Developing a Low-resource Approach to Trauma Patient Care - Findings from a Nigerian Trauma Registry.

BACKGROUND: Trauma is a worldwide problem that results in significant morbidity and mortality in developing countries. OBJECTIVE: This study looks at the demography of trauma from data abstracted from a Nigerian trauma registry and considers the peculiarities of a low-resource setting from this perspective. METHODS: Trauma registry data from January 2013 to June 2014 were analyzed. RESULTS: A total of 542 patients were included in the study. The mean age of the patients was 33.43 ± 12.79 years; the median time from injury to arrival at the hospital was 3 h (interquartile range IQR 1 - 5.1 h); three-quarters of the patients sustained their injuries on the road-tricycles were rarely involved in road traffic injuries (RTIs) (6.9% of RTIs) but were used in transporting a third of the patients whose data on means of transportation were captured. There were 15 (2.7%) deaths in the first 24 h period postinjury covered by the study - 13 (86.7%) of these patients had head-and-neck injury. About half of the assault injury (50.5%) was from persons known to the victim. The shock indices suggested that a majority of the patients were not at a high risk of mortality. CONCLUSION: Most of the trauma patients at our hospital were in low- to middle-income categories. The median time to arrival of injured patients was 3 h (IQR 1 - 6 h). Most injuries occurred on the road because of RTIs. The involvement of tricycles in accidents was uncommon, but they were used fairly commonly by lay responders in transporting the injured victim to hospital. A high proportion of assailants were known to the victim. The use of trauma registries provides essential data for prioritizing limited resources and can guide a contextualized approach to reducing trauma and improving trauma patient care.

Computed Tomographic Imaging Appraisal of Traumatic Brain Injury in a Tertiary Hospital in South-South Nigeria: A 6-Year Review.

BACKGROUND: Computed tomography (CT) remains the gold standard in imaging evaluations of traumatic brain injury (TBI). TBI on its own has become a major concern in developing countries with its untoward effects. OBJECTIVES: The objective was to appraise the craniocerebral computed tomograms of patients who had TBIs. MATERIALS AND METHODS: A retrospective study of patients who underwent craniocerebral CT on account of head injury in the University of Uyo Teaching Hospital, Uyo, Nigeria, from November 13, 2013 to May 31, 2019 was done. The duration was regardless of the disjointed periods of service interruption. Patients' demographic and CT features were evaluated with application of simple analysis of data. RESULTS: Two hundred and thirty-two patients were evaluated with minimum and maximum ages of 6 months and 78 years, respectively. Males were predominant with a ratio of 2.74: 1. Most affected age ranges were 30-39 years (23.27%) and 20-29 (22.84%). Normal brain CT was seen in 44 patients (18.97%). The most frequent lesion in patients with abnormal CT was intracranial hemorrhages (n = 188, 81.03%). Here, extra-axial hemorrhages (n = 100, 53.19%) supersede intracerebral hemorrhages (n = 88, 46.81%). Half of the intracerebral hemorrhages were multiple. Calvarial fractures were seen in 34.48% (n = 80) of patients. The most common localization was the facial bones (n = 24, 30.00%), whereas the least site was the occipital bone (n = 4, 5.00%). Fifteen percent of the patients had multiple fractures which also included base of the skull. CONCLUSION: TBIs commonly occur among young active males. The most frequent lesion is intracranial hemorrhages with extra-axial bias.

Students' perceptions of the learning environment in two Nigerian medical schools offering different curricula.

OBJECTIVE: Compare the results of administering the DREEM questionnaire in two Nigerian medical schools offering traditional and student-centred curricular respectively, to identify any differences in the learning environment and appreciate advantages of the more modern curriculum. METHODS: A survey design was used. Data was analysed using the DREEM scoring rubric. The independent t-test was used to compare results. SETTING: The DREEM questionnaire was administered to final year medical students at two participating centres. PARTICIPANTS: Final year students of a teacher-centred and a student-centred medical school. RESULTS: There were 138 respondents - 50 (96.2% of the final year students) from the teacher centred school and 88 (59.1% of the final year students) from the student-centred school. The mean total DREEM score was 117+22.3 in the former and 119 +23.6 in the latter (p = 0.798). Mean age of students in the teacher centred school was 28 ± 5.28 years, while that of the student-centred school was 23 ± 1.83 years (p < 0.05). CONCLUSION: The mean total DREEM score proximity between the schools suggests that the younger students using a more student-centred curriculum have less of an appreciation of their improved learning environment than is expected. Thus, the hidden curriculum could be lagging behind the written one. The older students in the teacher centred environment have a more mature appreciation of their learning climate. FUNDING: Personal sources.

The Uyo Trauma Registry-developed for sustainable audit of trauma care and cause in Nigeria.

The Cape Town Trauma Registry (CTTR) was developed as a minimum data set for low-resource settings and was applied in a southern Nigerian tertiary hospital. Based on the outcome of the study, the CTTR was modified to produce the Uyo Trauma Registry. Using the CTTR, data was obtained prospectively from injured patients who presented to the Accident and Emergency Department of the University of Uyo Teaching Hospital over a 7 week period in June and July 2012. The final data set was determined based on the ease of capture of each item and its relative importance to injury surveillance. The goal for satisfactory data capture was chosen as ≥ 80%. The Uyo Trauma Registry has 19 patient-variable items and may be the first locally relevant hospital based injury surveillance tool in Nigeria. The Uyo Trauma Registry has provided the resource constrained setting in Nigeria with a simplified tool in order to sustainably obtain trauma data and thus engage in objective locally relevant efforts at injury prevention and improved care of the injured patient.