Paediatric trauma in hospitalised patients as seen at Kenyatta National Hospital

Abstract

In low, middle and high income countries, injuries are identified as the most important preventable cause of death and disability for children beyond the first few months of life. There is little data on paediatric trauma in developing countries. This study aimed at giving an indication of the epidemiology of paediatric trauma in Nairobi by prospectively studying the pattern at Kenyatta National Hospital (KNH). Kenyatta National Hospital as a national referral and teaching hospital. Approval from the Ethical and Research Committee of KNH was given on is" October 2003. Trauma patients admitted to KNH and aged 13 years and below were consecutively recruited for a 9 months period. Data on demographics, place, cause, intent, anatomical deformation and cause of the injuries was collected by the use of a pre-coded questionnaire. The results are summarised and presented with a view to highlighting exposure factors key in addressing childhood injury prevention. Objectives: Broad Objectives: To identify causes of trauma in paediatrics and short term outcomes of hospitalisation at KNH Specific objectives: l. Identify the causes of trauma in the paediatric age group. 2. Describe demographic characteristics of the study patients. 3. Identify pre-hospital events such as first aid given, mode of transport 4. Describe the short term outcome of hospitalization Methodology: This descriptive prospective study was carried out from October 2003 to July 2004 at KNH. During the study, patients 13 years and below who were admitted to KNH with trauma had their parents/guardians fill questionnaires prepared to accomplish the above objectives. Results: One hundred and eighty seven patients were recruited into the study. The outcome of the study was that the commonest cause of trauma is burns with 34.8% of cases followed by foreign bodies, 17.6%, falls from height 14.4% and fall from level ground 10.7%. The other causes accounted for the rest. More male patients 53.5% got injured compared to female patients 46.5% and the commonest place of injury was at home accounting for 78.1 % followed by the streets and the school. Non intentional causes of injury accounted for 82.4% of those injured while 63.1 % of those injured had first aid given prior to admission at KNH. The mode of transport to the hospital was by public transport in 57.2% of the patients, 16.0% by taxi, and 13.4% by ambulance and private vehicles. At casualty, 50.3% were seen by medical officers, 41.7% were seen by senior house officers while 8% were seen by consultants at triage. By the time the study was completed, 89.3% had been discharged, 1.1% (2 patients) had died and 9.6% were discharged with deformity. Distribution of places of residence for these patients revealed that 25.7% came from Westlands, 24.1 % Northlands, 16.6% Eastlands and 12.8% Southlands. The rest were referrals from outside Nairobi. Injuries occurred during the day in 63.1 % while 26.7% occurred at night. Time of injury for the rest could not be determined. Conclusions: From the study, burns is a major cause of trauma in children followed by foreign bodies and falls from a height in trauma. Boys are affected more than girls. Patients come mainly from the western and northern regions of Nairobi. Public transport is the main mode of transportation to the hospital. Injuries occurred more during the day than at night and medical officers in casualty saw most of the patients first. Two patients died in the study.