Date of Award

2-2024

Degree Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Advisor

Dr. Idris Chikophe

Second Advisor

Prof. Abdallah Abdulkarim

Third Advisor

Dr. Edwin Mogere

Department

General Surgery (East Africa)

Abstract

Introduction: This study set out to evaluate how adopting a standardized trauma care protocol, based on the Advanced Trauma Life Support (ATLS) program by the American College of Surgeons, impacts the 30-day outcomes of severe trauma patients with Injury Severity Scores (ISS) higher than 15.

Objectives: To determine the association between Advanced Trauma Life Support (ATLS) trauma care protocol use (Introduction) and mortality within 30 days among polytrauma patients at AKUH, N between 2010 and 2022.

Methods: A total of 184 patients, evenly distributed into two groups, were included in the study, all diagnosed with polytrauma with an ISS score exceeding 15. Ethical approval was obtained from the Aga Khan University Hospital – Ethics Review Committee (AKU ERC) and licensed by the National Commission for Science, Technology and Innovation (NACOSTI). Data analysis was conducted using the R Statistical language (version 4.3.0; R Core Team, 2023).

Results: In both pre- and post-implementation groups, we found no statistically significant differences in the patient characteristics. There were neither significant differences in the mechanism and nature of injuries, care levels on admission, length of hospital stay nor revised trauma and injury severity scores. Road traffic accidents (RTA) were the primary cause of polytrauma, with prevalence rates of 72% and 78%, respectively. Males constituted a higher percentage of cases at 82% and 77%, respectively. Median ages for trauma were 36 and 40 years in these groups.

A lower median Revised Trauma Score (RTS) was linked to increased mortality (P < 0.05). Higher median ISS scores and lower median Revised Trauma Score (RTS) scores were also linked to increased mortality. Before the implementation of the trauma care protocol, the 30-day mortality was 22%, which reduced to 7% after implementation with P < 0.05.

Conclusion: The introduction of an ATLS trauma care protocol at Aga Khan University Hospital Nairobi in 2016 has positively impacted the outcomes of trauma patients, as evidenced by the observed decrease in mortality rates. These findings highlight the feasibility of implementing such programs in developing nations like Kenya, emphasizing the global dissemination of this protocol, especially in low- and middle-income countries.

First Page

1

Last Page

39

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