemiology and Pattern of Road Traffic Injuries in Ngaoundere; Cameroon: a Retrospective Hospital Based Study Prior to the Implementation of a Formal Trauma Registry

Low income countries are disproportionately affected by injuries. Most injury related death and disabilities occur as the result of road traffic accidents. This study aims at analysing the epidemiology and pattern of road traffic related injuries in a semi-urban area in the northern part of Cameroon where no such data existed before.This hospital based retrospective analysis was conducted over a period of five years in a level III institution in the Adamaoua region of Cameroon. The records of all patients received in the emergency department of Ngaoundere hospital after a road traffic related injury were reviewed for epidemiological variables; type of vehicle involved; nature and severity of injuries; modalities of management and outcome. A total of 1257 victims of road traffic injuries could be analyzed. Their ages ranged from 2 to 84 years and males were more affected than females. Almost 60 of victims were motorcycle users. Each patient sustained a mean of 1.3 lesions. The head and lower limbs were the most affected body parts. The most frequent lesions were soft tissue injuries and bone fractures; involving mostly the lower limb. Most injuries were of minor or moderate severity and the admission rate was 28. A total of 79 patients (6.3) were reported dead. Most of them sustained a head injury. The massive presence of motorcycles in the Adamaoua region seems to influence the pattern of road traffic injuries. A more comprehensive system of capturing injury cases needs to be developed in Ngaoundere

Profil epidemiologique des traumatises par accidents de trafic routier aux cliniques universitaires de Kisangani

Introduction : Les accidents de trafic routier sont frequents a Kisangani et representent un grave probleme de sante publique. Materiel et Methode : Nous avons conduit une etude retrospective realisee dans le departement de chirurgie des Cliniques Universitaires de Kisangani sur une periode de six mois d'activites. Resultats : Les traumatismes par Accident du Trafic Routier representent 17;8 de la totalite des urgences admises durant la periode allant de mois de juillet a celui de decembre 2012. Tous les ages sont concernes; avec une predominance de la tranche d'ages 15 a 44 ans; soit 61;14 ; le sexe ratio hommes/femmes est de 2. Les taximen moto et taximen velo sont plus touches dans l'ordre respectif de 36;8 et 27;9. Les victimes residant les communes de Makiso representent 35;2. En dehors des blesses legers incluant les lesions cutaneo-muqueuses de moindre gravite qui representent 31;6des cas; les lesions traumatiques uniques representent 66;2 et concernent le crane 34;7; les membres 27;5. Les contusions thoracique et abdominale ont successivement represente 1;6 et 2 des cas. La letalite precoce est de 5;7 .Conclusion : L'absence d'une prise en charge pre-hospitaliere et d'un service de ramassage adequat des victimes a Kisangani rendent compte pour une bonne part de ce taux eleve de morbidite et de mortalite

Patterns of Injury at Two University Teaching Hospitals in Rwanda: Baseline Injury Epidemiology Using the Rwanda Injury Registry

Introduction: Globally; more worldwide deaths in 2010 could be attributed to injuries than the total number of deaths from infection with AIDS; tuberculosis; and malaria combined; with a disproportionate number of these deaths occurring in low- and middle-income countries. Yet; worldwide research and plans for prevention of injuries are far below other world health problems; especially in developing countries. Methods: A 31-item; 2-page registry form was adapted from regional trauma registries for use in Rwanda to collect data at the two main university referral hospitals in Kigali and Butare. Beginning in 2011; registrars recorded demographics; pre-hospital care; initial physiology; early interventions; and disposition of injured patients who met our selection criteria. Inpatient 30-day discharge status; mortality; and complications were abstracted from patient charts; ward reports and operating room logs. Descriptive analysis was used to evaluate patterns of injury and basic injury epidemiology at the two study hospitals from August 1; 2011-January 31; 2013. Results: A total of 3599 patients were registered from August 1; 2011 to January 31; 2013. Patients were predominantly male; and road traffic crashes were the leading cause of injury overall; contributing to a greater proportion of injuries in the more urban capital than the smaller city of Butare. The majority of patients were admitted to the hospital. All variables evaluated except for the percentage of injuries acquired via a penetrating mechanism showed statistically signifiant differences at an alpha signifiance level of 0.05; illustrating that the trauma population presenting at the two hospitals may be quite different. Conclusion: The Rwanda Injury Registry indicates a high burden of road traffic injuries in a predominantly working age male population over an eighteen-month period. This information can be useful in expanding injury surveillance programs and hopefully implementing population-based prevention programs

Epidemiology of Child Injuries in Uganda: Challenges for Health Policy

Globally; 90 of road crash deaths occur in the developing world. Children in Africa bear the major part of this burden; with the highest unintentional injury rates in the world. Our study aims to better understand injury patterns among children living in Kampala; Uganda and provide evidence that injuries are significant in child health. Trauma registry records of injured children seen at Mulago Hospital in Kampala were analysed. This data was collected when patients were seen initially and included patient condition; demographics; clinical variables; cause; severity; as measured by the Kampala trauma score; and location of injury. Outcomes were captured on discharge from the casualty department and at two weeks for admitted patients. From August 2004 to August 2005; 872 injury visits for children

Les traumatismes de l'appareil genito-urinaire : aspects epidemiologiques et lesionnels

Objectif: Analyser la frequence; les etiologies et les types de lesions observees lors des traumatismes de l'appareil urinaire et genital. Patients et methodes: Etude retrospective portant sur 38 victimes de traumatisme de l'appareil genito-urinaire traites entre avril 2000 et decembre 2006 au CHU de Cocody; Abidjan; Cote d'Ivoire. Les parametres etudies ont ete: l'age; le sexe; la profession; les causes des traumatismes; le type de lesions constatees; les interventions chirurgicales realisees l'ensemble repertorie sur des fiches de recueil. Resultats: 38 victimes de traumatisme de l'appareil genito-urinaire ont ete enregistrees sur l'ensemble des 16425 traumatises; soit une prevalence de 0;2. Il s'agissait de 37 hommes et d'une femme avec un age moyen de 26;9 ans (extremes: 5-63 ans). Les patients etaient pour la plupart victimes d'accidents de la voie publique (AVP) (16 cas; 42;1); ensuite 11 patients (28;9) ont eu un accident de travail. Les agressions etaient responsables de 9 victimes soit 23;7des traumatises urogenitaux. Chez 2 patients (5;3) le traumatisme a ete engendre par un accident de sport. L'uretre et la vessie etaient le plus souvent atteints (81;6des cas); pendant que les traumatismes du rein et des organes genitaux externes ont ete observes respectivement dans 7;9et 10;5des cas. 25 cas (65;8) ont eu des fractures de bassin associees. Tous les traumatismes etaient directs dont 29 fermes (76;3) et 9 penetrants (23;78). Les gestes chirurgicaux realises etaient en particulier les uretrorraphies termino-terminales (20 cas; 52;6). Conclusion : les traumatismes de l'appareil uro-genital sont rares; surviennent surtout chez les hommes jeunes victimes d'accidents de la voie publique et de travail. Ces traumatismes peuvent etre responsables de sequelles fonctionnelles invalidantes

Patterns of accidents among children visiting Jimma University Hospital; South West of Ethiopia

BACKGROUND:Accidents are now becoming the leading causes of morbidity and mortality after the first year of life; hence the need to analyze the pattern in prospective manner will help plan preventive measures as well as indicate the magnitude of the problem.OBJECTIVE:To assess the pattern of childhood accidents among children under 15 years of age.METHODS:A cross-sectional analysis was undertaken in and out patient service settings of Jimma University specialized hospital, from July 2003 to June 2004. The information was collected using structured and pre-tested questionnaire, on factors related to socio-demographic and economic variables as well as on the nature and type of accident and analysed by SPSS Version 12.0.RESULTS:Of the total 452 cases of accidents 79 (17.5%), 271 (60.0%) and 102(22.6%) of the subjects were within age group of 0-4, 5-9, and 10-14 years, respectively. The predominant observed accidents among all age groups were laceration wounds, 304 (67.3%) and soft tissues contusions, 111 (24.6%). Traumatic injury other than car accident accounted for 82.38%, burn 15.0%, poisoning 1.3% and car accident 1.3%. Burn was common among children 5 - 9 years. There was statitically significant association between age and type of accident and nature of injury (p <0.05). Two hundred eight one of the accident occurred at home (62.2%), followed by school (14.8%), high way (16.8%) and in sport fields (6.2%). One hundred twenty four (27.4%), 76(16.8%) and 252(55.8%) ended with complete recovery, recovery with major and minor sequelae respectively.CONCLUSION:The study, has tried to indicate that accidents are becoming a public health problem in the area which needs designing a local as well as a national strategy on child accident prevention, control and management

Traumatologie a Kinshasa : approche epidemiologique

L'auteur a realise cette etude avec comme objectif de decrire la traumatologie pour l'ensemble de la ville de Kinshasa; determiner la victime la plus vulnerable; les agents en cause et les milieux le plus propices a la survenue des accidents; decrire les victimes; la nature de leurs lesions; apprecier la prise en charge et formuler les propositions en fonction des conditions socio-economiques du milieu