TRAUMA-RELATED MORTALITY IN A RESOURCE-LIMITED SETTING: A 12-MONTH PROSPECTIVE ANALYSIS OF EPIDEMIOLOGY, OUTCOMES, AND SYSTEMIC CHALLENGES AT A NIGERIAN TERTIARY HOSPITAL
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Abstract
Introduction: Trauma-related mortality remains a critical public health challenge in low-resource settings. This study aimed to determine the incidence, predictors, and systemic challenges of trauma-related mortality at a Nigerian tertiary hospital over 12 months.
Methods: A prospective observational study was conducted at Alex Ekwueme Federal University Teaching Hospital (January–December 2022). All trauma patients aged ≥12 years admitted to the Accident & Emergency unit were included. Data on demographics, injury mechanisms, clinical parameters (Glasgow Coma Scale [GCS], Revised Trauma Score [RTS]), interventions, and outcomes were analyzed.
Results: Among 3,290 trauma admissions, 118 fatalities occurred (3.6% mortality rate). Most victims were males (84.0%) aged 16–39 years (55.1%). Road traffic accidents (RTAs) caused 67.7% of deaths, predominantly motorcycle collisions (58.8%). Severe head/neck injuries (67.7%) and delayed hospital arrival (median: 3.2 hours) were common. The RTS strongly predicted mortality: 68.6% of fatalities scored ≤4 (severe) versus survivors’ mean RTS of 6.4 (p<0.001). Multivariate analysis identified RTS ≤4 (aOR=5.1), head injuries (aOR=3.8), and prehospital delays >3 hours (aOR=2.4) as independent mortality predictors. Critical care limitations included absent CT scans, ventilators, and neurosurgical capacity. Most deaths (75.4%) occurred within 24 hours, linked to hypotension (41.5%) and tachypnea (57.6%). Basic interventions (analgesics: 96.1%, IV fluids: 93.4%) were common, but advanced care (e.g., craniotomies) was unavailable.
Conclusion: Preventable trauma deaths in Nigeria reflect systemic gaps in prehospital care, emergency infrastructure, and workforce shortages. Policy reforms should prioritize motorcycle safety laws, trauma registries, and context-specific interventions like community first-responder training. Aligning with WHO’s Decade of Road Safety, these findings advocate for multisectoral collaboration to strengthen trauma systems in low-resource settings.
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