Department of Paediatric Surgery, King Saud Medical City, Riyadh, Saudi Arabia.
Department of Surgery, College of Medicine, Honorary Consultant and Chief Paediatric Surgery Unit, Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria.
Afr J Paediatr Surg. 2024 Jan 1;21(1):6-11. doi: 10.4103/ajps.ajps_80_22. Epub 2023 Feb 14.
Trauma is a leading cause of morbidity and mortality in children worldwide. There is a need for development and provision of efficient paediatric trauma services based on adequate information and funding which are lacking in low- and middle-income countries.
This study was carried out to assess the scale of the problem, identify the most common causes of trauma in Pan African Paediatric Surgical Association (PAPSA) zone and to define the limiting factors for provision of the necessary services required to reduce the potential mortality and disability.
Data were collected through an electronic form sent out in PAPSA platform. Members were requested to provide prospective data on all paediatric major trauma admitted to or seen at their health facilities between the beginning of April 2019 and the end of June 2020. Hospital location, child's age, gender, type of injury, mechanism of injury, severity, initial management, method of transport, time to arrive to hospital, availability of surgical specialities, length of hospital stay and injury outcome were analysed.
There were 531 entries. The mean age was 3.53 years and median age 1.34 years. Male-to-female ratio was 2:1. The leading causes for injuries were falls 194 (36.53%) and motor vehicle crashes (MVCs) 176 (33.15%) followed by obstetrical 42 (7.9%), thermal 27 (5.1%) and domestic injuries 22 (4.1%). The most common injuries were limb fractures 181 (34.1%) and traumatic brain injury 111 (20.9%). Public and private transport were used in 313 (58.9%), while ambulance service was used in only 54 (10.1%). Distances to a health facility varied between 1 and 157 km. 70.2% of cases did not receive any primary care, while definitive care was received in 95.5% of the cases. Outcome was full recovery in 90.6% of patients, morbidity in 8.1% and a mortality rate of 1.3%.
Most of the injuries were in the under 5-year age group. The two main causes of trauma in children in this study were the falls from height and MVCs. Long distance travels to reach health-care facilities were noticeable in this study, together with substantial lack of adequate ambulance facilities and shortage in necessary subspecialty services such as neurosurgical, orthopaedics and rehabilitation. Implementing proposed recommendations can reduce the burden.
创伤是全球儿童发病率和死亡率的主要原因之一。低中等收入国家缺乏足够的信息和资金，需要开发和提供有效的儿科创伤服务。
本研究旨在评估问题的严重程度，确定泛非小儿外科学会（PAPSA）区域最常见的创伤原因，并确定提供必要服务以降低潜在死亡率和残疾率的限制因素。
通过在 PAPSA 平台上发送的电子表格收集数据。要求成员提供 2019 年 4 月初至 2020 年 6 月底期间在其医疗机构收治或接诊的所有儿科重大创伤的前瞻性数据。分析医院位置、患儿年龄、性别、损伤类型、损伤机制、严重程度、初步处理、转运方式、到达医院的时间、外科专业的可用性、住院时间和损伤结局。
共记录了 531 例病例。平均年龄为 3.53 岁，中位数年龄为 1.34 岁。男女性别比为 2:1。受伤的主要原因是跌倒 194 例（36.53%）和机动车碰撞（MVC）176 例（33.15%），其次是产科 42 例（7.9%）、热伤 27 例（5.1%）和家庭损伤 22 例（4.1%）。最常见的损伤是四肢骨折 181 例（34.1%）和创伤性脑损伤 111 例（20.9%）。313 例（58.9%）使用公共和私人交通工具，只有 54 例（10.1%）使用救护车服务。到达医疗机构的距离在 1 至 157 公里之间不等。70.2%的病例未接受任何初级护理，95.5%的病例接受了确定性护理。90.6%的患者完全康复，8.1%的患者出现并发症，死亡率为 1.3%。
大多数受伤发生在 5 岁以下儿童。本研究中儿童创伤的两个主要原因是高处坠落伤和 MVCs。研究中注意到到达医疗保健机构的长途旅行，同时缺乏足够的适当救护车设施以及神经外科、骨科和康复等必要专科服务的短缺。实施建议可以减轻负担。
