Epidemiology and prehospital factors associated with Injury severity of motorcycle related femoral fractures At Mbarara and Kampala international university teaching Hospitals
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Date
2017-07
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Kampala international international: School of Health Sciences
Abstract
Background: Motorcycle related femoral fractures constitute a poorly documented trauma entity in Uganda. There is paucity of data on socio-demographic, anatomical and prehospital determinants of motorcycle related femoral fracture injury severity. Knowledge of most at risk of poor injury outcome in resource limited settings with no formal prehospital care system is not only mandatory for evidence based preventive policy formulation but also guidance of clinical practice.
Objectives: To determine socio-demographic characteristics, anatomical patterns and prehospital factors associated with injury severity of motorcycle related femoral fractures at two teaching hospitals in Uganda, using the Kampala Trauma Score II (KTSII). Methodology: Cross sectional descriptive and analytical hospital based six months study of consecutively recruited patients, using investigator-administered questionnaire at the Accident and Emergency Departments of Mbarara and Kampala International University Teaching Hospitals in Western Uganda, between December 2016 and June 2017. Ethical clearance was obtained from Mbarara University of Science and Technology Research and Ethics Committee (IRB No.l9/l 0-16). Data including history, clinical examination and radiological findings were recorded on a pretested coded questionnaire. Multiple logistic regression analysis and Odds ratios were computed using IBM SPSS 20.0. Statistics for windows (Armonk. NY: IBM Corp) at 95% Confidence Interval and P=0.05 as statistically significant results: Of 230 patients, the mean age was 32 years (Std. Deviation 18.5 years), with male to female ratio of 2.4: l. The femoral shaft 72.6% (n=l67) was the most fractured anatomical site. Being a passenger on a motorcycle (OR 1.636; 95% CI [1.261-3.417; P=0.007), receiving no first aid before arrival (OR 2.106; 95% CI [1.818-2.495]; P<O.OOI), sustaining an open (OR 2.124; 95% CI [1.885-2.427], femoral neck (OR 4.222 [1.294-13.776] 95% CI, P=O.OI6) and femoral shaft (OR 1.155; 95% CI [1.101-1.902]; P=0.024) fractures, were pre-hospital factors significantly associated with a severe Kampala Trauma Score II amongst patients sustaining femoral fracture secondary to motorcycle accidents. There was no association between means of arrival, prehospital time; pre-existing comorbidities and severity of KTSII in this patient category. Conclusion: Being a passenger on motorcycle and receiving no first aid before arrival were significant prehospital determinants of motorcycle related femoral fracture injury severity. Road traffic legislative efforts should protect the passenger in the same manner as for riders and pedestrians. There is need to strengthen the pre hospital care system in Uganda. Prospective studies are required to determine how these factors impact on long-term femoral fracture outcome Key words: Accident, Femoral fracture patterns, Motorcycle, pre-hospital factors, Uganda
Description
A research dissertation submitted to the faculty of Clinical medicine and dentistry in partial fulfillment of the requirements for the award of master of medicine Degree in general surgery of Kampala international University
Keywords
General surgery, Epidemiology, Prehospital factors, Injury severity, Motorcycle, Femoral fractures, Mbarara and Kampala international university teaching Hospitals