Pattern of Organ Disruption, Management and Outcomes in Adult Patients With Blunt Abdominal Trauma in Kenyatta National Hospital

Abstract

Background: Blunt abdominal trauma (BAT) is a common condition encountered in daily clinical practice worldwide. Many factors interact to determine the outcome of patients. Institutions even in the same country report different mortality rates and complication rates. Operative and non-operative management options are employed depending on the clinical scenario. Information on Injury patterns, management and outcomes of BAT patients in Kenyatta National Hospital (KNH) is unavailable. Objective: To determine the patterns of organ disruption, management, and outcomes of adult BAT patients in KNH. Methodology: This was a longitudinal observational study. It was conducted at the general surgery, orthopaedic and neurotrauma surgical wards of Kenyatta National Hospital (KNH). A total of 176 adult patients were consecutively recruited into the study. Organ injury was graded using the American Association of surgery in Trauma (AAST) grading system as found on abdominal Computer Tomography (CT) images or laparotomy findings. The New Injury Severity Score (NISS) was calculated from the Abbreviated Injury Score (AIS) to determine severity of patient injury. Patients were followed up from admission to discharge, death or thirty days. Demographic characteristics, Length of stay (LOS), blood transfusion, admission into the critical care unit (CCU) and extra- abdominal injuries were recorded. Data analysis: SPSS version 26.0 was used for data analysis. Means, mode, median and frequencies were used for descriptive statistics. Chi square test was used for categorical testing xii between occurrence of outcomes and demographic and clinical characteristics. Logistic regression was used for multivariate analysis to assess the risk factors for mortality. A p value of 0.05 or less was considered statistically significant. Results: Out of the 176 patients recruited, 164(93.3%) were male with a male to female ratio of 13.7:1. Mean age was 30.3 years with a range of 18- 62 and median of 28. A total of 127(73.3%) aged between 20-40 years. Road traffic accidents (RTA) were the leading cause of BAT in 133(76.7%) of the participants. The mean duration from injury to KNH was 13.72 hours with a range of 1-312 hours. The liver was the most common injured organ in 95(54%) participants. Extra abdominal injuries were present in 87(49%) with long bones injuries the commonest in 38(21.6%). The mean NISS was 14, range of 1-36 and a median of 13. A total of 108(61.9%) had successful non-operative management (NOM), while 53(30.1%) had laparotomy immediately after admission. The remaining 14(7.9%) had failed NOM. The mean LOS was10.9 days with a range of 1-30 days. There were 26(14.8%) mortalities and 13(8.7%) complication rate among the survivors. The commonest complication was surgical site infections (SSI) in 8(5.3%) cases. High score on NISS (Odds ratio (OR): 2.53, P=<0.039), preoperative hemodynamic instability (OR:6.55, P=<0.001) and blood transfusion (OR:0.11, P=<0.001) significantly predicted mortality. Conclusion: the leading cause of BAT was RTA and the liver was the most common injured organ. It was associated with other body region injuries in half of the participants. Severe injury in NISS, preoperative hemodynamic instability, ICU admission and blood transfusion significantly predicted mortality.