Injury characteristics and Sub-Acute phase disabilities amongst hospitalized and non-hospitalized road traffic injured patients managed at Webuye County Hospital, Kenya

Abstract

Background: Globally 20-50 million people suffer road traffic injuries (RTIs) and majority lead to disabilities. Outcomes of RTI amongst Inpatients (hospitalized patients) have been widely studied in Kenya whereas very few have followed up the outpatient (non-hospitalized) group whose injuries mostly have been considered minor. Studies have reported significant disability among the non-hospitalized victims. This study investigated sub-acute phase disabilities (SAPDs) that is disabilities between ten and twelve weeks post injury amongst hospitalized and non-hospitalized patients and factors associated with SAPDs. Objective: To determine characteristics of Road Traffic Injuries and sub-acute phase disabilities amongst hospitalized and non-hospitalized patients managed at Webuye County Hospital Methods: A prospective cohort study of 184 participants was done in the emergency department and surgical wards in Webuye County Hospital. RTIs were dichotomized into hospitalized (n=92) and non-hospitalized (n=92). Patients who met the inclusion criteria and consented were consecutively sampled. Interviewer-administered questionnaires were used to collect socio-demographics and injury details. Injury severity was assessed using the Kampala trauma score. SAPDs were assessed using the World Health Organization disability schedule (WHODAS) tool 8-10 weeks post injury. Categorical variables were summarized as frequencies and percentages and continuous variables as means and median. Chi-square and Fisher’s exact tests were used to check for associated factors to SAPDs. A p value ≤0.05 was considered significant. Results: The ages of the patients ranged from 16 to 63, mean age of 33.8 (SD 13.7) and a male:female ratio 3:1. Most of the victims (72.8%) were either unemployed or casual laborers. Some patients had multiple injuries but the most prevalent were lower limbs (69.5%), upper limbs (43.5%) and head/face (32.1%). On injury severity, 73.9 % of the hospitalized patients had mild injuries and 25% moderate injuries while 91.3% of the non-hospitalized were mild and 8.7% moderate. Most patients suffered severe SAPDs (hospitalized 92.4% , non-hospitalized 66.3%). Factors associated with with severity of SAPDs were hospitalization with an adjusted risk ratio (ARR) 1.406 (p<0.001) and multiple injuries ARR 1.298 (p=0.001). Conclusions: Even though the hospitalized group had a higher proportion of severe SAPDs , more than half of the non-hospitalized group had severe SAPDs as well. Recommendations: An assessment for SAPDs should be made for the non-hospitalized patients and prompt follow up made.