Thoracic trauma in national hospital Abuja, Nigeria: The epidemiology, injury severity and initial management options

Background: Trauma is the leading cause of death in individuals between the ages of 1 and 44 years and it is the third commonest cause of death regardless of age. Thoracic trauma is a relatively common cause of preventable death among trauma patients. The spectrum of injuries after blunt chest trauma presents a challenging problem to the emergency physician. This study is intended to discuss the epidemiology, severity and initial management strategies in chest trauma patients, in a low income country. Methods: A cross sectional retrospective study among chest trauma patients seen in the emergency room of National Hospital Trauma Centre, Abuja, Nigeria, from January 2015 to December 2017. Relevant patients' information was retrieved from the trauma registry kept in the trauma centre. Data processing and analysis was done using statistical package for social sciences (SPSS) version 24. Test of significance was done where applicable using chi square and student t test, using p value less than 0.05 as significant. Results are presented in tables and figures. Results: A total of 637 patients, male to female ratio of 3.6 and mean age of 34.18 ± 11.34 were enrolled into the study. The most common mechanisms of injury were MVC (54.6%) and assault (23.5%). Blunt injuries were 3.5 times more frequent than the penetrating injuries. The RTS of 12 (76.3%) and the ISS of 1-15 category (52.3%) were the most common scores. Up to 98% of patients were managed non-operatively. Recovery rate was high (89%) with relatively low mortality rate of 4.2%. Conclusion: Majority of thoracic trauma can be managed effectively by employing simple, non-operative procedures such as needle decompression and chest tube insertion. Efforts should be made to include these procedures in the skill set of every medical officer working in the emergency room, particularly in low and middle income countries where there is paucity of emergency physicians.

Non-operative management of blunt abdominal solid organ trauma in adult patients

Introduction: Despite agreement in the literature that"stable"blunt trauma patients may be managed con-servatively, in Egypt many such patients receive operative management. This paper presents the results of apragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP) versus operative (OP)management of blunt abdominal solid organ trauma in hemodynamically stable adults admitted to TantaUniversity Emergency Hospital (TUH) in Egypt.Methods:A prospective observational study enrolled adult blunt abdominal trauma patients with solid organinjury at TUH over a 3-year period (June 2014­June 2017). Inclusion criteria were age≥18 yr, mean arterialpressure > 65 mm Hg, heart rate < 110 bpm, hematocrit≥7 mg/dl, and abdominal organ injury diagnosed byultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; pa-tients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All pa-tients were assigned to non-operative or operative management based on clinician preference. Outcomes ofinterest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics andχ2wereused to compare outcomes. Results:During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominaltrauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10­NOP vs. 28 ± 11­OP,p= 0.126). NOP received less transfused blood (213.41 ± 360.3 ml [NOP]vs.1155.17 ± 380.4 ml [OP] (p< 0.0001)) but had a longer length of stay (8.29 ± 2.8 [NOP] vs.6.45 ± 1.97 days [OP] (p= 0.012)). There was no difference in mortality between groups (p= 0.091). Conclusion:Our study demonstrated that non-operative management in Egypt of blunt abdominal trauma wassafe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longerlength of stay for non-operative patients might reflect treating physician caution in their management

Intra-abdominal injury identified by CTA in stable blunt polytrauma patients

Background: Patients with multiple injuries are a challenge to evaluate and to exclude abdominal injury, especially those who are intubated and sedated. Ultrasound is a screening tool and peritoneal lavage is unreliable. The aim of the study was to determine the incidence of intra-abdominal injury and describe the subsequent management after CT "panscan" in patients sustaining blunt trauma with injuries both above the thoracic and below the pelvic diaphragm. Methods: In a retrospective analysis anonymised patient data were extracted from a prospective ethics approved database of patients admitted to the level I Trauma Unit at Inkosi Albert Luthuli Central Hospital for the period from April 2007 to March 2011. Blunt polytrauma patients, aged 2 years and older with injuries above the diaphragm and below the pelvic floor were included, provided they were investigated by a full-body trauma Computed Tomography contrast study. Descriptive statistics were employed for all variables of interest, with counts/frequencies and associated percentages being reported. Results: Of 284 patients with injuries above the thoracic and below the pelvic diaphragm, 87 (30.6%) had intra-abdominal injury and 197 (69.4%) had no intra-abdominal injuries. Of those 87 patients, 54 (62.1%) were treated non-operatively and 33 (37.9%) were treated surgically with regard to their abdominal injuries. Twenty (22.9%) patients died, 4 due to intra-abdominal injuries and 16 due to of extra-abdominal injuries. Nine (45%) of the twenty patients who died were treated operatively for intra-abdominal injuries and the remaining 11 (55%) were treated non-operatively.Conclusion: Around thirty percent of patients with injuries above the thoracic and below the pelvic diaphragm had concomitant intra-abdominal injuries. Of those with abdominal injury, just over half required laparotomy. For haemodynamically stable patients CT scanning identified those who require surgical intervention and those who may be managed non-operatively, therefore liberal CT-scanning is advisable for this patient group

Accuracy of ultrasound diagnosis after blunt scrotal trauma (10 years experience)

Objectives:To evaluate the role of ultrasonography (US) and its accuracy; sensitivity and specificity for the diagnosis of testicular rupture after blunt scrotal trauma. Moreover; tunica albuginea breach; testicular hematoma; testis avulsion; epididymal injuries and hematocele are particularly examined. Patients and Methods: Between 1998 and 2008; 24 patients presented to Suez Canal University Hospital after blunt scrotal trauma and underwent surgical exploration. All patients had an emergency scrotal US examination with the use of a 7.5-10 MHz linear transducer. US findings were compared with the surgical findings to calculate the sensitivity and specificity of US for each type of lesion. Results: Out of 24 patients; 12 were diagnosed as having testicular rupture and tunica albuginea breach was visualized on US in 6 patients. Sensitivity and specificity of US were 92and 50for testicular rupture; 85and 75for hematocele; 80and 79for testicular hematoma; and 100 and 96 for testicular avulsion; respectively. US diagnosis of epididymal injuries was poor as it failed to detect 3 out of 5 epididymal lesions. Conclusion: US was highly sensitive in the diagnosis of testis rupture. This can provide information on the integrity of the scrotal contents that can help the physician to determine the optimal treatment