Trauma death in a resource constrained setting: mechanisms and contributory factors, the result of analysing 147 cases.

AIMS AND OBJECTIVES: The objective of the following study is to analyze the trauma type (causes), injury pattern and factors that may have contributed to death within 72 h of admission into our emergency department (E.D). MATERIALS AND METHODS: An 18 month prospective observational study, done from April 2009 to September 2010. All the patients were that admitted for 72 h following a full assessment by the attending clinician were enlisted for the study. The demographic data of each patient, time of arrival at the E.D, type of injury sustained, time of incident, previous care at any peripheral hospital, clinical state of the patient, Glasgow coma scale (GCS), Injury severity score (ISS) and treatment offered before death were entered into a Proforma. DATA ANALYSIS: This was done using EPI-Info statistical programme version 3.4.3 of 2007(by CDC Atlanta Georgia , USA). RESULTS: A total of 4011 patients were seen in the E.D during the period. 1943 (48.4%), were trauma emergencies, with a (147; 41.4%) mortality. Their ages ranged from 4 to 87 years, with an average of 34.5 years. The male:female ratio was 7:1. The assessed GCS ranged from 6 to 15, with an average of 9.1, the ISS ranged from 9 to 75 with an average of 31.3. Road traffic accidents (RTAs) accounted for 118 (80.3%) of the deaths, assaults 14.3%, falls from height 4.0% and gunshot injuries 1.4%. The overall mortality was 17.1%. CONCLUSION: The major source of trauma death was RTA; The most frequently injured part of the body was head, with death resulting clinically hemorrhage. The 17.1% mortality is multifactorial: The late presentation (in some cases occasioned by interference by persons not knowledgeable in the basics of trauma care) lack of trained personnel and the systemic deficiencies.

Closed drainage of liver abscesses: the 'UNICAL' drain as an efficient and cost saving device in a tropical setting.

INTRODUCTION: Liver abscesses occur in both the developed and developing countries. Up to the time of this study lever abscesses in our centre were drained with open laparotomy, because of the lack of standard equipment for percutaneous drainage. We present a preliminary report of six cases of liver abscesses drained percutaneously using the 'UNICAL' closed drainage system. METHODOLOGY: Six patients all males aged 23 54 years were treated for liver abscesses using the 'UNICAL' drain (a locally devised active drain system), under ultrasound guidance. Five of the patients had amoebic abscesses, all located in the right hepatic lobe. The sixth patient had multiple pyogenic abscesses involving both hepatic lobes. The six patients had pre and post-drainage antimicrobial therapy for a total of two weeks. RESULTS: One patient, who was a diabetic, had a recollection of pus within a week after the initial drainage. He was redrained with the same device with complete cure. Full blood count and liver function tests showed anaemia (haemoglobin < 10 g/dl), leucocytosis and hyperbilirubinaemia in five patients. CONCLUSION: We conclude that the 'UNICAL' drain is an effective and cheap device for percutaneous drainage of liver abscess under ultrasound guidance in a'resource poor environment'.

Epidemiology of death in the emergency department of a tertiary health centre south-south of Nigeria.

BACKGROUND: The emergency department (E.D) of any hospital is an important entry point of critically ill patients. The initial management of these patients is often challenging, and for valuable lives to be saved, the in fracture and manpower should be up to date. OBJECTIVE: To analyze the epidemiology of death in our Emergency Department within 72hours after admission, the death rate, and to establish any contributory factors. METHOD: Demographic data, time of arrival at the ED, physical finding, the Glasgow coma scale(GCS), the injury severity score(ISS), the diagnosis, investigations done, treatment offered, the time of death and the autopsy report, were entered into a Proforma. These data was analyzed using EPI-Info statistical programme version 3.4.3 of 2007. RESULTS: Four thousand and eleven (4,011) patients were seen in the E.D during the period. A total of three hundred and fifty five (355) mortalities were recorded. Their ages ranged from 4-87years, with an average of 34.5years. The male: female ratio was 2.1:1. The overall mortality in the hospital during the period was 859: the E.D mortality figure representing 41.3%. Fifteen patients were brought in dead. The 355 deaths fell into two categories: trauma and non-trauma. One hundred and forty-seven (41.4%) persons died from trauma; road traffic accidents (RTAs) accounting for 118 (80.3%). Two hundred and eight (58.6%) persons died from nontrauma related causes, with chronic cardiovascular disorders been the most frequent cause of death 52[25.0]. Majority of the mortalities were between 26-50 years age range. 86.2% of the mortalities presented late, greater than 6hours after the incidence. Within the 72 hours period, only 129(36.3%) were able to do the requested tests. Out of the 355 deaths, only 4[1.1%] were autopsied. An in-hospital 72hours death rate of 8.6 was recorded. CONCLUSION: Road traffic accidents and cardiovascular disorders are the common causes of emergency death in UCTH. A recorded death rate of 8.6% is high, suspected contributory factors include systemic deficiencies such as the lack of a trauma system, prehospital care; late presentation, the role of chemist operators, traditional healers, and delayed referral systems.