Gebremariam, Shemeles (PhD.)Friew, Hedagewoin2025-08-132025-08-132023https://etd.aau.edu.et/handle/123456789/6716Background; 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.en-USTraumaAbdominal injuryThesis