Pattern of trauma in elderly patients seen at the trauma centre of national hospital Abuja, Nigeria.

INTRODUCTION: The global population is aging, creating challenges for health systems. The mean age of patients with major trauma has increased over time, posing some challenges for trauma system designs. Elderly trauma patients are said to have higher mortality rates and longer hospital and intensive care unit stays. This study is aimed at assessing the pattern of injuries in elderly population in a dedicated trauma centre of a developing economy. METHODS: This is a retrospective study of all patients aged 60 years and above seen in the trauma centre of a West African tertiary hospital over a three year period from January 2017 to December 2019. Relevant parameters including Sociodemographic data, injury pattern and injury scores were derived from the trauma registry. Data analysis was done using statistical package for social sciences (SPSS) version 24. Results were presented using tables and a figure. RESULTS: A total of 183 patients aged 60 years and above were enrolled out of 4549 general trauma patients, representing 4% of the trauma patient population seen. Male to female ratio was 2.3 with the mean age of 65 ± 6.3. The most frequent mechanisms of injury were motor vehicular crash (MVC) (48.4%), followed by falls (16.5%). More proportion of females (21.8%) were significantly found to suffer falls compared to their males (14.2%) counterparts (p < 0.05). Traumatic brain injury was the commonest diagnosis accounting for 24.3% of cases. The predominant revised trauma scores (RTS) and injury severity scores (ISS) were 12 and 1-15 respectively, with overall mortality of 6.1%. CONCLUSION: The proportion of elderly trauma patients studied in this centre is low. MVC is still the leading mechanism of injury in our elderly trauma population. The mortality rate is however low in this study, in line with the low trauma and severity scores. Preventive measures for MVC should be strongly encouraged to reduce the incidence of elderly trauma patients in this part of the world.

A qualitative study of causes of prescribing errors among junior medical doctors in a Nigeria in-patient setting.

AIMS: The aims of this study were to identify and understand the factors underlying prescribing errors in order to determine how to prevent them. MATERIALS AND METHODS: A prospective qualitative study that involved face-to-face interviews and human factor analysis in a Tertiary Referral Hospital in Central Nigeria, from July 2011 to December 2011. Pharmacists in the study hospital prospectively reviewed prescription orders generated by doctors in selected wards (male and female medical, pediatric and the private wing wards) and identified prescribing errors. The 22 prescribers involved in the errors were interviewed, and given questionnaires to discover factors causing the errors. A model of human error theory was used to analyze the responses. RESULTS: Responses from the doctors suggest that most errors were made because of slips in attention. Lack of drug knowledge was not the single causative factor in any incident. Risk factors identified included individual, team, environment, and task factors. Junior doctors were affected by the prescribing habits of their seniors. Organizational factors identified included inadequate training/experience, absence of reference materials and absence of self-awareness of errors. Defenses against error such as other clinicians and guidelines were absent or deficient, and supervision was inadequate. CONCLUSIONS: To reduce the risk of prescribing errors, a number of strategies addressing individual, task, team, and environmental factors such as training of junior doctors, enforcing good practice in prescription writing, supervision, and reviewing the workload of junior doctors must be established.

Stroke risk factors, subtypes, and 30-day case fatality in Abuja, Nigeria.

BACKGROUND: Stroke is the second leading cause of death and the leading cause of adult disability worldwide. A better understanding of stroke risk factors and outcome may help guide efforts at reducing the community burden of stroke. This study aimed to understand stroke risk factors, imaging subtypes, and 30-day outcomes among adult Nigerians. MATERIALS AND METHODS: We prospectively recruited all patients presenting with acute stroke at the National Hospital Abuja between January 2010 and June 2012. We assessed clinical and laboratory variables, as well as brain computerized tomography, magnetic resonance imaging, and carotid Doppler ultrasound scans. We also assessed case fatality and functional outcome at 30 days after stroke. RESULTS: Of 272 patients studied, 168 (61.8%) were males. Age at presentation (mean ± standard deviation) was 56.4 ± 12.7 years in males and 52.9 ± 14.8 years in females (P = 0.039). Neuroimaging was obtained in 96.7% patients, revealing cerebral infarction (61.8%), intracerebral hemorrhage (ICH) (34.8%), and subarachnoid hemorrhage (SAH) (3.4%). Carotid plaques or stenosis ≥50% were detected in 53.2% patients with cerebral infarction. Stroke risk factors included hypertension (82.7%), obesity (32.6%), diabetes (23.5%), hyperlipidemia (18.4%), atrial fibrillation (9.2%), and cigarette smoking (7.7%). At 30 days after stroke, case-fatality rate was 18.8%, whereas modified Rankin Scale (mRS) scores for cerebral infarction, ICH, and SAH were 3.71, 4.21, and 4.56, respectively. Atrial fibrillation, a previous stroke, and age older than 50 years were all associated with worse mRS scores at 30 days. CONCLUSION: Although hypertension, obesity, diabetes mellitus, and atrial fibrillation were important stroke risk factors, in many patients, these were detected only after a stroke. While the commonest stroke subtype was cerebral infarction, observed in almost two-third of patients, SAH was associated with the highest case-fatality rate at 30 days of 44.4%. Larger population-based studies may provide additional data on stroke incidence and outcome among Nigerians.

A qualitative study of causes of prescribing errors among junior medical doctors in a Nigeria in-patient setting

Aims: The aims of this study were to identify and understand the factors underlying prescribing errors in order to determine how to prevent them. Materials and Methods: A prospective qualitative study that involved face-to-face interviews and human factor analysis in a Tertiary Referral Hospital in Central Nigeria; from July 2011 to December 2011. Pharmacists in the study hospital prospectively reviewed prescription orders generated by doctors in selected wards (male and female medical; pediatric and the private wing wards) and identified prescribing errors. The 22 prescribers involved in the errors were interviewed; and given questionnaires to discover factors causing the errors. A model of human error theory was used to analyze the responses. Results: Responses from the doctors suggest that most errors were made because of slips in attention. Lack of drug knowledge was not the single causative factor in any incident. Risk factors identified included individual; team; environment; and task factors. Junior doctors were affected by the prescribing habits of their seniors. Organizational factors identified included inadequate training/experience; absence of reference materials and absence of self-awareness of errors. Defenses against error such as other clinicians and guidelines were absent or deficient; and supervision was inadequate. Conclusions: To reduce the risk of prescribing errors; a number of strategies addressing individual; task; team; and environmental factors such as training of junior doctors; enforcing good practice in prescription writing; supervision; and reviewing the workload of junior doctors must be established. Aims: The aims of this study were to identify and understand the factors underlying prescribing errors in order to determine how to prevent them. Materials and Methods: A prospective qualitative study that involved face-to-face interviews and human factor analysis in a Tertiary Referral Hospital in Central Nigeria; from July 2011 to December 2011. Pharmacists in the study hospital prospectively reviewed prescription orders generated by doctors in selected wards (male and female medical; pediatric and the private wing wards) and identified prescribing errors. The 22 prescribers involved in the errors were interviewed; and given questionnaires to discover factors causing the errors. A model of human error theory was used to analyze the responses. Results: Responses from the doctors suggest that most errors were made because of slips in attention. Lack of drug knowledge was not the single causative factor in any incident. Risk factors identified included individual; team; environment; and task factors. Junior doctors were affected by the prescribing habits of their seniors. Organizational factors identified included inadequate training/experience; absence of reference materials and absence of self-awareness of errors. Defenses against error such as other clinicians and guidelines were absent or deficient; and supervision was inadequate. Conclusions: To reduce the risk of prescribing errors; a number of strategies addressing individual; task; team; and environmental factors such as training of junior doctors; enforcing good practice in prescription writing; supervision; and reviewing the workload of junior doctors must be established