Factors Influencing the Major Trauma Clinical Outcomes in Hospitals in the Lake Region Economic Block (LREB), Kenya

Abstract

Context: Trauma contributes to substantial economic losses, accounting for over 3.9% of global Gross Domestic Product (GDP). In countries like Kenya, it heavily strains healthcare systems. Effective management of major trauma, particularly in emergency departments, is critical to improving outcomes and reducing preventable deaths.

Aim: This study aimed to assess factors influencing the major trauma clinical outcomes at hospitals in the Lake Region Economic Block (LREB), Kenya.

Methods: This study employed an analytical cross-sectional design and recruited 110 major trauma patients. A multi-stage sampling technique was utilized to select participants. The study was conducted in two major hospitals Kakamega and Vihiga counties. A trauma chart review form adapted from the WHO Data Set for Injury was used to collect data.

Results: There was a trend-level correlation between the mechanism of injury and ICU admission (p=0.055). Patients who sustained gunshot injuries had the significant shortest hospital length of stay (4 days) compared to Road Traffic Accident (RTA) (19 days). Airway intervention had a statistically significant association with ICU admission (p<0.001), mortality (p<0.001), and hospital length of stay (p<0.008). Endotracheal intubation (ETT) and suctioning were more common among patients who were admitted to the ICU than among those who were not (21.7% vs 3.4%; 39.1% vs 20.7%, respectively). The majority (80%) of the patients who died had an airway intervention performed at the Emergency department (ED) with ETT and suctioning as the most common intervention (66.6%). ED duration and hospital Length of Stay (LOS) correlation was moderately positive (ρ=0.263, p=0.0055). Age and gender significantly contributed to ICU admission decisions (Δχ² = 24.80, p=0.010).

Conclusion: Age and gender are associated with ICU admission. Gunshot injuries were linked to shorter hospital stays and death. Endotracheal intubation and suctioning were associated with the need for ICU admission and increased mortality. ED duration was positively associated with longer hospital length of stay (LOS). Hospitals should adopt mechanism-specific clinical pathways and ensure timely ED interventions and disposition for definitive care to reduce prolonged hospital stays and mortality.