Etiology, pattern and outcomes of abdominal injuries among patients admitted at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Abdominal injuries are common surgical emergencies across high, middle and low-income countries. This can be attributed to increased road traffic accidents (RTAs), falls, sports, agricultural and industrial injuries, animal injuries, violence and crimes. The proportion of abdominal injuries varies from 1 to 30% of all injuries and most common in the first four decades of life. Abdominal injury remains to be a distressing frequent cause of preventable death. Infectious complications are common and hospital stay varies depending on etiology and whether injuries were blunt or penetrating. Indicators of patient outcomes include; etiology of injury, polytrauma, injury score, admission to ICU and blood transfusion. Objective: To describe the etiology, pattern and outcomes of abdominal injury among patients admitted at Moi Teaching and Referral hospital. Methods: A hospital-based prospective and descriptive study employing a census sampling method. Data was collected between 1st of June 2018 and 31st of June 2019. Ninety-seven (97) participants were recruited from the adult and pediatric surgical wards as well as ICU. Demographic data was analyzed for frequencies, means, standard deviations and percentages using STATA version 15 and presented in frequency tables. Type of trauma and intra-abdominal injury sustained were individually subjected to univariate analysis and their frequency distribution reported in tables and graphs. Bivariate regression analysis was used to determine the correlation between etiology of trauma and intra-abdominal injury sustained, penetrating, BAT and whether one underwent laparotomy against outcomes. Clinical factors were subjected to multivariate analysis against three outcomes; length of hospital stay (LOS), infectious complications and mortality within admission and at 30 days post-injury. Results: Out of 97 participants, 75 were male and 22 female giving a ratio of 3.4:1. The mean age was 27.8±12.9 with a range of 2 to 63 years. Majority 66(68%) of the participants were between 20 to 40 years and a greater proportion 42(42.3%) were casual laborers. RTAs were the leading cause of injuries 43(44.3%). Within the RTAs category, there were 27(62.3%) motorcycle accidents hence emerging as the overall leading cause of injuries. Blunt abdominal injuries were the majority 63(64.9%). Commonly injured organs were liver 20(20.8%), small gut 19(19.8%) and spleen 16(16.7%). Median LOS was 7(5, 14) days while those who had infectious complications were 12(12.4%). All mortalities 4(4.1%) had sustained BAT. Injuries associated with admission to ICU and blood transfusion had statistically significant influence on all the three outcomes; LOS (P=; 0.001, 0.003), infectious complications (P= <0.001, 0.03) and mortality (P= <0.001, 0.009) respectively. Conclusions: RTAs, motorcycle accidents in particular, were the leading cause of abdominal injuries. Solid organs were the most frequently injured. Despite a low mortality rate, BAT likely carries a higher risk of death than penetrating trauma. Injuries requiring admission to ICU and blood transfusion were independent predictors of adverse outcomes. Recommendations: Further studies are required to establish the causes of rising RTA incidence. Surgeons should maintain a high index of suspicion for solid organ injuries in patients with abdominal trauma.