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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 128-131

Prospective trauma registration using the international categorization of external causes of injury guidelines in a teaching hospital in Nigeria


Department of Surgery, Aminu Kano Teaching Hospital, PMB 3452 Kano, Nigeria

Date of Web Publication13-Dec-2013

Correspondence Address:
Usman A Gwaram
Department of Surgery, Aminu Kano Teaching Hospital, PMB 3452, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.122932

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  Abstract 

Background: Classification of external causes of injury is essential for injury surveillance. The aim of this study was to evaluate the external causes of injury using the international categorization of external causes of injury (ICECI) guidelines.
Materials and Methods: Patients 18 years and above with injuries were prospectively selected for the study between 1 st July 2009 and 1 st December 2009. Written informed consent was obtained from each of patients or their relation if unconscious. Bio-data was obtained from each of patients, the registration and data of the event was recorded according to the ICECI guidelines.
Results: A total of 252 patients were studied. Their age ranged from 18 to 72 years. There were 192 ( 76.2%) males and 60 (23.8%) females with a male to female ratio of 3.2:1. Most of the injuries were following road traffic accidents, a third of which were motorcycle related crashes. There was a low utilization of vehicular safety devices and alcohol and psychoactive substances contributed to injury in about 9% of patients.
Conclusion: Use of the ICECI guideline in trauma registration could yield relevant data necessary for injury surveillance and we recommend its use for injury registration in our hospitals.

Keywords: Injury causes, injury surveillance, international categorization of external causes of injury


How to cite this article:
Gwaram UA, Sheshe AA, El-Yakub AI. Prospective trauma registration using the international categorization of external causes of injury guidelines in a teaching hospital in Nigeria. Arch Int Surg 2013;3:128-31

How to cite this URL:
Gwaram UA, Sheshe AA, El-Yakub AI. Prospective trauma registration using the international categorization of external causes of injury guidelines in a teaching hospital in Nigeria. Arch Int Surg [serial online] 2013 [cited 2024 Mar 1];3:128-31. Available from: https://www.archintsurg.org/text.asp?2013/3/2/128/122932


  Introduction Top


The international categorization of external causes of injuries (ICECI) was designed by the World Health Organization to enable classification of external causes of injuries to help researchers and practitioners to describe measure and monitor occurrence of injuries. The core module includes mechanism of injury, objects or substance producing the injury, place of occurrence, activity when injured, the role of human intent, use of alcohol, use of (other) psychoactive drugs and additional modules to enable collection of data on special topics; (violence, transport, sport, occupational injuries). [1]

Injuries are caused by a complex interaction of various factors; at the societal level, they include low socio-economic status and cultural norms that support violence to resolve conflicts, at the community level, factors include poor safety standards in the workplace, unsafe roads and easy access to firearms while at the level of family relationships, factors include a lack of care and supervision, physical abuse and a ruptured family structure. Finally, at the individual level, factors include a history of aggression, alcohol and substance abuse. [2]

Injury surveillance is a key element in developing geo-cultural and resource specific intervention to enhance prevention and treatment of injuries without, which it is difficult to understand the problems and risk factors for types of trauma, design appropriate interventions to prevent and treat trauma, monitor effectiveness of interventions and provide information to policy makers. [3]

This study was conducted to evaluate the external causes of injury, using the ICECI core module in the accident and emergency of a teaching hospital in Nigeria as part of an ongoing data collection to evaluate injury severity in the hospital.


  Materials and Methods Top


This was a prospective observational study of consecutive adult patients more than 18 years, with trauma over a 6 month period who present to the accident and emergency of a teaching hospital in Nigeria.

Biodata was obtained as regards age, sex, marital status, occupation and residential address. Data of the event was also recorded with regards to the mechanism of injury, where the injury occurred, activity when injured, whether it's work-related or not and whether it's an intentional or unintentional injury. For motor-vehicular crashes; patients responsibility in the crash, counter part of the crash, safety instruments used or deployed. These were recorded in the individual proforma. The data obtained was analyzed using an IBM compatible computer software Epi-Info version 3.2.2 (CDC, WHO). Results were expressed as mean, standard deviation or median with ranges as appropriate.

Application was made for approval to conduct the study and obtained from the ethical committee of the University teaching hospital. Well-informed written consent was obtained from each patient or relations if unable to communicate adequately.


  Results Top


A total of 252 patients were studied between 1 st July and 1 st December 2009. Their age ranged from 18 to 72 years with a mean age of 32.9 ± 11.9 years. The modal age range of 18-24 year age group with 65-74 year age range being the least.

There were 192 males and 60 females with a male:female ratio of 3.2:1. Married patients constituted 43.7% while 50% were single, 12 (4.7%) divorced and 4 victims (1.6%) were widowed. In the distribution of occupation, 89 (35. 3%) were students, traders and civil servants together accounted for 40.1%, farmers 51 (20.2%) while others such as clergy and unemployed pensioners accounted for 4.4% in the series.

Data of event

About half of the patients were brought to hospital after the incident by their relations. Police and federal road safety corp (FRSC) brought 31.7%, 7.5% came on their own and 9.5% were brought by good Samaritans. About 84.9% of the incidents occurred on the road while 11.5% at home and 3.6% occurred at work. Most of the incidents (37.69%) occurred between the hours of 6 am and 5 pm, only 3.96% occurred between 6 pm and 5 am. Nearly, 70% were transport related accidents, 3.2% were due to burns, 9.9% were because of assault and gunshot wounds accounted for 5.2%, nine patients out of which were during armed robbery, three were during civil unrest and one patient was from a stray bullet [Table 1].
Table 1: Mechanism of injury

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In the transport related injuries, motorcycle was responsible for 35.28%, car - 24%, 21.14% were pedestrians, bus accounted for 14.28% and 2.29% as a result of truck. None of the injuries was as a result of bicycle accidents.

Out of the patients that were involved in the car or bus incidents only 2 (3.22%) used seat belts; none of the patients involved in motorcycle accidents used a crash-helmet. Only 1.44% of patients admitted to exceeding the speed limit of 100 km/h on a highway. Nearly, 8.7% of the incidents were associated with the use of alcohol or psychoactive drugs.


  Discussion Top


Most of the victims were young men, similar to other studies in most parts of Africa. [4],[5],[6],[7],[8] This may be because they are more active and involved in outdoor and physical activities in the continent. Reports in the United States showed male to female ratio to be higher (1.7 to 1) in young adults, it is still markedly lower than in Africa and in those patients 75 years and over, female to male ratio was 1.6 to 1. [9] This difference may be because women in the developed world may engage in as much outdoor activities as their male counterparts and have equal access to medical care.

Most of injuries occurring in traders, students or civil servants, further buttress the fact that the injuries occur in people in their productive age. This is similar to the finding in Ilorin, in which two-third of their study population were traders. [5]

The mode of presentation to hospital following the incidents is largely by self or relations, this is because there is no ambulance services in the environment for the transport of the injured to hospital. Relations are also required at receiving hospitals to make payments and render other social supports to the injured while the police and FRSC were due to the injuries occurring at distant remote areas where their help is soughted and at times due to medico-legal nature of the incident requiring police documentation before the reception at hospital.

Predominantly, the injuries occurred on the road which differs from the finding in USA, in which most of the injuries occurred when the victims were engaged in leisure and sports with only 8% occurring on the road. [9] This is because people in affluent societies are likely to engage in dangerous leisurely activities with resultant injuries and the decrease rate of injuries on the road may be due to better road design and traffic safety regulations.

Most of the injuries occurred during working hours, which may be as a result of the existing curfew in the state during the period of study between the hours of 6 pm and 6 am, however, the finding was similar to that by Thanni et al. in which 70% of the injuries occurred during the day time and 23% at night. [6]

Transport related incident accounted for more than two-third of the injuries. A study carried out in the same environment earlier found 44.67% from road traffic accident (RTA), gunshot wounds - 11.47% and assault 8.6% reflecting a similar percentage of assault and decrease in gunshot wounds. [10] This differs from the finding of Thanni et al. [6] who found 92% from RTA. In Addis Ababa, they found 61.0% to be from RTA and falls were a common mechanism of injury. [11] This is different from the finding in USA, in which falls accounted for highest emergency department visit for trauma; motor vehicle transport related injuries 12% and 18% were accounted by assault, [9] which is a similar finding in other countries except Argentina, Puerto Rico, Brazil and Columbia, in which firearms were the leading mechanism of injury. This was attributed to easy access of civilians to firearms and high rate of interpersonal violence. [12] This also shows how environmental factors play a significant role in trauma.

Motorcycle ranked highest in transport related injuries, followed by car, pedestrian-struck and buses; there were no victims of bicycle injuries in the series. This contrasted with a study of trauma related mortality from the environment earlier, which showed motorcycle to be responsible for only 20.5% and motorcar 59%, perhaps reflecting a period without the restriction of movement [4] in addition to the increased use of motorcycles for commercial transportation. Bicycle is not a common means of transport in the city, being low speed vehicle and not fashionable in the city. This differ from the finding in Kenya, in which pedestrians and passengers of public transport accounted for 80%, while in Mozambique and Ghana, pedestrians alone accounted 55% and 46% respectively. [13] A traffic mix of incompatible users (pedestrians, cyclists, motorbikes, cars and trucks) explains this large proportion of vulnerable road users with communities living within the vicinity of roads or engaging in trade activities.

About 3% of patients that had injuries from car, bus and truck admitted to using seat belts and none of the patients that were on a motorcycle admitted to the use of crash helmet in spite of existing laws in the country to the effect. A total of 1.44% admitted to exceeding the speed limit of 100 km/h on a highway, this is difficult to establish because the police and road safety officials lack speed limit checker and the victim may not readily volunteer the information. Only 8.7% of the incidents was associated with use of alcohol or other psychoactive agents though unconfirmed with toxicology screen at the accident and emergency, this is quite lower than the 50% quoted in another study earlier in the environment on trauma related mortality, [4] this may be attributed to the law in the state prohibiting sale and consumption of intoxicants during working hours in the state, effective at the time of this study. This differs significantly from the finding in USA, in which legal intoxication accounted for a third of all fatally injured drivers. [14]


  Conclusion Top


Pertinent information on the external causes of injury, necessary to articulate injury prevention measures could be obtained with the use of ICECI. It is comprehensive, easy to adapt to different practice environments and can permit comparison with different communities. We recommend its use for collecting injury surveillance data in the hospital setting.

 
  References Top

1.ICECI Co-Ordination and Maintenance Group. International Classification of External Causes of Injury (ICECI) Version 1.2. Amsterdam, Adelaide: Consumer Safety Institute, AIHW National Injury Surveillance Unit; 2004.  Back to cited text no. 1
    
2.Holders P. Injury surveillance guidelines. Bull World Health Organ 2001.  Back to cited text no. 2
    
3.Nwomeh BC, Lowell W, Kable R, Haley K, Ameh EA. History and development of trauma registry: Lessons from developed to developing countries. World J Emerg Surg 2006;1:32.  Back to cited text no. 3
[PUBMED]    
4.Mandong BM, Madaki JK, Mohammed AZ, Kidmas AT, Echejoh GO. Epidemiology of accident deaths in Jos, Nigeria. Ann Afr Med 2006;59:149-52.  Back to cited text no. 4
    
5.Solagberu BA, Adekanye AO, Ofoegbu CP, Udoffa US, Abdur-Rahman LO, Taiwo JO. Epidemiology of trauma deaths. West Afr J Med 2003;22:177-81.  Back to cited text no. 5
[PUBMED]    
6.Thanni LO, Tade AO. Epidemiology of severe injury in a Nigerian Hospital. Niger J Orthop Traumatol 2007;6:67-9.  Back to cited text no. 6
    
7.Akinpelu OV, Oladele AO, Amusa YB. Pattern and epidemiologic characteristics of trauma admissions to the Obafemi Awolowo Teaching Hospital. East Afr J Surg 2007;12:63-7.  Back to cited text no. 7
    
8.Akiode O, Izegbu NC, Agboola AO, Aina OO. Medico-legal deaths from road traffic accidents in Shagamu. Niger Med Pract 2004;45:1-2.  Back to cited text no. 8
    
9.Injury in the United States: 2007 Chart Book. USA: U.S. Department of Health and Human Services, CDC, National Center for Health Statistics; 2008 p. 43-4.  Back to cited text no. 9
    
10.Manasseh AN, Mohammed AZ, Mandong BM. Epidemiology of trauma deaths in Jos, Nigeria. Niger J Surg Sci 2003;13:10-3.  Back to cited text no. 10
    
11.Wolde A, Abdella K, Ahmed E. Pattern of injuries in Addis Ababa, Ethiopia: A one year descriptive study. East Cent Afr J Surg 2008;13:14-22.  Back to cited text no. 11
    
12.Data provided by participants in the 2005 meeting of the International Collaborative Effort on Injury Statistics. Injury Issues Monitor 2005;32:14-16.  Back to cited text no. 12
    
13.Odero W, Garner P, Zwi A. Road traffic injuries in developing countries: A comprehensive review of epidemiological studies. Trop Med Int Health 1997;2:445-60.  Back to cited text no. 13
[PUBMED]    
14.Insurance Institute for Highway Safety. IIHS fatality facts, alcohol, 2005. Available from: http://www.iihs.org/research/fatality_facts/alcohol.html.2007. Last assessed on 20 February 2010.  Back to cited text no. 14
    



 
 
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