Clinical Spectrum of Trauma at a University Hospital in Nigeria

Abstract

Background and Objectives: Data on trauma in Nigeria requires updating just as trauma care needs coordination and organization. This study was done to examine the clinical spectrum of trauma and to propose measures for organization of trauma care.

Patients and Methods: A 2-year prospective report of an ongoing trauma research is presented. Data obtained from September 1999 to December 2000) include name, age, sex, presenting diagnosis at the accident and emergency (A and E) unit, injury-arrival time, ode of transportation of patients to the hosptial, and the outcome of care.

Results: Trauma patients comprised 2,913 of the 4,164 (70.0%) surgical patients seen in the A and E but 129 of 171 deaths (75.4%). Types of trauma were lacerations (585 patients, 20.1%), fractures (542, 18.7%), head injury (250, 8.6%), multiple injuries (249, 8.6%), burns (159, 5.5%), and others. Road traffic accidents (RTA) occurred in 1,816 patients (62.3%), falls in 308, assaults in 258, burns in 159, home accidents in 122, gunshot injuries in 107, industrial accidents in 73, and foreign body injuries in 70. There was no pre-hospital care. Transport to the A and E was done by relations, the police and a few Good Samaritans. Most of the patients reached the hospital in < 6 h. Common mortalities were from head injury (37 patients, 28.7%), multiple injuries (35, 27.1%), fractures (12, 9.3%), and burns (9, 7.0%). Of 106 deaths with timed records, 22 (20.7%), 56 (53.0%) and 28 (26.3%) occurred in 0–1 h, > 1–24 h and > 24 h, respectively.

Conclusions: The spectrum of trauma is predominantly RTA-related, hence, trauma care organization would include prevention of RTA, organization of pre-hospital care aimed at transport time of < 2h, training volunteers from the populace and the police as emergency medical services technicians for resuscitation during transport and getting patients to hospital in optimal state, and an enhanced in-hospital care by designation and categorization of hospitals. These strategies, including continuous trauma research and funding, would go a long way in reducing mortalities from trauma, especially from RTA.