Pediatric trauma at a government referral hospital in the Gambia

Abstract

Objective: To determine the pattern of childhood injuries at a government referral hospital in sub-Saharan Africa. Methods: Twenty-nine month hospital based study at the Royal Victoria Hospital (RVH) in Banjul, The Gambia. Children with injuries were identified from a prospectively recorded pediatric surgery database. Rate of pediatric trauma presenting to RVH was calculated for an urban population of 270,540 (32.3% aged 0-14 years) living within 25km of the hospital. Results: From January 1996 to June 1998, 798 children aged 0-14 years were admitted for treatment of injuries. Injuries accounted for 4.8% of all pediatric admissions. Burns (38.7%), fractures (20.9%), head injuries (16.2%) and soft tissue injuries (9.4%) were the most common injuries - together responsible for 85% of admissions and 74 % of total hospital days. Average length of stay was 20.6 days, with injuries accounting for 16,696 total hospital days. Seventeen percent of injured children required a surgical procedure. The most common surgical procedures were burn contracture release (20%), reduction of fracture and dislocations (20%) and skin grafts (18.7%). In hospital mortality was 5.5%, with 71% of deaths related to burns. The annual cases of trauma presenting to RVH from the Greater Banjul Area was 181 admissions, 3317 hospital days, 28 surgical procedures and 7 deaths per 100,000 children aged 0-14 years. Conclusion: Childhood injuries, particularly burns place a significant burden on inpatient services. While accounting for a small fraction of pediatric admissions, injuries account for long hospital stays and surgical procedures.