Specialized supportive care for patients with road traffic injuries and associated challenges in the critical care unit Kenyatta National Hospital, Kenya

Abstract

Background: Road Traffic Accidents (RTAs) are a major cause of Severe Head Injuries (SHI) among Kenyan citizens of productive age comprising 14.3% of adult Intensive Care Unit/ High Dependency Unit ICU/HDU admissions. Severe injuries are managed in a Critical Care Unit (CCU) for specialized supportive care.
Objectives: To determine the specialized supportive care for patients with road traffic injuries (RTI’s) and identify the challenges  experienced by health care workers managing the patients in CCU.
Design: A one-year retrospective cohort study.
Setting: Critical Care Unit at Kenyatta National Hospital- (CCU-KNH)
Subjects: Patients admitted to CCU-KNH with Road Traffic Injuries (RTI’s) in 2013 and managers for Anaesthesiologists, Nurses,  Physiotherapists and Nutritionists.
Results: The specialized supportive services offered to RTA patients included radiological services; Computerized Axial Tomography (CT Scan) (95.8 %); XRay services (78.9%); Abdominal Ultra-Sound (5.6%); Laboratory services; Full hemogram (FHG) (81.7 %), Grouping and Cross-Matching (GXM)(29.6%), Urea and Electrolytes (77.5%), Coagulation profile (1.4%) and Arterial Blood Gas Analysis (ABGs) (87.3%), Physiotherapy (97.2%), Nursing care and Nutritional support. Challenges were reported as inadequate resources, poor staffing, lack
of multidisciplinary teamwork, delayed admission, lack of specialized training, long stay patients and complications among patients. Electrolyte imbalances, infections, shock and arrhythmias were significantly associated with mortality among the patients, P<0.05.
Conclusion: Specialized supportive care for RTA patients was provided though at varied levels. Addressing the challenges of care can improve health outcomes of patients