Abstract:

Background: Multiple injuries have been reported to be a major cause of hospitalization and intensive care utilization worldwide and contribute significantly to high morbidity, mortality and long-term disabilities. Despite continued advances in intensive care unit technology for the treatment of multiply injured patients, the outcome of these patients has not improved much in our setting. This study was conducted to describe the prevalence of multiple injuries among trauma patients in our centre and to identify factors predicting the outcome of these patients.

Methods: This was cross sectional study which was carried out at Bugando Medical Centre between February 2013 to May 2013. After informed consent to participate in the study, all patients were consecutively enrolled into the study. Data were collected using a pre-tested questionnaire and analyzed using SPSS computer software version 17.0

Results: A total of 150 patients representing 21.1% of trauma admissions were studies. Males outnumbered females by a ratio of 2.5.1. The majority of patients were in the third decade of life. Road traffic accident mainly motorcycle injuries (65.3%) was the most common cause of injury accounting for 93.3% of cases. Only twelve (8.0%) patients had pre-hospital care. Musculoskeletal (extremities) and the head was the most common body region injured in 89.2% and 78.7% of cases respectively. Sixteen (10.7%) patients were HIV positive. More than 90% of patients were treated surgically of which wound debridement was the most common surgical procedure performed in 87.3% of patients.

Postoperative complication rate was 54.7% and surgical site infection (SSI) was the most frequent complication in 45.9% of cases. HIV positivity and low CD4+ count were the main predictors of SSI (p<0.001). The overall median length of hospital stay was 23 days patients who developed postoperative complications and those who had long bone fractures stayed longer in the hospital, and this was statistically significant (p < 0.001). Mortality rate was 38.7% and it was significantly associated with co-existing medical illness, late presentation, HIV positivity, low CD4 count, admission systolic blood pressure, high ASA class and presence of missed injuries and complications (p < 0.001).

Conclusion: Road traffic accidents remain a major of multiple injuries in our setting and contribute significantly to unacceptably high morbidity and mortality. Accurate identification of a patient at high risk for poor outcome is necessary for decision making. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of multiple injuries in our centre.