Pattern and outcome of abdominal injuries at Kenyatta National Hospital, Nairobi..
East Afr Med J. 2006 Jan;83(1):37-43. : 1999 Abstract
OBJECTIVE: To establish the pattern and results of interventions in patients with abdominal injuries requiring admission. DESIGN: A descriptive, prospective, hospital-based study involving observation of patients from admission to final outcome of management as either discharged or deceased. SETTING: Kenyatta National Hospital, a tertiary teaching and referral hospital in Nairobi, Kenya, from November 2004 to February 2005 in the adult general surgical wards. PATIENTS: Eighty consecutive admissions of adult patients with either blunt or penetrating abdominal injuries. MAIN OUTCOME MEASURES: Type and cause of injury, demographic data, temporal parameters, morbidity and mortality. RESULTS: The 80 patients had a male to female ratio of 12.3:1, the majority were in the third decade of life with a range 15-56 years and mean of 28.2 years. Penetrating to blunt abdominal injuries had 2:1 ratio with the leading causes of injury being stab wounds, gunshot wounds and road traffic accidents. Blunt abdominal injuries had a higher tendency to extra-abdominal injuries. Duration prior to presentation to hospital and surgery depended on severity of injury. Modes of management varied between attending surgical firms. There was a 20% change in the mode of management and a 16.1% rate of negative laparotomy. Penetrating injuries had a better interventional outcome. Penetrating abdominal injuries had higher rates of complications while the blunt injuries had higher rates of mortality. Overall, both the complication and mortality rates were 12.5%. Correlates of mortality included delay before surgery, associated injuries, need for blood transfusion, admission to intensive care unit and duration prior to admission. Abdominal injury patients stayed an average of 6.4 days with the blunt injuries with complications staying close to twice as much as their penetrating counterparts. CONCLUSION: Abdominal injuries are a predominantly male disease with the majority in the third decade of life. As opposed to previous studies, gunshot wounds are now a significant cause of abdominal injuries in Kenyatta National Hospital (KNH). The rate-of negative laparotomies has come down by 10% over the past 15 years. The outcome of management depends on the severity and type, of injury sustained.