Outcome of blunt abdominal trauma in Mulago hospital.

Abstract

Background This study was conducted at Mulago hospital, a 1500 bed National referral and teaching hospital that is situated in Kampala, the capital city of Uganda. The A&E Unit of this hospital handles over 4,700 trauma cases per year. Blunt abdominal trauma is a common finding in trauma patients presenting to Mulago, and it rarely occurs in isolation. This poses a formidable diagnostic as well as therapeutic dilemma to a surgeon on duty. So far studies done in Mulago reported that blunt abdominal trauma occurs in more than half of patients presenting with abdominal injuries. Objectives The aim of this study was to assess the outcome of blunt abdominal trauma in Mulago hospital. These included describing the causes, patterns of injury to various viscera, and determining clinical outcomes of patients with blunt abdominal trauma. Methods This study employed two study designs: cross-sectional and case series. This study was conducted from October 2005 to February 2006. 100 patients were studied. On admission they were assessed according to ATLS protocol, which involves primary survey, resuscitation, and secondary survey. Injury severity score was used for scoring patients with multiple injuries. Investigations done included: Hb, grouping and cross matching, abdominal US scan, CXR, and plain abdominal X-ray. 52 cases were operated and 48 were managed non-operatively. Medical treatment given consisted of: IV fluids/blood, analgesia, appropriate antibiotics, and tetanus prophylaxis was also instituted. Data collected was analyzed and a summary of these results was done using and Epiinfo statistical programmes. Results Most of the patients with blunt abdominal trauma had a good outcome, 95% survived and 5% died. The commonest injured organ was the spleen 63.5%, other organs constituted 36.5% (bladder, bowel, liver, kidney, and abdominal all). Time lapse between injury and arrival at hospital, severity of associated injuries, Age, and prior medical care given before arrival to hospital significantly influenced outcome. Although the males were more affected than females, sex had no significant influence on outcome (p-value>0.05). Conclusion and Recommendations Most of the blunt abdominal injuries were major 72%, but the outcome was generally good. Patients with blunt abdominal trauma, who stayed in the ward for more than ten days, had associated injuries (head injury, chest injury, fractures and extensive tissue involvement). The outcome of blunt abdominal trauma may be improved by: equipping A&E unit with facilities for resuscitation and investigations of patients, improving the pre-hospital emergency ambulatory services so that patients are timely delivered to hospital for intervention.