Surgical emergencies in a Nigerian university hospital

Abstract

An audit of surgical emergencies was carried out to monitor acute trauma care and determine areas needing clinical improvement. This is essential for the development of institutional and national health policies on trauma and non-trauma diseases. All patients attending the surgical Accident and Emergency were studied prospectively from September 1999 to August 2000 to obtain their age, sex and diagnosis and to determine causes and injury-arrival time for trauma cases and the outcome of care for all cases. Out of 2,455 patients comprising 1,696 males and 759 females (M:F = 2.2:1) age range two weeks to 95 years, trauma accounted for 1,679 (68.4%). The median age (and the mode) of presentation overall and in males was in the third decade. Females had a 'plateau' age of presentation for the first four decades before the gradual fall to zero. Superficial skin trauma (lacerations, abrasions and bruises) represents the commonest presentation (16.1%) followed by fractures (13.9%), acute abdominal conditions (7.6%), head injury, HI (5.5%), multiple injury (4.1%), urinary retention (3.3%), burns and scalds (3.3%) and others. Eight-one patients died, comprising 54 males and 27 females, out of which 64 were trauma related deaths. Most common causes of death were HI (35 patients, 43.2%) and septicaemia (13 patients, 16.0%). Late presentation and poor finances contributed to the deaths in patients with septicaemia. Trauma is an important entity in our emergency practice. Prompt access to surgical care should reduce the morbidity and mortality from acute abdominal conditions and HI. The high incidence of urinary retention requires further analysis. Statistics of this nature can aid planning of care delivery and study of preventable deaths.