Trauma intensive care in a terror-ravaged, resource-constrained setting: Are we prepared for the emerging challenge?

Abstract

Introduction Trauma in developing countries has been on the increase, a situation perpetuated by rising road traffic collisions, terrorism and firearms proliferation. Some of the victims of trauma are left with life threatening conditions requiring urgent surgical intervention and/or intensive care. The objectives of this study were to determine the pattern of major trauma needing intensive care in the region, and to determine the outcome of major trauma admitted to intensive care unit. Methods A six-year retrospective cohort study of trauma patients needing intensive care, set in the Intensive Care Unit of Ahmadu Bello University Teaching Hospital, Zaria, North-West Nigeria. Subjects were major trauma patients admitted into the intensive care unit of the institution, identified via an admission register kept in the unit. The main outcomes measured were length of stay and mortality. Results Trauma admissions represented 25.1% of the all intensive care admissions. Severe traumatic brain injury accounted for 32.1% of the trauma admissions, while burns accounted for 23.2%. Of the injuries, 15.5% were sustained in bomb blasts, and 8.3% were firearm injuries. The majority of the patients stayed for no more than seven days from admission. Burns patients had the worst outcomes, with 82.1% mortality. Conclusion Major trauma contributes significantly to local intensive care admissions, with terrorism- related trauma now an emerging challenging cause of major trauma in our region. The observed poor outcomes in this study are a reflection of the quality of available intensive care, and lends credence to the concept of appropriately resourced, specialised intensive care units for optimisation of care.

The Effect of Blast-Related Burn Injuries from Prolonged Field Care to Rehabilitation and Resilience: A Review of the Scientific Literature

“…Together, they serve as indicators of a population's health status with respect to a portfolio of health conditions and diseases. It is estimated that approximately 5-20 percent of combat-related casualties during the first ten years of OIF and OEF involved severe burns (Breederveld and Tuinebreijer, 2009;Wolf et al, 2006); this is consistent with a variety of estimates from other recent conflict settings, such as Mali (Akpoto et al, 2015), Nigeria (Amaefule et al, 2019;Dabkana et al, 2015), and Israel and Palestine (Mosleh et al, 2018).…”

Trauma-Related Deaths in the Accident and Emergency Department of a Nigerian Teaching Hospital

“…Traumatic brain injuries are by far the leading cause of trauma related deaths in our ER (82.5%). Amaefule et al [27] also showed that traumatic brain injuries caused more deaths (66.2%) within the first 72hours in the ER than all other causes combined. Etebu and Ekere [28] in a similar study 2 decades ago in the same institution showed that traumatic brain injury was the leading cause of trauma-related deaths in children.…”

Terrorism’s impact on low and middle-income countries’ healthcare services: A perspective

“…30 For example, a retrospective cohort study of trauma patients in a Northwestern Nigerian hospital demonstrated that the said cases exceeded the capacity of their respective intensive care units. 30 Furthermore, policies installed by active terrorist groups, such as the Taliban's ban on female patients seeking medical care at hospitals in Kabul, mediate difficulties in accessing the necessary healthcare services. 22 These barriers to healthcare are worrisome as they result in poorer chronic disease management, an increase in the burden of avoidable illness and comorbidities, and early mortality.…”