D. Asiimwe1, A. Abio2, 3, K. Nelson2, M. L. Wilson2, 3, P. Kyamanywa1, H. Lule1, 2 1Kampala International University Western Campus, Directorate Of Research And Innovations, Department Of Surgery, KAMPALA, KAMPALA, Uganda 2University of Turku, Injury Epidemiology And Prevention Research Group, Turku Brain Injury Centre, Division Of Clinical Neural Sciences, TURKU, TURKU, Finland 3University of Heidelberg, Heidelberg Institute Of Global Health (HIGH), HEIDELBERG, HEIDELBERG, Germany
Introduction: Interpersonal violence is increasingly becoming a global public health concern in the context of human rights advocacy. In Uganda, intentional injuries contribute to a large burden of trauma after road traffic crash, however there is paucity of data on assault related injury severity and their treatment outcomes. The objective of this study was to determine the severity and factors associated with thirty-day mortality of assault attributable injuries at two tertiary hospitals in Uganda.
Methods: Prospective observational cohort study of 140 consecutive patients with history of assault (Ethical clearance No.UG-REC- 023/2021-17). We used the Kampala Trauma Score (KTSII) to assess injury severity, coded as mild (9-10), moderate (7-8) or severe (≤6). The main outcome was mortality after 30 days from time of arrival at the trauma units. Other predictor variables of interest included the specific body part injured, neck strangulation, type of injury, interval from injury to hospitalization, who accompanied the patient to the hospital, whether there was alcohol intoxication at time of incidence and if a weapon was used in the assault process. Using Stata Version.17.0 (StataCorp, TX, USA), Firth’s logistic regression analyses for rare cases and odds ratios (OR) were computed at 95% confidence interval, regarding p<0.05 as statistically significant.
Results: Mean age was 29.98 years±12.76 SD and majority were unemployed 67.1% (n=94). Males were overrepresented 77.4% (n=108). Majority of assault incidents occurred on the streets 35.7% (n=50) and homes 30% (n=42) in urban areas 50.7% (n=71). A weapon was used during the assault in 80% (n=112) of the cases and the use of a sharp object was the most common 42.86% (n=48). Nearly half of the patients were multiply injured 49.0% (n=68) and 43.6% (n=61) had consumed alcohol at the time of injury. Majority of cases required surgery 84.3% (n=118). Mortality occurred in 5.7% (n=8) of patients. The Kampala Trauma Score was moderate 20.7% (n=29) and severe in 35.0% (n=49) of the cases respectively. Factors significantly associated with mortality at 30 days were: a severe Kampala Trauma Score [OR = 95.02, 95% CI (4.32, 2091.31); P=0.004), where hot water or paraffin were used [OR = 18.60, 95% (2.13-162.28); P=0.008] and pelvic injuries [OR = 88.29, 95% CI (0.97-8030.08)]. Least likely to die were those who underwent surgery [OR = 0.16, 95% CI (0.04-0.65); P=0.010] or sustained cuts and soft tissue injuries [OR = 0.18, 95% CI (0.04-0.89); P=0.036].
Conclusion: Severe injuries due to assault occur in 35% of cases and are associated with higher mortality. In our settings, mortality was higher with conservative treatment as opposed to operative intervention. The Kampala Trauma Score II was a good predictor of injury severity and mortality in this patient population and could be used by triaging teams in remote settings.