Patterns of Injury and Outcomes of patients with Thoraco-abdominal Injury in public hospitals in Addis Ababa, Ethiopia
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Date
2023
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Addis Ababa University
Abstract
Background; Trauma is a major public health issue accounting for 10% of the total death globally.
The thorax and the abdomen are commonly injured sites in association with RTA and account for
the most common cause of death next to head injury. In relation to several compounding factors
concurrent presence of injury in this two body cavities imposes significant challenge in the
diagnosis as well as in the management plan of such cases. The relative rarity in this pattern of
injury has hindered large scale study both in this country and globally. Therefore, the optimal
management strategies in this population still remains area of debate. Worldwide, the mortality
rate of abdominal trauma is reported to be between 1 and 20%. Thoracic trauma is a significant
cause of mortality. Globally, chest trauma is the third important cause of mortality and morbidity.
Abdominal injuries require careful triaging for appropriate intervention because approximately
25% of such injuries require surgery. Therefore, the optimal management strategies in this
population still remain area of debate. The aim of this study is to assess the pattern and outcome
of patients with thoraco-abdominal injury attending four public hospitals, Addis Ababa, Ethiopia,
Objectives; Assess the patterns of injury, associated factors and outcomes among patients with
thoraco- abdominal injury attending in four public hospitals, Addis Ababa, Ethiopia.
Method; Institution based retrospective quantitative cross-sectional study design was used to get
patients chart for assessing the patterns of injury and outcomes in patients with thoraco-abdominal
injury admitted to the 4 hospitals in Addis Ababa over a period of 3 years. A standard checklist
was used to collect all the necessary data from patient’s medical record and OR registry. The
collected data was entered into Google Form, and then exported to IBM SPSS version 26 for
analysis and descriptive statistics was used to present the result. Descriptive and inferential
statistics as well as binary logistic regression analysis was done. All factors on the bivariate
analysis discordant at P 0.25 were included in a stepwise logistic regression model to identify
independent predictors of mortality. Model fitness checked by Hosmer-Lemshow goodness of fit
test and multi collinearity checked by VIF.
Results;96 patients fulfilling the inclusion criteria were identified, men make up the majority of the study
population 84(87.5%). The mean age of the patients was 31.2 years ± SD 11.3. 56(58.3%) arrived
at the health facility within 6 hours of injury. Penetrating injury is the commonest mechanism of
injury 50(52.1%), stab accounts for 35(36.5%), gunshot occurred in 16(16.7%) and blast in 5
(5.2%). 50(52%) were hemodynamically unstable at presentation and among this 42(84%) were
managed operatively. 27(28.1%) required ICU admission and 9 (9.4%) patients had massive
transfusion. FAST was done in 50(52.1%) patients at the emergency and it was positive in
35(70%). The diagnosis of thoraco-abdominal injury was made with CT scan in 22 patients and
13(59%)of them were managed operatively. Among these patients only 1(7%) patient was
operated within 24 hours of presentation. Majority of the patients were managed with concomitant
tube thoracotomy and laparotomy 47(49%), 15(15.6%) were managed with laparotomy alone,
4(4.2%) undergone thoracotomy, 10(10.4%) were conservatively managed and only 1 patient had
dual cavity intervention. Among the 63 patients who had laparotomy, in 1(1.5%) patient the
laparotomy was unnecessary and in 13(19.40%) of them the laparotomy was non-therapeutic and
among this 5(38.46%) had died and 1 patient was re operated.
From the 67 among the total 96 patients who were operatively managed repair was done for the
39(40.6%) as part of the operative intervention, 4(4.2%) underwent resection and
anastomosis,12(12.5%) had diversion. Among the 8 patients who had IOF of splenic injury
7(7.3%) had splenectomy and 1 patient had splenorraphy, there were two patients who had IOF of
kidney injury, 1(1%) of them had nephrectomy and the other one1(1%) had renorraphy. damage
control surgery was performed in 4(4.2%) of the patients, 1(1%) patient had right middle lobe
wedge resection for massive hemo thorax, Cholecystectomy was done for 2(2.1%) of the patients,
2(2.1%) of the patients were just explored.
The in hospital mortality rate is 14.6%. For those patients discharged improved the average length
of hospital stay is 16.18 days. The need for ventilator support was associated with increased risk
of mortality.
Conclusion;Patients presenting with thoraco abdominal injury poses significant diagnostic and therapeutic
challenge due to the high requirement of timely surgical intervention despite a considerable
number of negative and non-therapeutic laparotomy rate. Therefore, Routine laparotomy should
be abandoned and should be reserved for patients who are hemodynamically unstable, having
signs of peritonitis, or evisceration and non-operative management should be considered in select
cases provided that close follow up and imaging modalities are available.
The significant mortality rate associated with ICU admission requirement calls for improvement
in the setup of the facilities as well as in the provision of care of critical trauma patient starting
from the emergency to the ICU unit. A multidisciplinary team of health professionals should also
be organized in the management of this patients to effect in a better outcome.
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Keywords
Trauma, Abdominal injury