Abstract
Background
Abdominal injuries exert a significant impact on global morbidity and mortality. The aggregation of mortality data and its determinants across different regions holds immense importance for designing informed healthcare strategies. Hence, this study assessed the pooled mortality rate and its predictors across sub-Saharan Africa.
Method
This meta-analysis employed a comprehensive search across multiple electronic databases including PubMed, Africa Index Medicus, Science Direct, and Hinari, complemented by a search of Google Scholar. Subsequently, data were extracted into an Excel format. The compiled dataset was then exported to STATA 17 statistical software for analysis. Utilizing the Dersimonian-Laird method, a random-effect model was employed to estimate the pooled mortality rate and its associated predictors. Heterogeneity was evaluated via the I2 test, while publication bias was assessed using a funnel plot along with Egger's, and Begg's tests.
Result
This meta-analysis, which includes 33 full-text studies, revealed a pooled mortality rate of 9.67% (95% CI; 7.81, 11.52) in patients with abdominal injuries across sub-Saharan Africa with substantial heterogeneity (I2 = 87.21%). This review also identified significant predictors of mortality. As a result, the presence of shock upon presentation demonstrated 6.19 times (95% CI; 3.70-10.38) higher odds of mortality, followed by ICU admission (AOR: 5.20, 95% CI; 2.38-11.38), blunt abdominal injury (AOR: 8.18, 95% CI; 4.97-13.45), post-operative complications (AOR: 8.17, 95% CI; 4.97-13.44), and the performance of damage control surgery (AOR: 4.62, 95% CI; 1.85-11.52).
Conclusion
Abdominal injury mortality is notably high in sub-Saharan Africa. Shock at presentation, ICU admission, blunt abdominal injury, postoperative complications, and use of damage control surgery predict mortality. Tailored strategies to address these predictors could significantly reduce deaths in the region.
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Background
Injuries, whether from accidents or violence, account for around 4.4 million annual fatalities, representing nearly 8% of global deaths. Within this global context, 17.6% of fatalities are attributed to the African region [1]. It is noteworthy that injuries stand as the third leading cause of death globally across all age groups [2]. Moreover, they contribute significantly to about 10% of the global burden of disability [3]. In the context of this larger problem, abdominal injuries whether blunt or penetrating emerge as a crucial component, making a substantial contribution to the overall spectrum of injuries [4, 5]. The abdomen emerges as the third most commonly affected body region, with 7-10% of all trauma-related fatalities attributed to injuries in this area [6]. Traumatic brain injury stands as a predominant factor, contributing to one-third to one-half of all trauma-related fatalities [7]. Following closely, thoracic trauma accounts for approximately 25% of these deaths [8].
Abdominal injuries can have profound and life-threatening consequences for individuals. Their impact spans a range of outcomes, from causing organ damage [9] to severe, life-threatening conditions [4, 10]. The abundance of normal floras within the gastrointestinal system heightens the vulnerability of abdominal injuries to infectious complications [11]. The rupture of major blood vessels within this region also significantly exacerbates the severity of these injuries [12]. Moreover, the abdomen presents a diagnostic challenge often referred to as a "black box," compounding the complexities associated with addressing these injuries [13]. All these factors collectively increase the mortality rates associated with abdominal injuries.
Abdominal injuries cause significant mortality. Globally, a recent systematic review showed a 17% mortality rate from patients presented with blunt abdominal trauma [14]. Despite a lack of comprehensive evidence summaries in Africa, studies have highlighted high mortality rates linked to abdominal injuries in this continent, ranging from 2% [15] to 28% [16]. These rates exhibit considerable variation across diverse geographical settings and periods.
In a prior review, significant risk factors for mortality in patients with abdominal injuries were identified. These factors encompass older age, firearm injuries, associated injuries, vascular injuries, an increased number of red blood cell transfusions, and solid organ injuries [17].
The fragmented state of studies on abdominal injury mortality in sub-Saharan Africa (SSA) underscores the critical need for a comprehensive review and meta-analysis on this issue. Pooled estimates play a vital role in identifying key factors influencing mortality rates, providing essential guidance for clinicians and policymakers. Nevertheless, based on our search, there is currently a lack of synthesized evidence on this topic across sub-Saharan Africa, a region characterized by inadequate healthcare infrastructure and limited resources. Therefore, this review aimed to estimate the pooled mortality rate and its predictors within the SSA region.
Methods
Protocol and registration
The findings presented in this review adhere to the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement [18] (Additional file 1). The protocol for this review has been prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO), under the registration number CRD42023484989.
Search strategy and selection criteria
To identify relevant studies, we conducted searches across multiple databases including, PubMed, Africa Index Medicus, Science Direct, Hinari, and a search engine, Google Scholar. Our search, carried out from November 10 to 22, 2023, utilized specific keywords such as mortality, predictors, abdominal injuries, and sub-Saharan Africa. Search strategies incorporated various techniques including truncation (*), boolean operators ('OR' and 'AND'), and phrase searching (“...”). Additionally, we employed MeSH terms and synonyms to make our searches comprehensive. The detailed search terms in each database are provided (Additional file 2). Our search was broadened by accessing exclusive digital repositories from Addis Ababa University and Bahir Dar University. A manual search of the included articles' reference lists was also performed to identify additional relevant studies.
Inclusion and exclusion criteria
This review included diverse studies published in English-language that reported mortality rates and/or predictive factors related to mortality in cases of abdominal injuries, without restricting the study period. To provide additional clarity, the inclusion criteria covered studies that detailed in-hospital mortality and/or the factors contributing to it in patients with abdominal injuries of any type. This inclusion was regardless of whether associated extra-abdominal injuries were present or not, irrespective of the severity status, and regardless of the causative factor. Articles accessible within our search source from November 10-22, 2023, were included. Exclusions comprised articles lacking abstracts or full texts, anonymous reports, editorials, studies lacking clear reporting of outcomes, and qualitative studies.
Quality assessment and data abstraction procedure
The initial phase involved importing references from the searched databases into EndNote software version 20 to remove duplicates and prepare the references for subsequent processing. Then, two authors (DE and OA) independently reviewed and screened titles and abstracts based on predefined criteria. Following this, full-text articles were retrieved and reviewed independently by both authors. Any discrepancies in selection were resolved through discussion with a third author (EKB). Selected studies underwent a quality assessment for risk of bias using the Joanna Briggs Institute (JBI) critical appraisal checklist tailored for cross-sectional (both descriptive and analytical) and cohort studies. The checklist, accessible online at https://jbi.global/critical-appraisal-tools, comprises 9 items for descriptive cross-sectional studies, 8 for analytical cross-sectional studies, and 11 for cohort studies. Response options include 'yes,' 'no,' 'not applicable,' and 'unclear.' Additionally, the tool features an overall appraisal option for the final decision to include or exclude a paper. Two authors independently conducted assessments, resolving any discrepancies through discussion and involving a third author.
Outcome measurement
The first outcome was the mortality rate in patients with abdominal injuries. It was determined as the proportion of patients who died after sustaining abdominal injuries in all reviewed studies, calculated against the total number of patients with abdominal injuries. The second outcome was predictors of mortality in patients with abdominal injuries which was measured by adjusted odds ratio. In our review, a predictor was defined as an independent variable or factor that had a significant association with mortality among patients with abdominal injuries. A variable was considered a predictor if it showed a statistically significant association (p-value < 0.05) with the outcome of mortality in the multivariable analysis. Alternatively, it met the criteria for predictor if the adjusted odds ratio (aOR) did not cross 1.
Data extraction and analysis
The data extraction format was prepared by authors using Excel 2013 software. The format consisted of the author(s) name, publication year, country, region, study design, sampling technique, sample size, participant’s age group, mechanism of injury, description of included patients, injury pattern elucidating the proportion with associated extra-abdominal injuries and/or multiple organ injuries, injury severity as assessed by different severity assessment score, the percentage of the most affected organ, mortality rate, and the adjusted odds ratio with its 95% CI of selected predictors of mortality. After extraction, data were exported to STATA version 17 statistical software for meta-analysis. Pooled analysis was conducted using a random-effects model with the Dersimonian-Laird method [19]. Finally, the results were presented using texts, tables, and different plots. The level of heterogeneity among the studies was assessed using the I-squared statistic, with values of 25%, 50%, and 75% indicating low, moderate, and high heterogeneity, respectively [19, 20]. In response to the value of heterogeneity, we performed subgroup analyses by study region, study design, participants’ age group, and mechanism of injury. To examine publication bias, we utilized funnel plots and performed Begg's and Egger's regression tests for a more objective assessment [21]. Trim and fill analyses were also performed. Furthermore, sensitivity analysis was employed to assess the influence of individual studies on the overall estimation.
Results
Search results
The initial search identified a total of 1,065 articles from various sources. After eliminating 25 duplicate articles, 1,040 unique articles remained. Subsequently, 959 articles that were considered irrelevant for this review were excluded, resulting in 81 articles selected for retrieval. Out of these, 19 articles lacked full-text availability and therefore could not be retrieved for further analysis. Following this, 62 full-text articles were thoroughly assessed based on the inclusion criteria. Among the assessed articles, 29 were excluded due to various reasons. Specifically, eight studies were excluded due to not reporting the outcome clearly [22,23,24,25,26,27,28,29], four were excluded as they were reported in a language other than English [30,31,32,33], sixteen were outside the predetermined study area [9, 34,35,36,37,38,39,40,41,42,43,44,45,46,47,48], and the remaining one was a review article [49]. Ultimately, 33 studies [15, 16, 50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80] met the inclusion criteria and were included in the meta-analysis (Fig. 1).
Characteristics of reviewed studies
In this meta-analysis, there were thirty-three included studies published between 2000 and 2023, incorporating a cumulative sample size of 6,124 patients with abdominal injuries. All studies employed consecutive sampling methods. Among the included studies, 25 utilized a cross-sectional design, with eight opting for a cohort approach. Predominantly, the highest number (22 studies) were conducted in South Africa and Nigeria, evenly split with 11 studies in each country (Table 1).
Risk bias assessment
The 33 studies meeting the inclusion criteria underwent evaluation using the JBI critical appraisal checklist. Notably, none of these studies were excluded during the appraisal process, thereby warranting the inclusion of all 33 studies for the analysis in this review.
Meta-analysis
Publication bias
The funnel plot showed an asymmetric distribution (Fig. 2), while both Egger’s and Begg’s tests yielded statistically significant results (p<0.001) when estimating the mortality rate in abdominal injuries, suggesting the existence of publication bias. To assess its impact on the pooled analysis, trim fill analysis was conducted, resulting in the imputation of ten studies. Through this analysis, the pooled mortality rate for abdominal injuries became 6.73% (95% CI: 4.82%, 8.63%). As a result, the confidence interval indicates a minimal alteration in the overall effect size.
Sensitivity analysis
A random effect model result showed that no single study has influenced the overall pooled mortality rate in abdominal injuries across SSA (Fig. 3)
Mortality in abdominal injuries across sub-Sharan Africa
In the random effect model analysis, the overall mortality rate in abdominal injuries across SSA was 9.67% (95% CI; 7.81%, 11.52) with the heterogeneity index (I2 = 87.21%, p value< 0.001), showing substantial heterogeneity of different studies. In this analysis, the mortality rate for abdominal injury ranged from 1.9% [15] to 28 % [16]. The forest plot showed a distribution of weight across studies with a relatively narrow range, extending from 1.71% to 3.93% (Fig. 4).
Subgroup analysis of mortality in abdominal injuries across sub-Sharan Africa
Due to the observed heterogeneity, we conducted an exploration of potential factors associated with this variability, including region, study design, publication date, sample size, mechanism of injury, and participants’ age group using a meta-regression model. However, none of these factors showed a statistical significance.
In light of the substantial heterogeneity observed, we proceeded with a subgroup analysis based on region, study design, participants’ age group, and mechanism of injury. Particularly, in the Southern Africa region, the mortality rate for abdominal injuries was relatively higher at 11.41% (95% CI; 7.94, 14.89). Specifically, patients with blunt abdominal injuries demonstrated a significantly higher mortality rate of 15.51% (95% CI; 2.69, 28.32) (Table 2).
Factors associated with mortality in abdominal injury across sub-Saharan Africa
Out of the articles we reviewed, five reported the role of shock at presentation in abdominal injury mortality [16, 51, 53, 58, 66]. In addition, different studies highlighted the significance of ICU admission [53, 66], blunt abdominal injury [51, 66], postoperative complications [58, 66], and damage control surgery (DCS) [16, 50] as predictors of mortality in abdominal injuries across SSA (Table 3).
Consequently, the odds of mortality in patients with abdominal injuries were 6.19 times higher among patients presented with shock (AOR: 6. 19, 95% CI; 3.70-10.38) compared to those without shock (Fig. 5). Additionally, ICU admission (AOR: 5.20, 95% CI; 2.38-11.38), presence of postoperative complications (AOR: 8.17, 95% CI; 4.97-13.44), and the use of DCS (AOR: 4.62, 95% CI; 1.85-11.52) were associated with the higher odds of mortality. Moreover, the odds of mortality among patients with blunt abdominal injury were 8 times (AOR: 8.18, 95% CI; 4.97-13.45) compared with patients with penetrating abdominal injury (Table 3).
Different studies also reported additional predictors associated with mortality in abdominal injuries across SSA. These include delayed presentation, repeat surgery, advanced age, associated extra-abdominal injuries, and increased trauma severity scores (Table 4).
Discussion
This systematic review and meta-analysis aimed to assess the mortality rate and predictive factors in patients with abdominal injuries across sub-Saharan Africa. The pooled mortality rate for this region was determined to be 9.67% (95% CI; 7.81, 11.52). This finding is in line with findings observed in a prior systematic review [17] and a large-scale study [81]. In contrast, our findings demonstrate a lower mortality rate compared to a global review, which reported a 17% pooled mortality rate [14]. Discrepancies in inclusion criteria might contribute to the variations between the two reviews. In the current review, studies that reported mortality rates in all types of abdominal injuries were included. In contrast, the global review had a narrower focus, concentrating on patients who suffered hollow viscus injuries arising specifically from blunt abdominal trauma [14]. Indeed, the body of evidence consistently indicates that blunt abdominal injuries tend to escalate the risk of mortality [51, 66]. Our subgroup analysis also confirmed this, showing a higher proportion of death among studies conducted only in patients with blunt abdominal injuries. Contrarily, without an exact match for comparison, our findings demonstrate a higher result than what is observed in individual studies [82, 83].
This review also identified predictors of mortality in patients with abdominal injuries. Accordingly, the presence of shock upon presentation emerged as a significant predictor of mortality. In fact, shock reflects the state of physiological instability, indicating severe hemorrhage, directly impacting mortality rates [84]. This association implies the critical need for early recognition and immediate interventions to stabilize patients upon admission to reduce the risk of mortality.
In this review, significantly higher odds of mortality associated with blunt abdominal injuries were also observed. The possible rationale behind this association lies in the potential impediment to timely internal damage detection inherent in blunt injuries which ultimately causes a delay in employing a definitive management [85]. This delay, compounded with the complexity of recognizing concealed injuries, negatively affects the outcome. This emphasizes the need for tailored and specialized management strategies for patients presenting with blunt abdominal injuries to improve survival rates.
Our study also indicates that ICU admission after abdominal injury was associated with a higher mortality risk. This might be because patients admitted to the ICU are in critical conditions, which predisposes them to a higher likelihood of complications and mortality. Moreover, our analysis showed the link between post-operative complications and mortality in abdominal injuries. The result revealed that mortality was eight times higher among patients who had post-operative complications. This implies the importance of vigilant monitoring and comprehensive post-operative management to improve patient prognosis following surgeries for abdominal injury.
This review highlights a heightened mortality rate among patients with abdominal injuries subjected to damage control surgery (DCS). The plausible explanation for this association stems from the severity of underlying injuries that necessitate the implementation of damage control surgery. In cases of major abdominal trauma, DCS deviates from the immediate application of definitive surgery, opting instead for a cautious approach that avoids extensive procedures on unstable patients. DCS prioritizes addressing critical issues, such as rapid control of bleeding and contamination, during the initial operation. Subsequently, staged surgery is employed after achieving successful initial resuscitation [86]. However, the scarcity of intensive care units in many African settings, crucial for the effective restoration of physiological status, adversely impacts this approach and ultimately contributes to the observed elevated mortality associated with DCS. The link between DCS and increased mortality underscores the critical need for comprehensive trauma care strategies in regions where infrastructure limitations impact patient outcomes.
Although this review presents summarized evidence of mortality and its determinants in SSA, its scope was limited by excluding articles published in languages other than English as well as those without full texts. This exclusion limits the comprehensiveness of the review, potentially overlooking valuable findings from those studies. Furthermore, the application of consecutive sampling in all included studies, at the very least, might introduce bias associated with nonprobability sampling.
Conclusion
The mortality rate in abdominal injuries across SSA was considerably high with substantial heterogeneity. The presence of shock upon presentation, ICU admission, blunt injury type, presence of postoperative complications, and the use of DCS were predictors of mortality. Addressing these predictors and implementing tailored strategies could significantly impact reducing mortality rates in patients with abdominal injury across the region.
Availability of data and materials
All data supporting the findings of this study are available within the paper and its Supplementary Information.
Abbreviations
- DCS:
-
Damage control surgery
- ICU:
-
Intensive care unit
- SSA:
-
Sub-Saharan Africa
References
Organization WH. Global health estimates 2020: deaths by cause, age, sex, by country and by region, 2000–2019. WHO: Geneva; 2020.
GBD 2019 Cause and Risk Summary: Injuries—Level 1 cause. Seattle, USA: IHME, University of Washington: Institute for Health Metrics and Evaluation (IHME); 2020.
Injuries and violence: key facts. WHO. 2021. Cited December, 2023. Available from: https://rb.gy/zd7s45.
Tyson AF, Varela C, Cairns BA, Charles AG. Hospital mortality following trauma: an analysis of a hospital-based injury surveillance registry in sub-Saharan Africa. J Surg Educ. 2015;72(4):e66-72.
Pothmann CEM, Sprengel K, Alkadhi H, Osterhoff G, Allemann F, Jentzsch T, et al. Abdominal injuries in polytraumatized adults : Systematic review. Unfallchirurg. 2018;121(2):159–73.
Arumugam S, Al-Hassani A, El-Menyar A, Abdelrahman H, Parchani A, Peralta R, et al. Frequency, causes and pattern of abdominal trauma: a 4-year descriptive analysis. J Emerg Trauma Shock. 2015;8(4):193.
Kamal VK, Agrawal D, Pandey RM. Epidemiology, clinical characteristics and outcomes of traumatic brain injury: Evidences from integrated level 1 trauma center in India. J Neurosci Rural Pract. 2016;7(04):515–25.
Lin FCF, Li RY, Tung YW, Jeng K-C, Tsai SCS. Morbidity, mortality, associated injuries, and management of traumatic rib fractures. J Chin Med Assoc. 2016;79(6):329–34.
Wiik Larsen J, Søreide K, Søreide JA, Tjosevik K, Kvaløy JT, Thorsen K. Epidemiology of abdominal trauma: an age- and sex-adjusted incidence analysis with mortality patterns. Injury. 2022;53(10):3130–8.
Gad MA, Saber A, Farrag S, Shams ME, Ellabban GM. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. N Am J Med Sci. 2012;4(3):129–34.
Prahlow JA. Deaths: Trauma, Abdominal Cavity – Pathology. In: Payne-James J, Byard RW, editors. Encyclopedia of Forensic and Legal Medicine. 2nd ed. Oxford: Elsevier; 2016. p. 143–52.
Johnson SB. Pathophysiology and management of abdominal injury. In: Webb A, Angus D, Finfer S, Gattinoni L, Singer M, editors. Oxford Textbook of Critical Care. New York: Oxford University Press; 2016. p. 0.
Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, et al. Schwartz's principles of surgery, 10e: McGraw-hill; 2014.
Harmston C, Ward JBM, Patel A. Clinical outcomes and effect of delayed intervention in patients with hollow viscus injury due to blunt abdominal trauma: a systematic review. Eur J Trauma Emerg Surg. 2018;44(3):369–76.
Koto MZ, Matsevych OY, Motilall SR. The role of laparoscopy in penetrating abdominal trauma: our initial experience. J Laparoendosc Adv Surg Tech A. 2015;25(9):730–6.
Krige JE, Kotze UK, Setshedi M, Nicol AJ, Navsaria PH. Surgical management and outcomes of combined pancreaticoduodenal injuries: analysis of 75 consecutive cases. J Am Coll Surg. 2016;222(5):737–49.
Cabarcas Martinez AC. Predictors of mortality in abdominal trauma: Systematic review and meta-analysis. Revista de Cirugía. 2023;76.
Liberati A, Altman D, Tetzlaff J, Mulrow C, Gøtzsche P, Ioannidis J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions. BMJ. 2009;339.
Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1(2):97–111.
Rücker G, Schwarzer G, Carpenter JR, Schumacher M. Undue reliance on I 2 in assessing heterogeneity may mislead. BMC Med Res Methodol. 2008;8(1):79.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.
Adeolu AO, Oluseye AA, Adedayo KO, David RA, Wuraola FO. Severity, challenges, and outcome of retroperitoneal hematoma in a Nigeria Tertiary Hospital. Niger J Surg (Online). 2017;22(2):96–101.
Chirdan LB, Uba AF, Chirdan OO. Gastrointestinal injuries following blunt abdominal trauma in children. Niger J Clin Pract. 2008;11(3):250–3.
Hernandez MC, Traynor MD, Knight AW, Kong VY, Laing GL, Bruce JL, et al. Predicting the outcome of non-operative management of splenic trauma in South Africa. World J Surg. 2020;44(5):1485–91.
Matsevych OY, Koto MZ, Aldous C. Laparoscopic-assisted approach for penetrating abdominal trauma: a solution for multiple bowel injuries. Int J Surg. 2017;44:94–8.
Musau P. Risk indicators of morbidity and mortality in abdominal injuries. East Afr Med J. 2006;83(12):644–50.
Osifo OD, Ovueni ME. The predictors; prevalence and outcome of burst abdomen in emergency paediatric surgical centre. East Cent Afr J Surg (Online). 2010;15(2):97–103.
Wolmarans A, Fru PN, Moeng MS. Accuracy of CT scan for detecting hollow viscus injury in penetrating abdominal trauma. World J Surg. 2023;47(6):1457–63.
Zellweger R, Navsaria PH, Hess F, Omoshoro-Jones J, Kahn D, Nicol AJ. Gall bladder injuries as part of the spectrum of civilian abdominal trauma in South Africa. ANZ J Surg. 2005;75(7):559–61.
Choua O, Rimtebaye K, Yamingue N, Moussa K, Kaboro M. Epidemiological, clinical and therapeutic aspects of blunt abdominal trauma in patients undergoing surgery at the General Hospital of National Reference of N’Djamena, Chad: about 49 cases. Pan Afr Med J. 2017;26:50.
Doll D, Matevossian E, Kayser K, Degiannis E, Hönemann C. Evisceration of intestines following abdominal stab wounds: epidemiology and clinical aspects of emergency room management. Unfallchirurg. 2014;117(7):624–32.
Fanomezantsoa R, Davidà RS, Tianarivelo R, Fabienne RL, Aina RT, Auberlin RF, et al. Blunt and penetrating trauma the abdomen: retrospective analysis of 175 cases and review of literature. Pan Afr Med J. 2015;20:129.
Gaudeuille A, Doui Doumgba A, Ndémanga Kamoune J, Sacko E, Nali NM. [Abdominal trauma in Bangui (Central Africa). Epidemiologic and anatomical aspects]. Mali Med. 2007;22(2):19-22.
Alshabahi SH, Alhoraibi RK. Mortality of abdominal injuries in trauma patients at Al-Gamhoria Teaching Hospital. Univ Aden J Nat Appl Sci. 2021;25(2):297–301.
Arikanoglu Z, Turkoglu A, Taskesen F, Ulger B, Uslukaya O, Basol O, et al. Factors affecting morbidity and mortality in hollow visceral injuries following blunt abdominal trauma. Clin Ter. 2014;165(1):23–6.
Azzam AZ, Gazal AH, Kassem MI, Souror MA. The role of non-operative management (NOM) in blunt hepatic trauma. Alexandria J Med. 2013;49(3):223–7.
Baloche P, Szabla N, Freton L, Hutin M, Ruggiero M, Dominique I, et al. Impact of Hospital Volume on the Outcomes of Renal Trauma Management. Eur Urol Open Sci. 2022;37:99–105.
Boele van Hensbroek P, Ooijen MV, Lamers A, Ponsen KJ, Goslings J. Abdominal injuries after high falls: high incidence and increased mortality. Acta Chirurgica Belgica. 2013;113(3):170-4.
Collins DD. Mortality in traumatic abdominal injuries in the elderly. J Gerontol. 1950;5(3):241–4.
Cornwell EE, Velmahos GC, Berne TV, Tatevossian R, Belzberg H, Eckstein M, et al. Lethal abdominal gunshot wounds at a level I trauma center: analysis of TRISS (revised trauma score and injury severity score) fallouts. J Am Coll Surg. 1998;187(2):123–9.
Deree JMD, Shenvi EBS, Fortlage DBA, Stout PRN, Potenza BMD, Hoyt DBMD, et al. Patient factors and operating room resuscitation predict mortality in traumatic abdominal aortic injury: a 20-year analysis. J Vasc Surg. 2007;45(3):493–7.
Dharmarajan M, Ramu SP. Incidence, patterns and factors predicting mortality of abdominal injuries in trauma patients. J Evol Med Dental Sci. 2016;5(103):7515–20.
Gul M, Aliosmanoglu I, Oguz A, Ulger BV, Turkoglu A. Factors effecting mortality in abdominal major vascular injuries. HealthMED. 2012;2(11):4043.
Iflazoglu N, Ureyen O, Oner OZ, Tusat M, Akcal MA. Complications and risk factors for mortality in penetrating abdominal firearm injuries: analysis of 120 cases. Int J Clin Exp Med. 2015;8(4):6154.
Sah S, Grodetskyy V, Kryliuk V, Kuzmin V, Ivanov V, Sydorchuk R. Prediction of mortality in patients with combined closed abdominal injuries. 2014.
Ugur M, Akkucuk S, Koca Y, Oruc C, Aydogan A. Missed injuries in patients with abdominal gunshot trauma: risk factors and mortality rates. Eur Surg. 2016;48:347–51.
Uludağ M, Yetkin G, Çitgez B, Yener F, Akgün İ, Çoban A. Effects of additional intra-abdominal organ injuries in patients with penetrating small bowel trauma on morbidity and mortality. 2009.
Usman R. Management of traumatic abdominal inferior vena cava injuries and predictors of its mortality. J Surg Pakistan. 2019;24(3):110–5.
Leon Pachter H, Hofstetter SR. The current status of nonoperative management of adult blunt hepatic injuries. Am J Surg. 1995;169(4):442–54.
Abdulkadir A, Mohammed B, Sertse E, Mengesha MM, Gebremichael MA. Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar Ethiopia. Front Surg. 2022;9:914778.
Abebe K, Bekele M, Tsehaye A, Lemmu B, Abebe E. Laparotomy for Abdominal Injury Indication & Outcome of patients at a Teaching Hospital in Addis Ababa, Ethiopia. Ethiop J Health Sci. 2019;29(4):503–12.
Adejumo AA, Thairu Y, Egenti N. Profile of abdominal trauma in federal teaching hospital, Gombe, North-east, Nigeria: a cross sectional study. Int J Innov Med Health Sci. 2015;4:41–5.
Adenuga AT, Adeyeye A. Pattern of presentation and outcome of adult patients with abdominal trauma–A 7-year retrospective study in a Nigerian Tertiary Hospital. J Emerg Trauma Shock. 2023;16(1):8.
Agbroko S, Osinowo A, Jeje E, Atoyebi O. Determinants of outcome of abdominal trauma in an Urban Tertiary Center. Niger J Surg. 2019;25(2):167–71.
Alli N. Management of blunt abdominal trauma in Maiduguri: a retrospective study. Niger J Med. 2005;14(1):17–22.
Ameh EA, Mshelbwala PM. Challenges of managing paediatric abdominal trauma in a Nigerian setting. Niger J Clin Pract. 2009;12(2):192–5.
Ayoade BA, Salami BA, Tade AO, Musa AA, Olawoye OA. Abdominal injuries in olabisi onabanjo university teaching Hospital Sagamu, Nigeria: pattern and outcome. Niger J Othop Trauma. 2006;5(2):45–9.
Chalya PL, Mabula JB. Abdominal trauma experience over a two-year period at a tertiary hospital in north-western Tanzania: a prospective review of 396 cases. Tanzan J Health Res. 2013;15(4):230–9.
Demeke Altaye K, Zewdie Tadesse A, Bekele Muleta M, Wagenew Dode W. Assessment of Pattern of Abdominal Injury over a Two-Year Period at St Paul’s Hospital Millenium Medical College and AaBET Hospital, Addis Ababa, Ethiopia: a retrospective study. Emerg Med Int. 2022;2022:3036876.
Dodiyi-Manuel A, Jebbin NJ, Igwe PO. Abdominal injuries in university of port harcourt teaching hospital. Niger J Surg. 2015;21(1):18–20.
Dogo D, Yawe T, Hassan A, Tahir B. Pattern of abdominal trauma in North Eastern Nigeria. Niger J Surg Res. 2000;2(2):48–51.
Eaton J, Grudziak J, Hanif AB, Chisenga WC, Hadar E, Charles A. The effect of anatomic location of injury on mortality risk in a resource-poor setting. Injury. 2017;48(7):1432–8.
Howes N, Walker T, Allorto NL, Oosthuizen GV, Clarke DL. Laparotomy for blunt abdominal trauma in a civilian trauma service. S Afr J Surg. 2012;50(2):30–2.
Idriss AM, Tfeil Y, Baba J, Boukhary S, Hamad B, Abdllatif M, et al. Abdominal trauma: five years experience in National Centre Hospital, Mauritania. 2018.
Kong VY, Weale R, Blodgett JM, Buitendag J, Bruce JL, Laing GL, et al. Laparotomy for organ evisceration from abdominal stab wounds: A South African experience. Injury. 2019;50(1):156–9.
Mnguni MN, Muckart DJ, Madiba TE. Abdominal trauma in durban, South Africa: factors influencing outcome. Int Surg. 2012;97(2):161–8.
Monzon-Torres BI, Ortega-Gonzalez M. Penetrating abdominal trauma : trauma. S Afr J Surg (Online). 2006;43(1):11–3.
Musau P, Jani PG, Owillah FA. Pattern and outcome of abdominal injuries at Kenyatta National Hospital Nairobi. East Afr Med J. 2006;83(1):37–43.
Ntundu SH, Herman AM, Kishe A, Babu H, Jahanpour OF, Msuya D, et al. Patterns and outcomes of patients with abdominal trauma on operative management from northern Tanzania: a prospective single centre observational study. BMC Surg. 2019;19(1):69.
Nyongole O, Akoko L, Njile I, Mwanga A, Lema L. The pattern of abdominal trauma as seen at Muhimbili National Hospital Dar es Salaam, Tanzania. East Central Afr J Surg. 2013;18(1):40–7.
Ogbuanya AU, Ugwu NB, Kwento N, Enyanwuma EI, Anyigor FF, Oko U. Abdominal Injuries from Civilian Conflicts: An Emerging Global Health Challenge in Rural Southeast Nigeria. Ann Glob Health. 2023;89(1):4.
Ohene-Yeboah M, Dakubo JC, Boakye F, Naeeder SB. Penetrating abdominal injuries in adults seen at two teaching hospitals in ghana. Ghana Med J. 2010;44(3):103–8.
Ojo EO, Ozoilo KN, Sule AZ, Ugwu BT, Misauno MA, Ismaila BO, et al. Abdominal injuries in communal crises: the Jos experience. J Emerg Trauma Shock. 2016;9(1):3–9.
Omer MY, Hamza AA, Musa MT. Penetrating abdominal injuries: pattern and outcome of management in Khartoum. Int J Clin Med. 2014;5(01):18–22.
Oosthuizen GV, Kong VY, Estherhuizen T, Bruce JL, Laing GL, Odendaal JJ, et al. The impact of mechanism on the management and outcome of penetrating colonic trauma. Ann R Coll Surg Engl. 2018;100(2):152–6.
Reid R, Kong V, Xu W, Thirayan V, Cheung C, Rajaretnam N, et al. An audit of trauma laparotomy in children and adolescents highlights the role of damage control surgery and the need for a trauma systems approach to injury in this vulnerable population. S Afr J Surg. 2022;60(2):97–102.
Sander A, Spence R, Ellsmere J, Hoogerboord M, Edu S, Nicol A, et al. Penetrating abdominal trauma in the era of selective conservatism: a prospective cohort study in a level 1 trauma center. Eur J Trauma Emerg Surg. 2022;48(2):881–9.
Sheshe A, Yakubu A. Analysis of pattern and outcome of abdominal trauma in a tertiary hospital in Kano, Northwestern Nigeria. Arch Int Surg. 2017;7(1):22.
van der Merwe E, Moeng MS, Joubert M, Nel M. The mortality rate of patients with open abdomen and contributing factors - a three-year audit in a major academic trauma unit. S Afr J Surg. 2023;61(3):21–7.
Abraha D, Gebreyes E, Wolka E, Dender G, Sorsa A, Muhumuza J. Determinants of adverse management outcomes of blunt abdominal trauma patients operated at a referral hospital in southern Ethiopia: a retrospective record review. BMC Surg. 2023;23(1):357.
Cooper A, Barlow B, DiScala C, String D. Mortality and truncal injury: the pediatric perspective. J Pediatr Surg. 1994;29(1):33–8.
Lima SO, Cabral FL, Pinto Neto AF, Mesquita FN, Feitosa MF, de Santana VR. Epidemiological evaluation of abdominal trauma victims submitted to surgical treatment. Rev Col Bras Cir. 2012;39(4):302–6.
Kundlas R, Alexis J, Jagadish S, TP E. Clinico–epidemiological profile, pattern and outcome of abdominal trauma in A level 1 trauma centre in South India. 2020.
Houston MC. Pathophysiology of shock. Crit Care Nurs Clin North Am. 1990;2(2):143–9.
Abdominal trauma Victoria: Victorian Department of Health; 2023 [updated 5 October 2023; cited 2023. Available from: https://trauma.reach.vic.gov.au/guidelines/abdominal-trauma/introduction.
Cirocchi R, Montedori A, Farinella E, Bonacini I, Tagliabue L, Abraha I. Damage control surgery for abdominal trauma. Cochrane Database Syst Rev. 2013;2013(3):Cd007438.
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D.E., OA, E.K.B., A.A.T., and A.M.D. participated in conception, literature review, and data extraction. D.E. and T.F.A. did the analysis and interpretation of data. M.G.T. and E.T.F. participated in manuscript preparation. All authors reviewed and approved the final manuscript.
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Endeshaw, D., Delie, A.M., Adal, O. et al. Mortality and its predictors in abdominal injury across sub-Saharan Africa: systematic review and meta-analysis. BMC Emerg Med 24, 57 (2024). https://doi.org/10.1186/s12873-024-00982-3
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DOI: https://doi.org/10.1186/s12873-024-00982-3