Short term outcome of haemorrhagic shock in trauma at Mulago Hospital

Abstract

Background: More than 3000 deaths occur daily around the world due to road traffic injury, 85% of which are in low and middle income countries. Haemorrhage is the leading cause of death in trauma patients worldwide with intracranial haemorrhage accounting for most deaths followed by hemorrhagic shock. This pattern was noted in Uganda over 10 years ago. Objective: This study set out to determine the 24 hour survival/mortality of patients with traumatic haemorrhagic shock, adequacy of resuscitation of the survivors and the distribution of factors which are known to affect mortality between survivors and non-survivors of traumatic haemorrhagic shock at Mulago National Hospital. Methods: A prospective descriptive study was conducted in the A&E Department of Mulago Hospital from October 2012 to March 2013. Male and female patients aged 5 years and above with traumatic haemorrhagic shock {systolic BP ≤ 90mmHg for adults and < 70 + (2 x age in years) for children} were recruited consecutively to achieve a sample size of 55 participants. They were then managed according to the ATLS guidelines and followed-up for 24 hours in order to determine mortality/survival, adequacy of resuscitation and distribution of factors known to affect mortality. Data was entered using EpiData 3.1 and analyzed with STATA 12. Univariate and bivariate analyses were carried out. Mortality and adequacy of resuscitation were recorded as proportions while odds ratio and p-values were used for the distribution of factors known to affect mortality. A p-value of 0.05 or less was considered significant. Results: The 24 hour mortality was 16/55 (29.1%) and, 13/39 (33.3%) of the survivors were under resuscitated when clinical signs alone were used to monitor resuscitation. Grade IV shock, time since injury and need for major surgery to control bleeding, significantly affected mortality. Conclusion: The 24 hour mortality due to haemorrhagic shock at Mulago Hospital is slightly lower than that reported in some studies but strategies to reduce it further need to be explored.