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Blunt abdominal trauma in children at Kenyatta National Hospital
1Department of Surgery, Moi University, Eldoret.
Insights
Blunt abdominal trauma predominantly affects young males, often due to motor vehicle accidents. Diagnostic limitations led to unnecessary surgeries in 25% of pediatric cases.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Injuries
Background:
- Blunt abdominal trauma (BAT) is a significant cause of morbidity and mortality in children.
- Understanding injury patterns and management outcomes is crucial for improving pediatric trauma care.
- Kenyatta National Hospital (KNH) serves a large pediatric population in Nairobi, Kenya.
Purpose of the Study:
- To characterize the patterns of intra-abdominal injuries from blunt abdominal trauma in children.
- To evaluate the management strategies and outcomes of pediatric blunt abdominal trauma.
- To identify factors contributing to suboptimal outcomes.
Main Methods:
- Retrospective study design.
- Analysis of 55 pediatric patients treated for blunt abdominal trauma at KNH between 1983 and 1993.
- Evaluation of operative management, complications, mortality, and hospital stay.
Main Results:
- The study identified a higher incidence of BAT in males (2:1 ratio), particularly around age seven.
- Motor vehicle accidents were the primary cause of injury, with delayed hospital presentation being common.
- Spleen injuries were most frequent; 60% of patients underwent laparotomy, with 75% showing positive findings. Hypovolemic shock was a frequent complication.
- One mortality occurred, and the average hospital stay was seven days.
Conclusions:
- Blunt abdominal trauma disproportionately affects male children, with motor vehicle accidents being a major etiological factor.
- A significant proportion (25%) of pediatric patients underwent unnecessary laparotomies due to a lack of sensitive diagnostic tools.
- Improved diagnostic capabilities are needed to optimize surgical decision-making and reduce non-therapeutic operations in pediatric BAT.
Objective:
To determine the pattern of intra-abdominal injuries arising from blunt abdominal trauma and evaluate the management of blunt abdominal trauma and its outcome.
Design:
Retrospective study.
Setting:
Paediatric Surgical Department, Kenyatta National Hospital (KNH), Nairobi.
Subjects:
Fifty-five children who were admitted and treated for blunt abdominal trauma in KNH between January 1983 and December 1993.
Main Outcome Measures:
Morbidity as determined by operative management and complications, mortality and period of hospital stay.
Results:
Incidence of trauma was high in males with male to female ratio of 2:1. Incidence of trauma was prevalent in seven year age group. Motor vehicle accidents accounted for the majority of injuries. Most patients arrived late in hospital. Sixty per cent underwent laparotomy. Three quarters of these had positive findings. The spleen was the organ most commonly injured. Hypovolaemic shock was the most frequent complication. One patient died during management. On average, patients stayed for seven days in the ward before discharge.
Conclusion:
Blunt abdominal trauma more commonly affected male children. Motor vehicle accidents were a major aetiologic factor in blunt abdominal trauma in children seen in Kenyatta National Hospital. Twenty-five per cent of the children were subjected to unnecessary operation. This was due to unavailability of sensitive diagnostic modalities.