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.

Correlation of Vitamin D deficiency with chest X-rays severity scores and different inflammatory markers in severe and critical COVID-19 patients

Objective: To determine the relationship between Vitamin D deficiency with Chest X-Rays severity score and Different Inflammatory Markers in Severe and Critical COVID-19 Patients. Design: A cross-sectional study Setting: The study was conducted in COVID-19 isolation units at Mardan Medical Complex Teaching Hospital (MMCTH) and Bacha Khan Medical College, Pakistan Participants: 206 patients who tested positive for COVID-19 by PCR were included in the final analysis.Data Collection/Intervention: We collected demographic, comorbidity, laboratory, and clinical outcome data from the electronic records of admitted, deceased, or discharged patients.Main outcome measure: Frequency of symptoms, comorbidities, mortality and morbidity, chest x-ray severity scores, different inflammatory markers in Vitamin D deficient Covid-19 patients Results: 128(62.14%) were severe and 78(37.5%) were critical COVID-19 patients. The whole cohort had 82(39.80%) males and 124(60.20%) females, with a median age of 55 IQR (50-73). Study participants' median Vitamin D level was 14.01ng/ml, with a minimum of 7.5ng/ml and a maximum of 70.8ng/ml. 67/206 patients died, with a fatality ratio of 32.5%. 54/67(80.59%) suffered from one or more comorbid conditions. Conclusion: Low Vitamin D levels were linked to a higher risk of death, higher x-ray severity scores, and different inflammatory markers. Vitamin D levels greater than 30ng/ml for older patients and greater than 40ng/ml in older patients with comorbidities were associated with reduced severity and mortality in patients with COVID-19

A 5-year prospective study on chest trauma in children

Chest trauma is an important cause of mortality in children worldwide. In this study we present our experience with childhood chest trauma within a five years period. This was a 5-year prospective study of consecutive patients with chest trauma. Data entered into a pre-planned proforma included demographic information, type of injury, mechanism of injury, associated injuries, type of treatment given, outcome of management and duration of hospital stay. There were 36 children aged between 2 and 16 years (mean age: of= 10.5 ± 6.2 years). There were 24 males and 12 females (m:f 2:1). Twenty seven (75%) of the 36 patients had blunt trauma while nine (25%) had penetrating chest injury. Road traffic accident was responsible for chest trauma in 26 (72.2%) children, but 6 (16.7%) other children were victims of civil unrest while 4 (11.1%) fell from heights. Haemo-pneumothorax was common in 10 (27.8%) patients. Twenty five out of the 36(69.4%) patients had associated injuries, 10 (40%) were head injuries, followed closely by abdominal injury in 8 (32%). Chest trauma in children is common in our environment. Majority of the children suffered blunt trauma following road traffic accidents. Prompt recognition and treatment of affected children is needful for a successful outcome