Epidemiology of non-trauma surgical deaths

Abstract

Background and objectives: It is established that 70 % of morbidity and 75 % of mortality in the surgical accident and emergency (A and E) are due to trauma. However, non-trauma deaths still are an important entity requiring a specific study to highlight their pattern, and institute improvement strategies to lower death rates.

Methodology: A retrospective analysis among non-trauma surgical deaths that occurred in the A and E Department of the University of Ilorin Teaching Hospital, Ilorin, Nigeria, over 24 months was done. Data collected included age, sex, interval between onset of illness and presentation, clinical features, occurrence of prior hospital visit, investigations done, cadre of surgeons that reviewed the patients and the interventions done as part of treatment before death.

Results: 4164 patients visited the A and E, 2916 (70 %) were trauma, 1251 (30 %) were non-trauma conditions. There were 171 deaths, 129 (75.4 %) were trauma deaths while 42 (24.6 %) were non-trauma deaths. Thirty (71.4 %) of the 42 had complete information for analysis. Age range was 2-95 years (mean 42.7±21.8 years) comprising 18 males and 12 females. Patients with generalized peritonitis were in the majority 8 (26.7 %) comprising typhoid perforation 4, ruptured appendix 2 and perforated peptic ulcer 2. Terminal malignancies followed closely with 6 deaths (20.0 %), 3 from urological causes (2 prostatic and 1 bladder cancer), acute gastrointestinal bleeding 3 (10 %), intestinal obstruction 1 (3.3 %) and others. Nineteen patients (63.3 %) had visited a previous hospital where they had spent <48 hrs (4 patients), 48hrs-1 week (4 patients) and >1 week (2 patients), undocumented (9 patients). Less than 40% of the patients were able to do the requested investigations (electrolytes, X-rays and ultrasound) or got the desired interventions (blood and antibiotics).

Conclusion: Non-trauma deaths account for a quarter of the deaths in the A and E, generalised peritonitis and advanced malignancies were the main conditions responsible and characterized by late presentation, having spent a considerable time in a previous private hospitals.

Keywords: epidemiology, non-trauma deaths Nigeria

Rsum

Introduction et objectif: On dirait que 70% de la morbidit et 75% de la mortalit dans le service des urgences (SU) sont attribuables au traumatisme. Toutefois, des morts travers non traumatisme sont encore une entit importante qui demande une tude part afin de souligner leur tendance, et tablir des stratgies pour une amlioration afin d'abaisser le taux de mortalit.

Mthodologie: Une analyse rtrospective parmi des morts chirurgicales non traumatisme qui ont eu lieu dans le service des urgences au cours de 24 mois a t effectue. La collecte de donnes compris ge, sexe, intervalle entre le dbut de la maladie et prsentation, traits cliniques, la frquence avant d'aller l'hpital, des investigations effectues, le cadre des chirurgiens qui ont fait le bilan des patients et des interventions chirurgicales effectues comme partie du traitement avant la mort.

Rsultats: 4146 ont t inscrit dans le (SU), 2916 soit 70% taient traumatisme, 1251 soit 30% taient des conditions non-traumatisme. II y avait 171 morts, 129 soit 75,4% taient des morts travers le traumatisme, tandis que 42 soit 24,6% taient des morts non traumatismes. Trente soit 71,4% parmi les 42 avaient des informations complte pour l'analyse. Tranche d'ge tait de 2-29 ans (moyen 42,7 ± 21,8 ans) comprend 18 du sexe masculin et 12 du sexe fminin. Des patients atteints de la pritonite gnralise taient en majorit 8 soit 26,7% comprend 4 perforation typhoide, 2 appendiceruptur et 2 ulcre simple perfor. Des malignits terminales ont suivi de prs avec 6 morts (20,0%). 3 travers des causes urologiques, (2 prostatique et cancer de la vessie) saignant gastrointestinal aigu 3 soit 10%, obstruction intestinale 1 soit 3,3% et d'autres. Dix neuf patients soit 63,3% avaient visit l'hpital prcdamment avec un sjour < 48 heures (4 patients), 48 heures - 1 semaine (4 patients) et > 1 semaine (2 patients), sans documentation (9 patients). Moins de 40% de patients taient capable de faire des investigations requisses (lectrolyte, radiographie et ultrason) ou reu des interventions dsires (sang et antibiotiques).

Conclusion: Des morts travers non traumatisme constituent le quart des morts dans le services des urgences, pritonite gnralise et malignit grave taient les conditions principales responsable et caractris par prsentation tardive aprs avoir pass une longue moment dans un hpital priv prcdent.

West African Journal of Medicine Vol. 24(1) 2005: 321-324