Short Term Outcome of Haemorrhagic Shock in Trauma at Mulago Hospital, an Urban Tertiary Hospital in Sub Saharan Africa

Abstract

Introduction Haemorrhagic shock is a life threatening condition which continues to claim the lives of patients with major trauma all over the world, but especially in middle and low income countries [1-3]. It is the leading cause of potentially preventable death among trauma patients [4,5]. Worldwide, trauma is the leading cause of death in children over 5 years, adolescents and young adults [6], accounting for about 10% of mortality as a whole [7]. In Uganda, a tropical Sub Saharan country, over a quarter of deaths occurring in urban areas are due to trauma [2,8]. Haemorrhagic shock is defined as inadequate delivery of oxygen and nutrients to tissues due to reduced circulating volume as a result of blood loss [9-12]. It is classified into four grades: I, II, III and IV, based on the amount of blood loss and the clinical presentation of the patient. Though a life threatening condition, early recognition of haemorrhagic shock followed by timely and appropriate intervention can save lives. Management of haemorrhagic shock in a low income setting still poses a challenge due to various reasons, including lack of appropriate pre-hospital care and inadequate blood transfusion services. The leading cause of haemorrhagic shock is Road Traffic Injury (RTI). The WHO report on RTI prevention (2004) estimated that 1.2 million people die worldwide in RTIs annually [1]. Of these, 85% occur in low and middle income countries. With the upsurge in the number of vehicles in low and middle income countries, mortality rate due to RTIs is anticipated to rise by 80% between 2000 and 2020 [13]. A significant number of deaths resulting from this form of trauma are due to uncontrolled haemorrhage leading to haemorrhagic shock [2]. This reflects the importance of the need for comprehensive understanding of haemorrhagic shock in order to improve patient survival. Other direct forms of trauma leading to this condition include assault, Gunshot Injury (GSI) and 'mob justice' (mob lynching), among others. The current management of traumatic haemorrhagic shock at Mulago Hospital includes initial assessment using the ATLS guidelines; a primary survey is conducted following the Airway, Breathing, Circulation, Disability, Exposure and Environmental control (ABCDEs) approach. Identified life threatening conditions are managed, and then a secondary survey is conducted when the patient is stable. The grade of shock is also determined. In our study, we focus on grades III and IV. Grade III shock is defined as that resulting from a total blood volume loss of more than 30% but less than 40%; grade IV type involves a loss of more than 40% [13]. The pulse rate and respiratory rate for Abstract Introduction: Trauma is a major public health hazard, contributing significantly to mortality. It is the leading cause of death among adolescents and young adults worldwide. Road traffic injuries come top of the list of forms of trauma in urban areas, with more than 3000 deaths occurring daily. Most deaths (85%) occur in low and middle income countries and are a result of shock secondary to haemorrhage. There being a dearth of documented information on the short term outcome and associated factors of haemorrhagic shock in a Sub Saharan setting, a study to this effect was conducted.