Clinical profile and predictors of outcomes of adults patients with chest trauma presenting to the emergency department of Muhimbili National Hospital

Abstract

Introduction: Trauma causes significant morbidity and mortality across the world. Injuries to the chest are one of the leading causes of mortality in high-income countries; however, there is a paucity of data regarding the clinical profile and predictors of outcome in chest trauma patients in low-middle income countries. This study highlights the causes, management and outcome of chest trauma in Tanzania Aim of the Study: To describe the clinical profile and predictors of outcome in adult patients with chest trauma presenting to the Emergency Medicine Department (EMD) of the Muhimbili National Hospital (MNH). Methods and Material: This was a retrospective case review study involving all adult chest trauma patients captured in the trauma registry available at the EMD MNH, between June 2019 and December 2020. Data was captured in a data collection form developed in Research and Electronic Data Capture (REDCap) and was entered in the form using data from the EMD Trauma Registry and patient files form the wards. Demographics, mechanism of injury, the severity of injury using ISS, management offered, complications and mortality was recorded and analyzed. Descriptive analysis was was summarized as frequencies and median with IQR. Logistic regression and odds ratios were used to calculate association between predictors and outcomes. Results: We enrolled 218 (9.1%) from 2387 trauma patients screened. The overall median age was 32 years (IQR 26 – 43 years), and 183 (83.9%%) were male. The majority of patients were involved in the Road Traffic Accidents, 151 (69%), among them, 85 (39%) were motorists. Overall, 132 (61%%) of patients had extra thoracic injuries, of which 72 (33%%) had a traumatic brain injury (TBI). The 24-hours and 7- days mortality were 2.9% and 3.9%, respectively. Severe and moderate TBI were significantly associated with mortality, AOR 60.4 (CI 95% 5.38 – 678.07, p-value < 0.001), and AOR 22.67 (CI 95% 2.66 – 193.4 p-value 0.004), respectively. Furthermore, shock index and haemothorax were significantly associated with mortality, AOR 7.2 (CI 95% 1.28 – 40.32, p-value 0.025) and AOR 5.9 (CI 95% 1.3 – 26.9, p-value 0.022) Conclusion: Road Traffic Accidents involving motorcyclist is the main mechanism of injuries among patients presenting with chest injuries. The presence of extra thoracic trauma, especially traumatic brain injury, was associated with higher mortality. Future studies should focus on the improvement to be made, including factors related to the motorist’s adherence to traffic regulations to address morbidity and mortality.