Aetiological spectrum, injury characteristics and treatment outcome of multiple injuries at a tertiary care hospital in Tanzania

Background: Multiple injuries constitute a public health problem and contribute significantly to high morbidity, mortality and long-term disabilities worldwide. This study describes the etiological spectrum, injury characteristics and treatment outcome of multiple injuries at a tertiary care hospital in Tanzania.
Methods: This was a descriptive prospective study involving multiple injury patients admitted to Bugando Medical Centre (BMC) from March 2013 to June 2013 inclusive.
Results: Out of 712 trauma patients who were admitted to BMC during the study period, 150 (21.1%) had multiple injuries. Their male to female ratio was of 2.3:1. The majority of patients were in the second decade of life. Road traffic accidents (RTAs) were the most common (93.3%) cause of injury. The majority of patients, 142 (94.7%) sustained blunt injuries. Twelve (8.0%) patients had pre-hospital care. The limbs (89.2%) and the head (78.7%) were the most common body regions injured. The majority of patients (85.3%) sustained severe injuries (ISS ≥ 16). Out of 150 patients, 46 (30.7%) had 65 missed injuries. A total of 142 (94.7%) patients were treated surgically. Wound debridement (87.3%) was the most common surgical procedure performed. The complication and mortality rates were 54.7% and 38.7%, respectively. The overall median length of hospital stay (LOS) was 23 days. Co-morbid illness, HIV positivity, CD4 count (≤ 200 cells/μl), severe trauma (ISS ≥ 16), admission Systolic Blood Pressure < 90 mmHg, missed injuries and surgical site infection significantly influenced mortality (P < 0.001). Patients who developed complications and those who had long bone fractures stayed longer in the hospital (p < 0.001).
Conclusion: Road traffic accidents remain a major cause of multiple injuries at BMC and contribute significantly to unacceptably high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of multiple injuries in our centre.

Keywords
multiple injuries; etiological spectrum; injury characteristics; treatment outcome; Tanzania