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Clinico- demography profile and outcome of trauma patients admitted in the emergency department of a tertiary care teaching hospital in eastern nepal: a retrospective study

Author: 
Yadav, A K., Niraula, S.R., Giri, R., 1Paudel, M., Giri, S. and Chaudhary, R.
Subject Area: 
Health Sciences
Abstract: 

Background: Trauma is a major increasing cause of morbidity and mortality in both developed and developing countries like Nepal. The traumatic injuries account for major financial loss and may lead to permanent deformities and dysfunction leading to mental and psychological health problems. According to the Nepalese Ministry of Health and Population, unspecified Injuries are the third largest single cause of hospitalization and 10% of Nepal’s total burden of diseases. This study was done to improve the understanding of differerent spectrum, the mode of trauma, severity of injuries, and outcome of trauma victims in our hospital. Materials and Methods: This was a retrospective observational study of all adult trauma patients more than 18‑year‑old presenting to our emergency department (ED).Details of the incident in terms of causes, severity, mode, and outcome of injuries were noted. RESULT: Most vulnerable age group for traumatic injuries was between 20-40 years. The gender distribution was 70% males and 30% females. 80% patients arrived in Emergency ward beyond one hour of accident ( golden hours) between 8 am to 5 pm being stayed 24 hours. Fall from height on the ground (45%) was the most common mode of injury, followed by Road traffic injuries (41%), cut injuries (7. 5%),trauma related assault, sports and animal injuries (6.2%) electrical injuries (0.7%), industrial injuries 0.3% Regarding implementation of Australian triage system (ATS) in relation with different mode of trauma, fall from height( (137), out of which ATS 2 was 6, ATS 3 was 114 and ATS 4 was 17),Road traffic injury(124) out of which ATS 2 was 12, ATS 3 was 100 and ATS 4 was 12. Regarding implementation of ATS scoring in relation with injured area involved, upper extremity (130) out of which ATS 2 was 5, ATS 3 was 108 and ATS 4 was 17, Lower extremity (119) out of which ATS 2 was 10, ATS 3 was 98, and ATS 4 was 11. Extremity injuries (upper and lower limbs) were the most common injuries seen in 70% of patients followed by traumatic brain injury (TBI) (7%), thoracic injuries (6%), abdominal injuries (6%), Spinal injuries 6%, facial injuries (3.4%) and neck injuries (0.8%) with two wheeler accidents contributing to the majority.78% patients had moderate severity of injury, 17% had minor injury and 4% had serious injuries and 0.7% had severe injury. Emergency Department(ED) team alone managed around half of the patient (50%), while around 50 % patients were admitted in different wards for further evaluation and treatment in terms of either conservative management or surgical interventions. 42% were discharged in a stable condition.2% were gone on left against medical advice (LAMA),1% referred to other centre. out of which 49% patients had managed operative followed by 51 % had non operative .Conclusion: Falls and Road traffic injuries are the predominant causes of trauma. A. simple scoring system such as Australian triage system (ATS has been used to prioritize injured patients according to urgency.

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