Patterns and Short Term Outcomes of Chest Injuries at Mbarara Regional Referral Hospital in Uganda

Abstract

Background: This study was conducted to establish the causes, injury patterns and short-term outcomes of chest injuries at Mbarara Regional Referral Hospital. Methods: This was a prospective study involving chest injury patients admitted to Mbarara Regional Referral Hospital (MRRH) for a period of one year from April 2014 to 31 st March 2015. Results: A total of 71 chest injury patients were studied. Males (91.6%) were the majority and the ages ranged from 8 to 76 years (mean 32.9 years (+/-14.0). Majority of the patients (57.7%) sustained blunt injury. RTA was the most common cause of injury, affecting 49.3%.The commonest injury patterns were chest wall injuries and lung and pleural injuries accounting for 69.0% and 64.8 respectively. Rib fractures were the commonest chest wall injury (71.4%) while hemopneumothorax was the commonest (34.9%) finding among those with lung and pleural injury. Associated injuries were found in 64.2% and out of these, abdominal injuries were the commonest extra thoracic injury (39.1%) followed by head injury(37.0%),cuts and lacerations(37%) andfractures (28.3%).The commonest abdominal organs injured were spleen(44.4%), liver (27.8%) and stomach (16.7%). Majority of the patients had thoracostomy (47.9%) while 33.8% had non surgical treatment. Laparotomy and thoracotomy were done in 11(15.5%) and 3 (4.2%) of the patients respectively. Complications occurred in 20(28.2%) and the commonest complication was pneumonia 6 (30%).The mean length of stay was 7.14 days, SD=±6.1) and the mortality was 16.9%.The significant determinants of mortality were associated injuries (X 2 =4.57, F.E=0.046), complications (X 2 =36.82, F.E=0.000) and severe head injury (X2=13.85, F.E=0.001). Conclusion: The causes, patterns and short-term outcomes of this study are similar to those observed in other developing countries. Chest injury in our setting causes high mortality and measures to reduce road traffic accidents are urgently required.

Efficacy of extended focused assessment with sonography for trauma using a portable handheld device for detecting hemothorax in a low resource setting; a multicenter longitudinal study

“…In Uganda chest trauma contributed to 34.7% of road tra c injury cases seen at the Country's national referral hospital in Central Uganda (9) with a resulting mortality rate of 17%. A similar mortality (16.9%) was reported at Mbarara regional referral hospital in Western Uganda (10).…”

Chest trauma epidemiology and emergency department management in a tertiary teaching hospital in Kigali, Rwanda

“…Like neighboring African LMICs, thoracic trauma in Rwanda most commonly affects young males and those involved in RTCs [3] , [4] , [5] . These populations are targets of ongoing interventions and should continue to be.…”

“…Head trauma was often associated with thoracic trauma in Rwanda; this is similar to nearby Tanzania [5] . Interestingly, Uganda, Rwanda's other neighbor, had more associated abdominal trauma [4] . The frequent co-occurrence of significant associated injuries in thoracic traumas should lead providers to suspect other serious injuries when evaluating patients.…”

“…The most common admission complication was pneumonia. Pneumonia and other infection-related complications occur frequently in other East African studies revealing an important area for in-hospital prevention efforts [ 4 , 5 ]. Mortality was low but likely underestimated due to out-of-hospital deaths and exclusion of some sick patients without capacity to consent.…”

“…Frequent injuries include rib fractures and hemo- and pneumo-thoraces, often with polytrauma. Thoracostomies are among common interventions performed, and mortality greatly varies, sometimes over 15% [3] , [4] , [5] .…”