O. Kibu1, G. Nguefack-Tsague2, S. Maqungo3, S. Nkegeng4, F. Dissak Delon1, D. Touko1, R. Oke5, C. Umoh5, D. Tchuetia6, A. Christie5, C. Juillard5, A. Chichom Mefire1 1University of Buea, Data Science Center For The Study Of Surgery, Injury, And Equity In Africa (D-SINE- Africa), Buea, SOUTH WEST, Cameroon 2University of Yaounde I, Department Of Public Health, Faculty Of Medicine And Biomedical Sciences, Yaounde, CENTER, Cameroon 3University of Cape Town, Division Of Global Surgery, Faculty Of Health Sciences, Cape Town, South Africa 4University of Buea, Sustainable Trauma, Research, Education And Mentorship (STREaM) Program, Faculty Of Health Sciences, Buea, SOUTH WEST, Cameroon 5University of California Los Angeles, Program For The Advancement Of Surgical Equity, Department Of Surgery, Los Angeles, CA, USA 6African Institute for Mathematical Sciences (AIMS) Limbe, Limbe, SOUTH WEST, Cameroon
Introduction:
Thoracic trauma (TT) is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. It comprises around 10-15% of all traumas worldwide with a variety of injuries ranging from simple chest wall contusion or rib fractures to vital organ injury including lung contusion, hemothorax, pneumothorax, flail chest, and broncho-pleural fistula. Globally, it accounts for 10% of trauma admissions and an estimated 20 – 25% of fatalities in trauma patients. The accurate identification of a patient at high risk of TT mortality is necessary to avoid delays that may lead to significant morbidity and mortality. Therefore, the objective of this research was to assess the factors associated with mortality among thoracic patients in Cameroon.
Methods:
This is a retrospective analysis of prospectively collected data from the Cameroon Trauma Registry, currently running in 10 hospitals across seven of the ten regions of Cameroon. We retrieved data for all patients with thoracic involvement from June 2022 to May 2023 and analyzed them regarding demographics, injury characteristics, clinical presentation, management, and outcomes using multivariate logistic regression. Statistical significance was set at a p-value < 0.05.
Results:
Of the 4131 patients captured in the trauma registry, 360 (8.7%) presented a chest involvement. Over 80% of patients were males and 74.7% (269/360) were aged 16 – 49 years. Most patients [228 (63.3%)] presented with a penetrating injury, with the top injury mechanisms being road traffic injuries (RTI) and stab wounds. A total of 21 (5.8%) TT patients had unequal, absent, or abnormal breath sounds, while 31 (8.6%) displayed abnormal chest movements. The overall mortality rate among patients with chest involvement was 6.4% (23/360), with RTI being the main cause. TT contributed to 18.1% of the overall injury death toll. Based on the AIS score, patients with serious and possibly fatal injuries, were more likely to die (OR = 2.56, CI = 2.8 – 28.5, P = 0.01 and OR = 3.46, CI = 7.6 – 118.7, P < 0.001 respectively) while those who were unable to work and unemployed were about 4 times more likely to die (OR = 3.53, CI = 0.93-1731.46, P = 0.04). Absence of the patients’ injury history was identified as a risk factor for TT mortality (OR = 25.9, CI = 8.27 – 85.03, P = <0.001)
Conclusion:
This preliminary analysis highlights the burden of thoracic trauma in Cameroon and its contribution to the overall injury death toll. These deaths are more attributed to the overall injury severity. The management of patients with a TT should ideally be envisaged as requiring multidisciplinary approach.