Original Article The AnnAls of AfricAn surgery | www.sskenya.org The Pattern and Outcome of Chest Injuries in South West Nigeria Author: Ogunrombi A.B. 1 FWACS, MSc(Med)CTS, Onakpoya1 U.U. FWACS, Ekrikpo U.2 MBBS, MSc(Med), Adesunkanmi A.K. 1 FWACS, FICS, Adejare I.E. 1 MBBS Affiliations: 1- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife 2- Department of Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria Correspondence: Akinwumi B. Ogunrombi Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria. +2348062279218 Email- [email protected] Abstract Objective: The pattern and management outcome of chest injuries deaths (56%) in those with severe ISS. Majority of patients (51.8%) presenting to our tertiary university hospital located in a semi-urban required only analgesics, while additional closed tube thoracostomy population in the South West of Nigeria, has not been documented drainage was necessary (41.8%) in the others who suffered blunt previously. We therefore sought to identify factors that may contribute trauma. Thoracotomy was indicated for only 5 (4.5%) penetrating to mortality. injuries. There is a rising trend towards penetrating gunshot injuries, Method: We analyzed 114 patients presenting to the Accident and with mortality increasing with age (p=0.03) and severity of associated Emergency Unit with chest trauma, prospectively entered into a data injuries (ISS) (p=0.003). base over a two year period. Conclusion: Majority of the patients required only minimal interven- Results: Chest trauma accounted for 6% of all trauma admissions tion with chest drainage or analgesics, with low mortality. Increasing with a male preponderance (M:F = 3.6:1). Rib fractures were the most age and severity of injury contributed significantly to mortality. Initia- common injury (46.3%) while limb fractures were the most common tion of care for chest trauma victims is still delayed in our centre. associated injury (35.8%). Associated head injury accounted for most Introduction Patients and Methods Trauma is a leading cause of morbidity and death in de- The Obafemi Awolowo University Teaching Hospital, Ile- veloping countries with thoracic trauma contributing sig- Ife, (OAUTH), is a major trauma referral center in South nificantly to these figures especially where infrastructure Western Nigeria with compliment of specialists in all ma- and personnel are ill equipped to cater for these critically jor surgical and other disciplines. The Accident and Emer- ill patients. It is estimated that death from unintentional gency Unit of the hospital is a 15- bedded ward staffed trauma is on the increase in developing countries though by trauma doctors and nurses overseen by a trauma con- not as significantly as that from infectious diseases like sultant, while a 6-bedded Intensive Care Unit caters for diarrhoea and malaria, while it is on the decrease in in- the critically ill. The hospital is strategically positioned in dustrialized countries (1). Previous reports on incidence a network of highways linking major cities in the South of blunt versus penetrating injury from Nigeria have been West and other parts of Nigeria. conflicting depending on the urbanisation of the region All patients with blunt or penetrating chest trauma as well as prevailing circumstances of peace or regional presenting to the Accident and Emergency Unit of the armed violence which occur sporadically (2-3). OAUTH, Ile-Ife and having had appropriate chest radio- We have examined the spectrum of these civilian chest in- graphs, were prospectively entered into a database which juries during times of peace to determine the incidences was collected over a period of two years (May 2008 – of blunt and penetrating injuries and the outcomes of April 2010). All patients who did not require chest radio- our management strategies, evaluating the emergency graphs after careful physical examination were excluded room initiation of care for these critically ill patients to from the analyses. determine factors that may contribute to mortality and The demographics, mechanism of injury, time to presen- ascertain whether our current setup is achieving results tation, vital signs on admission, injury sustained, Injury comparable with other trauma centers. Severity Score (ISS) as well as management instituted were evaluated. The AnnAls of AfricAn surgery • Volume 9 • July 201215 78 The ANNALS of AFRICAN SURGERY. July 2012 Volume 9 Issue 2 The AnnAls of AfricAn surgery | www.sskenya.org Original Article The ANNALS of AFRICAN SURGERY | www.sskenya.org OriginalOriginal article a rticle The PatternTh ane dP atteOutcomrn aned o Outcomf Chest eInjurie of Chess int InjurieSouth sW iesn Soutt Nigheria Wes t Nigeria Ogunrombi A.B.Ogunromb, Onakpoyi A.B.a U.U., Onakpoy, Ekrikpao U.U.U., Adesunkanm, Ekrikpo U., iAdesunkanm A.K., Adejarei A.K.I.E. , Adejare I.E. ContinuousContinuou variables wser veariable summarizes were dsummarize using meands usin andg means injurand y than injurthe ydri thavern o fth ae budrisv e(p=0.r of a0 2)bu. sSea (p=0.t bel0t2) usage. Sea t belt usage The Pattern and Outcome of Chest Injuries in standard deviationstandarsd odeviationr medianss oanr dmedian inter-quartils and intere ranges-quartil e rangeswas low at 8.3wa%s lowitw ha tonl 8.3y% 36 wit% ho fonl driyv er36s% usin of gdri seavert sbelts usin g seat belts South West Nigeria (IQR) for th(IQRe highl) foy r skethew highled variabley skews e dan vdariable analyzes and dus analyze- d a tus th- e time oaft ththee accident.time of th e accident. ing two-samplinge ttw-teso-tsampl or Wilcoxoe t-testn o rrank Wilcoxo-sum ntest rank. Discrete-sum test . DiscreteThe most commoThe mosn injurt commoy weren ri injurb fracturey weres ri(46.3%b fracture) whiles (46.3% ) while variables wervariablee summarizes were dsummarize as countsd anasd count percentagess and percentages49 (44.6% ) 4ha9 d(44.6% hemothora) had x hemothora and 34 (3x0.9% and ) 3presented4 (30.9% ) presented Author: Ogunrombi A.B. 1 FWACS, MSc(Med)CTS, Onakpoya1 U.U. FWACS, Ekrikpo U.2 MBBS, MSc(Med), Adesunkanmi and compareandd usincompareg Chi-dsquar usinge tesChit -osquarr Fishere tes’st exacor Fishert test ’s exact wittesth pneumothorawith pneumothorax both necessitatinx both gnecessitatin chest drainagg chese. t drainage. A.K. 1 FWACS, FICS, Adejare I.E. 1 MBBS Affiliations: 1- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife 2- Department of Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria Correspondence: Akinwumi B. as appropriatase .appropriat A multivariate. Ae multi logistivariatc regressioe logistinc modelregressio n modelThe most commoThe mosn extrathoracit common extrathoracic injuries werc injuriee limbs frac wer-e limb frac- Ogunrombi Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria. was used to widentifas useyd factorto identifs thayt arfactore independentls that are independently associ- y associture-s in 29 ture(35.8%s in )2 an9 d(35.8% head )injur andy hea in d2 4 injur (29.6%y in ) 2pa4 -(29.6% ) pa- +2348062279218 Email- [email protected] ated with mortalitated wity.h P -mortalitvalues lesy. sP -thavaluen 0.s 0les5 sw thaeren consid 0.05 w- ere considtient- s. Abdominatients.l Abdominainjuries werl einjurie seen si nw 8er (9.9%e seen) ipatientn 8 (9.9%s. ) patients. ered statisticallereyd significantstatistically. Thsignificante data w. aThs analyzee data dw ausings analyze d usingThe medianTh ISeS mediascore wn aISs S9 scor(interquartile was 9 (interquartile range 4 – e18). rang e 4 – 18). Abstract Stata versionStat 10.a Statacorpversion 1,0 .T exaStatacorps, USA., Texas, USA. Figure 2 showFigurs the e2 proportioshows then proportioof individualn ofs individualwith ISS s with ISS This study wThias sappr studoyv ewda sb yappr the oHospitalsved by th’ e EthicaHospitalsl Com’ Ethica- l Comscor-e less thascorn 16e ,les 16s tha– 2n4 16an,d 1greate6 – 24r thaandn greate24. Our rtha studyn 24 . Our study Objective: The pattern and management outcome of chest injuries deaths (56%) in those with severe ISS. Majority of patients (51.8%) presenting to our tertiary university hospital located in a semi-urban required only analgesics, while additional closed tube thoracostomy mittee. mittee. showed a mediashowend IS aS mediaof 27 n(IQ ISRS o23.5f 27- 36(IQ) Rin 23.5those-36 who) in those who population in the South West of Nigeria, has not been documented drainage was necessary (41.8%) in the others who suffered blunt died and a mediadied ann dIS aS mediaof 9 (IQn RIS S4 -o16f 9) (IQin thosR 4e-16 wh) oin surthos- e who sur- previously. We therefore sought to identify factors that may contribute trauma. Thoracotomy was indicated for only 5 (4.5%) penetrating ResultsResults vived. vived. to mortality. injuries. There is a rising trend towards penetrating gunshot injuries, Method: We analyzed 114 patients presenting to the Accident and with mortality increasing with age (p=0.03) and severity of associated Emergency Unit with chest trauma, prospectively entered into a data injuries (ISS) (p=0.003). DemographicsDemographics TreatmentTreatment base over a two year period. Conclusion: Majority of the patients required only minimal interven- Out of a totaOul to fo 184f a 7tota patientl of 184s admitte7 patientd tso admittethe Accidentd to th e AccidentFifty three (48.1%Fifty thre) hae d(48.1% closed) tubhade closethoracostod tubem thoracostoy drain- my drain- Results: Chest trauma accounted for 6% of all trauma admissions tion with chest drainage or analgesics, with low mortality. Increasing and Emergencandy UniEmergenct folloywin Unig ttraum followina during traumg thea studyduring the studyage (CTTD)ag aes (parCTTDt of) theias parr treatment of theitr wit treatmenh 26.4%t wit inh- 26.4% in- age and severity of injury contributed significantly to mortality. Initia- with a male preponderance (M:F = 3.6:1).