Measurement of the Magnitude of Injury: A Review of the Trauma Scoring Systems

Background: Trauma scoring systems are a vast, ever expanding and often confusing field. There is a need for trauma surgeons, residents and all who manage trauma to be conversant with the more frequently used systems in order to be able to appreciate changes in trauma care emanating from trauma research.Objective: To review the current trauma scoring systems with a view to highlighting their various bases, strengths, weaknesses and areas of applicability.Methods: Literature review of the current trauma scoring systems was done using textbooks, journals and internet searches mainly with pubmed and Medline.Results: There are a plethora of trauma scoring systems. All have their various strengths and weaknesses. Different systems perform differently in different situations depending on which outcome parameter is of interest. The more frequently used systems such as the AIS, ISS and TRISS are discussed in detail.Conclusion: Although trauma scores are not designed for clinical decision making in individual patients, a good understanding of the basis of the more commonly used systems will enable doctors involved in the care of trauma patients to appreciate changes in patient care algorithms emanating from trauma research

Orthopaedic Injuries in Patients with Polytrauma: The Jos Experience and a Review of Literature

Background: Orthopaedic injuries constitute a major part of polytrauma. Treatment trends are evolving. In order to determine what is best for our environment, there is a need to define the magnitude of the problem.Aims and objectives: To describe the frequency of occurrence and pattern of distribution of orthopaedic injuries those occur in patients with polytrauma as well as carry out a review of relevant literature.Patients and Methods. This is a one-year prospective study of patients with polytrauma from which an analysis of orthopaedic injuries was performed. Patients were recruited at the point of presentation in the accident and emergency department and followed up to the point of discharge.Results: One hundred and twenty eight patients were recruited out of which orthopaedic injuries constituted 84 (64.1%). Lower limb injuries predominated in 63 (77%), with tibial fractures being the most common in 40 (49.6%) patients. Head injuries were the most frequent associated injuries in 57 (67.9%). Only three (3.6%) patients had operative treatment and all were delayed procedures. Eighty one (96.7%) were either managed non-operatively, or refused hospital treatment. Complications rate was 11.9%, mainly wound infection in compound fractures. Mortality rate was 7.1%, all had associated severe head injury. 33% of the patients discharged themselves against medical advice and opted for traditional bone setting.Conclusion: Orthopaedic injuries constitute a major part of polytrauma. Lower limb injuries predominate. Head injuries are the most common associated injuries and account for most of the early mortality. Increased operative management is advocated because of established advantages in literature.Key words: Orthopaedic injuries, polytrauma, trauma

The Influence of Craniotrauma on the Outcome of Polytrauma 1 2

Background: Polytrauma is often associated with poor outcome. This is frequently attributed to head injury which is present in a high proportion of such patients. This study examines the influence of head injury on the outcome of polytrauma in a tertiary health institution in Nigeria.Methodology: A prospective design in which consecutive patients presenting with polytrauma were recruited. They were categorised into those with head injury (A) and those without head injury (B). Out of group A, those in whom head injury was severe (GCS 3 - 8) was extracted and studied ( A1). Data were entered into a proforma and the Epi info 3.2.1 software was used for the statistical analysis. Specifically, the injury severity score, length of hospital stay, morbidity and mortality were compared in the groups.Results: One hundred and twenty eight patients with polytrauma were studied. There was head injury in 90 patients (A) and no head injury in 38 (B). Of the head injured patients, 13 had severe head injury (A1). There were no statistically significant differences in injury severity score (p=0.7), length of hospital stay (p=0.8), morbidity (p=0.5) or mortality (p=0.48) between the head injured (A) and the non-head injured (B) groups. Severe head injury (A1) was however associated with statistically significant increase in injury severity score (

Letter to the Editor: Sacrococcygealteratoma In An Adult Female Nigerian

Sacrococcygeal teratoma (SCT), though rare, is the most commonly diagnosed childhood tumor, occurring in about 1: 40 000 live births.1,2 Said to arise from the primitive totipotent cells of Hensen\'s node,3 it is usually diagnosed at birth because of its obvious nature and delayed presentations are unusual. It has a risk of malignant transformation that parallels the age of the patient. Annals of African Medicine Vol. 7 (3) 2008: pp. 149-15

The burden of morbidity in polytrauma

Background: Trauma is a leading cause of death, hospitalization and disability for all ages under 45years. The development of complications in the clinical course could make management more complex and worsen the outcome. We evaluated our polytrauma patients with a view to elucidating the pattern of morbidity and mortality in our practice.Methods: We prospectively studied the patients presenting to our institution with polytrauma over a one year period. Those who incurred any complications or died in the course of their management were extracted and studied. Survivors were followed up to the point of discharge and for two or three subsequent outpatient follow up visits.Results: 131 patients presented over the study period out of which there were complications in 27 patients (20.6%). The most common complications were wound infections particularly in patients with compound extremity fractures. 80% of the deaths occurred in patients with severe head injury. Mortality was 10(7.6%) ;al l had associated severe head injury.Conclusion: In fectious complications predominate in patients with polytrauma while head injury accounts for most of the mortality among patients presenting to the hospital. A more energetic management of these injuries is advocated as a way of reducing the morbidity and mortality associated with polytrauma.Keywords: injuries, morbidity, mortality, polytrauma, trauma

Outcome of traditional bone setting in the Middle belt of Nigeria

Background: This hospital based study was designed to elucidate the outcome of Traditional Bone Setting (TBS) practice in four states of the middle belt of Nigeria, via complications presenting in select hospitals.Methods: A combination of retrospective and prospective study of complications arising from traditional bone setting in Plateau and Nasarawa States and southern parts of the Kaduna and Bauchi States was undertaken.Results: Fifteen patients were retrospectively studied in the one year period between December 1999 and November 2000 inclusive, while seventy-six patients were recruited into a 1 year prospective study(January 2001 to December 2001). There were sixty-nine males and twenty-two females giving a male: female ratio of 3.1:1. The mostfrequently encountered patients were children in the first decade of life (34.1%), while the 3rd and 4th decades accounted for 20.9% and 18.7% respectively. 61.5% of the study population were residents inJos, Plateau State, and 19.8% were admitted from Nasarawa State. 12.1% came from Kaduna State while 6.6% were recruited from Bauchi State. The study population cut across all social strata with a preponderance of illiterates, children and primary school certificate holders. The presenting injuries clustered around femur, tibia and fibula, humerus and forearm with 19.61 each. These were followed by dislocations of hip, elbow and shoulders (15.2%). The presentation of complications included non union (13.1%), mal union (21.5%), volkman’s ischaemic contractures and compartment syndrome (8.4%), infections (24.4%), stiffness/ankylosis (15.9%) and gangrene (8.4%) among others. Eight two orthopaedic interventions were carried out ranging from minor procedures to open reduction and internal fixations (15.9%), amputations (7.3%) and arthroplasties (4.9%). Five  portalities were recorded giving a mortality rate of (5.5%).Conclusion: 91 complications with 5 mortalities, largely avoidable in two years calls for a serious look at traditional bone setting practice in the Middle Belt of Nigeria. We recommend that other zones undertake similar studies so that a national picture would emerge and policy dialogue initiated

Experience in the management of the mass casualty from the January 2010 Jos Crisis

Background: On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident.Objective: To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010.Methodology: We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010.Results: A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point.Conclusion: This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.Keywords: Conflict, disaster, hospital response, mass casualty, traum