Characteristics, management and outcome of patients with blunt abdominal injury at Moi Teaching and Referral Hospital, Eldoret Kenya.

Abstract

Background: Blunt abdominal trauma (BAT) is physical injury caused by transfer of energy to and within the person involved by non-penetrative mechanism to the abdomen. BAT remains one of the commonest causes of morbidity and mortality in patients with multiple injuries. Three mechanisms are involved, deceleration, crushing and compression. MTRH handles a significant proportion of these patients and local data is not available on their characteristics, management and outcome. This study was therefore necessary to generate MTRH data which will form the baseline in management of patients with BAT. Objective: To determine the characteristics, management and outcome of patients with blunt abdominal trauma at the MTRH. Methods: The study was carried out at the emergency department and surgical wards at MTRH. The study included Patients who presented with blunt abdominal trauma and met the inclusion criteria at the MTRH between October 2013 and September 2014.This was an observational cross sectional study that used the consecutive sampling technique. A total of 34 patients met the inclusion criteria and were all included. Data was collected using a standardized questionnaire, clinical examinations and review of medical records. The data was analyzed and presented in form of percentages and ratios. Results: A total of 34 patients, (29 males, 5 females) were studied, with a male to female ratio of 6:1.A median age of 29yrs (IQR 13, 36) with a range of 3yrs to 65yrs. Majority of patients 19 (55.9%) presented to the hospital more than 12hrs after injury. The commonest mechanism of injury was Road traffic accident 16 (46.1%) and they comprised of 8 (23.5%) motor bike accidents 6 (17.6 %) public service vehicles and 2 (5.9 %) personal vehicles while the spleen and mesentery were the commonest location of injury 13 (38.3%). Majority of patients 19(55.9%) presented to hospital more than 12 hours after injury. During presentation 30 (88.2%) patients were hemodynamically stable. The main presentation was abdominal pain 34 (100%) and vomiting 11(32.4%). Nausea was the least presentation 3 (8.9%).Tenderness and guarding were the main signs at 31(91.8%) and 12 (35.3%) of patients respectively. A total of 16 patients underwent laparotomy giving an operative management rate of 47.1%. Non operative management rate of 53%with a non-operative management failure rate of 11.1%. Complications occurred in 4 patients giving a complication rate of 11.8%. An overall mortality of 2.9% was observed in this study and this was attributed to multiple injuries, delayed presentation and a low Glasgow coma scale. Conclusion: Road traffic accident is the leading cause of blunt abdominal trauma at MTRH with the spleen and mesentery as the commonest injured intra-abdominal organs. Late presentation and multiple injuries were associated with poor outcome in patients with blunt abdominal trauma. Recommendation: Creation of public awareness on the importance of early presentation to hospital after BAT. Timely diagnosis and management of blunt abdominal trauma should be encouraged to reduce on morbidity and mortality. Nonoperative mode of management to be encouraged.