Early outcome of polytrauma patient attended at MOI and MNH emergency department

Abstract

Polytrauma is the occurrence of injuries to more than one body systems. In Tanzania due to tremendous increase in motor traffic crashes hence number of cases which bring about challenges in management of polytrauma patients besides well established emergency departments in Muhimbili Orthopedic Institute and Muhimbili National Hospital.

Methodology: This was a cross sectional study. A convenient sampling method was used to recruit polytraumatic patients attended at emergency departments of MOI and MNH. Patients aged 12 years and above were assessed by using Revised Trauma Score (RTS), Systemic Inflammatory Response (SIRS) parameters following a signed consent during the study period. Data was collected using structured questionnaires and analyzed by computer software SPSS version15 program.

Results: Majority (89.3%) of study patients were males and half of the study participants were between age group of 21-46 years 51.8%. Formal employed participants were (33.9% Motor traffic injuries was the leading cause of polytrauma 85.7%, followed by fall from height (10.7%) and assault and others was 1.8%. Moreover the study revealed that among those with MTC; pedestrians were 37.5% and drivers and passengers had similar percent 27.1%. Most patients (57.1%) were admitted in MOI and MNH within 6 hours of injury, while (32.1%) and (10.7%) were admitted within 24 hours and after one day respectively. Majority of patients had complications within 24 hours of follow up. Sepsis was noted in (22.2%) and deaths 44.2% and DIC was the least. Within 7 days the same complications occurred with proportion of sepsis 17.8% and deaths 4.46 %. The study revealed statistic significant difference on hospital stay and proportion of occurrence of DIC (p=0.005) and death (p=0.002) within 24 hours of observation. Only sepsis was observed within 7 days of follow up to be statistic significant (p=0.031). Also the age group of 26-41 had the largest number of deaths 14 with the p value of 0.024 which is statistically significant.

Most of the patients (72%) had Traumatic Brain injury. Mostly observed cause of traumatic brain injury in postmortem 32.1% was severe head injury (diffuse axonal injury) by 16.1% followed by intracerebral hemorrhage which gave 8.9%. From a total number of 18 deaths which were observed in postmortem reports were all because of TBI. (16.1%) of TBI were scored from GCS of 3 and 5-4 were about 11 patients which corresponds to a total number of 9 who had severe brain injury. (Diffuse axonal injury).

Conclusion and recommendations: Polytrauma is still a challenging condition in present set up, and continue to take lives of young population. Moreover improvement in management of TBI, and further research should be done to establish national wide records of polytrauma.