Epidemiology of trauma deaths.

OBJECTIVES: This study was done to highlight the pattern and distribution of trauma deaths in a Nigerian teaching hospital in order to enhance trauma research, improve treatment strategies and prevent trauma deaths. PATIENTS AND METHODS: a prospective data collection was done for 24 months beginning September 1999 detailing the age, sex, occupation, diagnosis, mechanism of trauma, injury-arrival time, and circumstances of death and determining retrospectively the severity of trauma using Revised Trauma Score (RTS), Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS). RESULTS: There were 129 deaths but 84 (65.1%) had sufficient data for trauma scoring. Male:Female ratio was 60:24 = 2.5:1. The age range was 2.95 years, mean 36.8 +/- 15.2 years for males and 45.5 +/- 23.0 years for females. Two thirds (66.7%) of the deaths occurred among traders/business 27.4%, artisans 20.2%, drivers and students 9.5% each. Three quarters of the deaths (75.0%, 63) were in patients involved in road traffic accidents (RTA) followed by violent trauma (10.7%), falls 9.5% and burns 4.8%. The trauma deaths include head injury (26 deaths, 31.0%), multiple injuries (30.0%), fractures (13.1%), cervical spine injury (10.7), gunshot injuries (8.3%), burns (4.8%) and others (5.0%). Sixty-two patients (73.8%) reached the hospital within 6 hours of the injury. The patients were brought by the Police, Good Samaritans or relatives in nearly equal proportions. The mean RTS, ISS and TRISS probability of survival scores were 5.16, 25 and 67% for males but 6.0, 22 and 75% for females, respectively. CONCLUSIONS: The pattern and distribution of trauma revealed a typical trauma death is a male aged below 40 years, who is a trader/businessman involved in RTA or violent trauma. Despite a probability of survival above 60% and majority of the patients getting to hospital within 6 hours, the inadequate A and E care has thrown up possibilities for prevention of trauma death, improving treatment strategies and enhancing trauma research.

Factors affecting outcome of emergency paediatric abdominal surgery

Background: Paediatric surgical abdominal emergencies are important causes of morbidity and mortality in children. None of the previous studies on abdominal surgical emergencies specifically addressed the problem as it affects children. Methods: An eight-year retrospective review of all children aged 0-15 years who presented with acute abdominal emergency. Results: Two-hundred and fifty one (251) children; male to female ratio of 1.5:1 and median age of presentation of 78 months (range 1 day-15 years). The median duration of symptoms before presentation to hospital was 96 hours. The median duration between admission and surgical intervention was 24 hours. Intestinal obstruction accounted for 87 (34.7) of acute abdominal emergency. This was the commonest emergency encountered overall. Typhoid perforation (TP) was responsible for 71 (28.3) of all acute abdominal emergencies and was the commonest condition encountered in children above the age of one year. Others included 55 (21.9) cases of appendicitis; 18 (7.2) of abdominal trauma; 6 (2.4) anterior abdominal wall defects and 5 (2.0) each of infantile hypertrophic pyloric stenosis and primary peritonitis. Postoperative complications were observed in 85 (33.9) of patients. The commonest complications were wound infection 31 (12.4) and wound dehiscence 23 (9.2); while mortality rate was 16 overall; and 31.8 in the neonatal period. Overwhelming sepsis was responsible for 26 (63.4) of all deaths recorded. Multiple congenital anomalies were the cause of death in 5 (12.2). Other causes of death were prolonged ileus with malnutrition in 4 patients; respiratory insufficiency in 2 patients and a patient each died from necrotising enterocolitis; acute renal failure; enterocutaneous fistula and over hydration. Conclusion: intestinal obstruction was the commonest acute abdominal emergency in children. The high rates of postoperative morbidity observed could be attributed to delayed presentation to hospital