Patterns and outcomes of patients with abdominal trauma on operative management from northern Tanzania: a prospective single centre observational study.

ABSTRACT

BACKGROUND: The abdomen is one of the most commonly injured regions in trauma patients. Abdominal injury surgeries are common in Tanzania and in many parts of the world. This study aimed to determine the relationships among the causes, characteristics, patterns and outcomes of abdominal injury patients undergoing operations at Kilimanjaro Christian Medical Centre. METHODS: A prospective observational study was performed over a period of 1 year from August 2016 to August 2017. A case was defined as a trauma patient with abdominal injuries admitted to the general surgery department and undergoing an operation. We assessed injury types, patterns, aetiologies and outcomes within 30 days. The outcomes were post-operative complications and mortality. Multivariate logistic regression was used to explore the association between factors associated with morbidity and mortality. RESULTS: Out of 136 patients, 115 (84.6%) were male, with a male-to-female ratio of 5.51. The most affected patients were in the age range of 21-40 years old, which accounted for 67 patients (49.3%), with a median age (IQR) of 31.5 (21.3-44.8) years. A majority (99 patients; 72.8%) had blunt abdominal injury, with a blunt-to-penetrating ratio of 2.71. The most common cause of injury was road traffic accidents (RTAs; 73 patients; 53.7%). Commonly injured organs in blunt and penetrating injuries were, respectively, the spleen (33 patients; 91.7%) and small bowel (12 patients; 46.1%). Most patients (89; 65.4%) had associated extra-abdominal injuries. Post-operative complications were observed in 57 patients (41.9%), and the mortality rate was 18 patients (13.2%). In the univariate analysis, the following were significantly associated with mortality associated extra-abdominal injury (odds ratio (OR) 4.9; P-value< 0.039); head injury (OR 4.4; P-value < 0.005); pelvic injury (OR 3.9; P-value< 0.043); length of hospital stay (LOS) ≥ 7 days (OR 4.2; P-value < 0.022); severe injury on the New Injury Severity Score (NISS) (OR 21.7; P-value < 0.003); time > 6 h from injury to admission (OR 4.4; P-value < 0.025); systolic BP < 90 (OR 3.5; P-value < 0.015); and anaemia (OR 4.7; P-value< 0.006). After adjustment, the following significantly predicted mortality severe injury on the NISS (17 patients; 25.8%; adjusted odds ratio (aOR) 15.5, 95% CI 1.5-160, P-value < 0.02) and time > 6 h from injury to admission (15 patients; 19.2%; aOR 4.3, 95% CI 1.0-18.9, P-value < 0.05). CONCLUSION: Blunt abdominal injury was common and mostly associated with RTAs. Associated extra-abdominal injury, injury to the head or pelvis, LOS ≥ 7 days, systolic BP < 90 and anaemia were associated with mortality. Severe injury on the NISS and time > 6 h from injury to admission significantly predicted mortality.