Pre-hospital care of patients with lower extremity fractures presenting at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Prehospital trauma care of patients with lower extremity fractures, a common injury in Kenya, influences morbidity and mortality. Delayed presentation of patients with lower extremity fractures can lead to life and limb threatening complications. Prehospital care consists of resuscitation, splinting, analgesics and transport to a trauma center. Objective: To assess the prehospital trauma care given to patients with lower extremity fractures presenting at Moi Teaching and Referral Hospital (MTRH). Methods: This was a Cross-sectional study conducted between 1st January 2017 and 31st December 2017 on adult patients with lower extremity fractures presenting at the Emergency department (ED), within forty-eight hours of injury. Systematic sampling of 196 patients out of the 400 seen annually with lower extremity fractures was done by selecting every second patient. Data was collected using interviewer administered questionnaire and clinical examination on patients at various stages of hospital experience. Associations between categorical variables were assessed using Pearson‘s Chi Square and Fisher‘s exact test. Variables found to be significant at bivariate level were fitted in to a multiple binary logistic regression analysis. Results: The male to female ratio was 5:1 with a median age of 35.5 (IQR 27, 50). The Injury severity scores (ISS) median was 9 (IQR 9, 13). Out of the 196 patients, those with closed fractures were 133 (68%). Road traffic accidents (RTA) were responsible for 149 (76%) of the patients and falls in 31 (16%). Findings indicated that initial first aid and extrication from injury site was by: bystanders in 135 patients (69%), ambulance personnel 44 (22%) and police 16 (8%) patients. Only 96 of the victims (48%) were transported to hospital by ambulance, while the rest were moved by public service vehicle 59 (30%), private vehicle 20 (10%), motorcycle 12 (6%) and police vehicle 9 (4.6%). Sixty seven (34%) patients arrived at ED within one hour after injury. Prehospital time was significantly lower (p=0.03) in those involved in RTA compared to other causes of injury. Most patients 141 (72%) had not received any analgesics before arrival. Haemorrhage control, dressing of open wounds and intravenous fluid resuscitation was carried out in 19 (30%), 28 (44%) and 12 (19%) patients with open fractures respectively. After multiple logistic regression, open fractures (p=0.003) and transport by ambulance (p=0.004) were significantly associated with adequate prehospital care. Conclusion: Road traffic accident was the major cause of lower extremity fractures and affected mostly young men. Most patients with lower extremity fractures had multiple injuries. A third of patients with lower limb fractures presented within the ―golden hour‖ of trauma and half of the injured patients were transported to hospital by ambulance. Recommendation: The national, county governments and non-state actors establish a formal prehospital trauma protocol and service, for safe care and expeditious transport of patients with lower extremity fractures.