| Abstract|| |
Background: Traumatic injuries are important causes of death and disability among adults and children. Trauma is one of the most common causes of emergency department visits in most part of the world. Objectives: The objective of the study is to evaluate the prevalence of the traumatic injuries in the accident and emergency department of our institution, to establish the burden of traumatic injuries. Patients and Methods: The study spans over 2 years, January 2013–December 2014. Patient's biodata, type of injuries sustained, etiology of injuries, and rate of patient transfer to the wards were extracted from the emergency department attendance and transfer registers and entered into a designed questionnaire. Statistical analysis was with SPSS version 20. Results: Of the 11,393 patients who visited the emergency department during the study, 2381 (20.90%) were traumatic injury patients. The mean age was 29.25 years ± 1.57 STD. Road traffic accidents (RTA) constituted 1200 (50.40%) of all traumatic cases, followed by assaults and falls which constituted 449 (18.86%) and 174 (11.17%) respectively. The part of the body mostly affected by injury was the head 478 (20.1%) patients. A total of 757 (31.8%) cases of traumatic injury were transferred to the hospital ward after being stabilized in the emergency department. Conclusion: This study had highlighted the burden which traumatic injuries and especially RTA imposed on the health facility and the need to provide adequate resources and increase the staff strength for smooth running of the emergency department.
Keywords: Emergency department, injury, road traffic accidents, teaching hospital, trauma
|How to cite this article:|
Onwuchekwa CR, Adiela VU. Prevalence of traumatic injuries visiting the emergency department of a regional university teaching hospital in Nigeria. Ann Trop Med Public Health 2018;11:19-22
|How to cite this URL:|
Onwuchekwa CR, Adiela VU. Prevalence of traumatic injuries visiting the emergency department of a regional university teaching hospital in Nigeria. Ann Trop Med Public Health [serial online] 2018 [cited 2020 May 29];11:19-22. Available from: http://www.atmph.org/text.asp?2018/11/1/19/272532
| Introduction|| |
People are exposed to different types of traumatic injuries daily and at every age. Every day, nearly 16,000 deaths occur due to various injuries around the world, 22% of which are related to road traffic accidents (RTA). Of the 129 million annual referrals to emergency departments in the United States, more than 22 million (17%) were related to trauma and accidents. According to the World Health Organization (WHO) and the results of a previous study, middle- and low-income countries represent more than 90% of global injury cases.
In Nigeria, trauma research is still not well established, trauma registries are not available in our health institutions; hence, injury documentation is inadequate.
This study was aimed at evaluating, the prevalence of the traumatic injuries, to establish the burden of traumatic injuries on our health facility. This will enable proper budgeting and policy-making to provide the needed resources for emergency care in a resource-constrained country.
| Patients and Methods|| |
This was a cross-sectional retrospective study on trauma cases visiting the emergency department of a tertiary health institution from January 2013 to December 2014. The emergency department receives all pediatric and adult surgical emergencies in the hospital during the period under review.
Patient's biodata, type of injuries sustained, etiology of injuries, and rate of patient transfer to the wards were extracted from the emergency department attendant register and entered into a designed questionnaire to enable easier data collection. Cases which were not managed in the emergency department were excluded. The study was approved by the ethics committee of our institution.
Data analysis was done using IBM statistical package for the Social Sciences (SPSS Inc. Chicago IL, USA). Simple frequency for non-numerical variables and simple average for numerical variables were generated.
| Results|| |
Of the 11,393 patients who visited the emergency department during the study, 2381 (20.90%) were traumatic injury patients. Majority were males 1622 (68.1%) while 759 (31.9%) were females with male to female ratio of 2.1:1.
[Table 1] shows gender and age distribution of the patients. The age was not specified in 52 (2.2%) patients, hence, they were excluded from mean age determination. The age range was from 2 months to 100 years, with a mean age of 29.25 years ± 1.57 STD. In all the age groups, there were more males involved than the females. Traumatic injuries were found to be most prevalent in the age range of 21–30 years (32.7%) and this was followed by the age range of 31–40 years (22.4%). In effect, 55.1% of traumatic injury visit to the emergency department were patients within the age range of 21–40 years.
|Table 1: Gender and age distribution of emergency department traumatic injury visits|
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Data analysis on etiology of injuries showed that RTA represented the largest proportion of traumatic injuries in the patients presenting to the emergency department. RTA constituted 1200 (50.40%) of the total patients while assaults and falls constituted 449 (18.86%) and 174 (11.17%), respectively. Dog bites and suicides were found more in females constituting 22 patients and 6 patients, respectively, while in males there were 16 cases and 3 cases, respectively, though the difference was not statistically significant (P = 0.32) [Table 2].
The injury patterns were found to vary, as some of the patients presented with soft-tissue laceration, multiple injury pattern and multiple or single part of the body involvement. The part of the body mostly affected by injury was the head seen in 478 (20.1%) patients. Soft-tissue laceration constituted 372 (15.6%) patients while multiple injury pattern was found in 451 (18.9%) patients [Figure 1].
|Figure 1: Bar chart of the part of the body affected by traumatic injuries|
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Totally, 757 (31.8%) cases of traumatic injury were transferred to the hospital ward after being stabilized in the emergency department as the severity of their injuries required continued management by a specialized team. Of these, the most common injury was brain/spinal cord injuries which were 212 (39.63%) patients. This was followed by fractures/dislocations which constituted 160 (29.63%) patients [Table 3].
|Table 3: Distribution of cases of traumatic injuries transferred to the hospital wards|
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| Discussion|| |
Trauma is one of the most common causes of emergency department visits in Nigeria and most parts of the world. According to the WHO and the results of previous studies, middle- and low-income countries represent more than 90% of global injury death cases. The result of the study shows that 20.9% of all emergency visits are due to traumatic injury. This value is lower than 28.8% reported in a pilot study in our institution in 1990. The reason for this reduction could be attributed to the availability of more health centers which had been established in the same city to handle trauma cases within the 27 years between the pilot study and this current study.
The mean age of the patients in this study was 29.25 years, which is similar to the finding in previous studies on emergency trauma injury visits., This falls within the age range of 21–40 years which was found to have the highest incidence, constituting 55.1% of traumatic injuries in this study. This is the age of high activity and constituted the productive population of every country. Similar observations had been made in similar studies in the published literature.,
The males constituted 68.1% of traumatic injury cases, showing that males were 2.1 times more likely to incur traumatic injury than the females. Similar high rates of TI in males had been reported by other researchers in several countries of the world,,, including Nigeria, where it was reported that males were 7.1 times more likely to suffer TI than females. This could be attributed to the tendency of the males engaging in high-risk jobs such as climbing of heights, construction work, vehicle driving, and other risks involving the roads.
RTA was the major cause of injuries seen in the emergency department in this study. The high prevalence of RTA 50.4% is worthy of note as similar high prevalence had been reported in Nigeria.,, Thanni reported a prevalence of 90.6% while Adoga and Ozoilo reported 56.7%, Solagberu et al. reported 62.3%. In Pakistan, RTA was reported to constitute 51.1% of emergency department visits.
These rates were high compared to 18% in the Netherland and 20% from West Indies. This confirms the statement that etiology of accidents has geographical, cultural, social, and economic factors. The rate is higher in developing, middle- and low-income countries. This could be due to poor traffic regulations, bad roads, and poor vehicles maintenance. Assault was found to be the second prevalent etiology in this study. The impunity of the law enforcement agencies and jungle justice which are common in Nigeria compound the issue of human assault as compared to falls and domestic accidents. The pilot study in our institution some 27 years ago reported that domestic accidents (42.5%) was most prevalent followed by assault (30.4%) before RTA (26.0%). This change in the trend of trauma prevalence may be due to industrialization in the city which had become the hub of crude oil exploration and exploitation as well as rapid urbanization with influx of vehicles of different sorts and increase in tarred roads as well as poor road maintenance and poor knowledge of road traffic rules.
Injury to the head, multiple injuries and soft-tissue lacerations are the common forms of injuries encountered in the emergency department. The human head is prone to injuries probably because of its location in the human body. Other studies had shown that most patients involved in RTA sustained head injury which may be responsible for the high mortality from RTA.,, This could also explain the high prevalence of head injury in our study as RTA constituted the major reason for traumatic injury emergency department visit in this study.
The study also shows that majority of the cases transferred to the ward for continued management by specialized team are brain and spinal cord injured patients, followed by skeletal fractures and burns. These are critical illnesses that require close attention and long hospital stay. We did not look at injury severity and mortality as these are beyond the scope of this research.
This was a single-center study hence may not represent the true burden of traumatic injury in the larger society. There were much difficulties in assembling the data as record keeping was not adequate. There were series of industrial actions during the study which could have affected the number of patients visiting the accident and emergency department.
| Conclusion|| |
Traumatic injuries had been shown in this study to present commonly in our emergency department. RTA was the most common etiology and readily present with head injury that may result to death. Hence, the emergency department should be designed to specifically monitor injury events as surveillance helps to characterize events leading to injury and also help in prioritizing effective interventions by allocating appropriate resources towards prevention. This study had highlighted the burden which traumatic injuries and especially RTA imposed on the health facility and the need to provide adequate resources and increase the staff strength for smooth running of the emergency department. RTA and assault being the major causes of injury event, need to be prevented by public education on adherence to traffic rules and regulations as well as the use of protective gadgets such as seat belts and helmets. The law enforcement agents should be trained to observe human rights laws and to be up and about on their duties to stop human assaults.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Gupta A, Gupta E. Challenges in organizing trauma care systems in India. Indian J Community Med 2009;34:75-6.
] [Full text]
Villaveces AM, Owens PI, Barrett MI. Causes of Injuries Treated in the Emergency Department 2010. HCUP Statistical Brief # 156. 2013. Agency for Healthcare Research and Quality, Rockville, MD. Available from: http:// www.hcup us.ahrq.gov/reports/stat briefs/sb 156.pdf
. [Last accessed on 2017 May 06].
Bashah DT, Dachew BA, Tiruneh BT. Prevalence of injury and associated factors among patients visiting the emergency departments of Amhara regional state referral hospitals, Ethiopia: A cross-sectional study. BMC Emerg Med 2015;15:20.
Bun E. Road traffic accidents in Nigeria: A public health problem. Afrimedic J 2012;3:34-5.
Philips S, Kathryn C, Rae OB, Emily H, Yona M, James L, et al
. Epidemiology of injuries, outcomes, and hospital resources utilization at a tertiary teaching hospital in Lusaka, Zambia. Afr J Emerg Med 2014;4:115-22.
Ogendi JO, Ayisi JG. Causes of injuries resulting in a visit to the emergency department of a provincial general hospital, Nyanza, Western Kenya. Afr Health Sci 2011;11:255-61.
Elechi EN, Etawo SU. Pilot study of injured patients seen in the University of Port Harcourt Teaching Hospital, Nigeria. Injury 1990;21:234-8.
Fararoei M, Javad Sadat S, Zoladl M. Epidemiology of Trauma in Patients Admitted to an Emergency Ward Yasuj. Trauma Mon 2017; 22:e30572. [doi: 10.5812/traumamon. 30572.
Adoga AA, Ozoilo KN. The epidemiology and type of injuries seen at the accident and emergency unit of a Nigerian referral center. J Emerg Trauma Shock 2014;7:77-82.
] [Full text]
Yadollahi M, Anvar M, Ghaem H, Ravanfar P, Paydar S. Epidemiologic study of trauma patients admitted to a level 1 trauma center in Shiraz: One year survey. Razavi Int J Med 2015;3:e29642.
Mehrpour SR, Nabian MH, Oryadi Zanjani L, Foroughmand-Araabi MH, Shahryar Kamrani R. Descriptive epidemiology of traumatic injuries in 18890 adults: A 5-year-study in a tertiary trauma center in Iran. Asian J Sports Med 2015;6:e23129.
Ugare GU, Bassey IE, Udosen JE, Ndifon W, Ndoma-Egba R, Asuquo M, et al
. Trauma death in a resource constrained setting: Mechanisms and contributory factors, the result of analyzing 147 cases. Niger J Trauma Resusc Emerg Med 2014;22:51.
Thanni LO. Epidemiology of injuries in Nigeria-a systematic review of mortality and etiology. Prehosp Disaster Med 2011;26:293-8.
Solagberu BA, Ofoegbu CK, Abdur-Rahman LO, Adekanye AO, Udoffa US, Taiwo J, et al.
Pre-hospital care in Nigeria: A country without emergency medical services. Niger J Clin Pract 2009;12:29-33.
Hyder AA, He S, Zafar W, Mir MU, Razzak JA. One hundred injured patients a day: Multicenter emergency room surveillance of trauma in Pakistan. Public Health 2017;148:88-95.
Oskam J, Kingma J, Klasen HJ. The Groningen Trauma Study. Injury patterns in a Dutch trauma centre. Eur J Emerg Med 1994;1:167-72.
Crandon I, Carpenter R, McDonald A. Admissions for trauma at the University Hospital of the West Indies. A prospective study. West Indian Med J 1994;43:117-20.
Ekere AU, Yellowe BE, Umune S. Surgical mortality in the emergency room. Int Orthop 2004;28:187-90.
Dr. Chinwe Regina Onwuchekwa
Department of Radiology, University of Port Harcourt Teaching Hospital, Rivers State
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]