Critical Care Services and Health Outcomes among Road Traffic Accident Patients Managed At Kenyatta National Hospital Nairobi, Kenya

Abstract

Road traffic accidents (RTA) are rapidly growing posing a public health problem since it is projected to become the third leading cause of morbidity and mortality by the year 2020 (WHO, 2013). There is inadequacy of public health infrastructure in providing treatment for road traffic injured patients in developing countries. Kenyatta National Hospital (KNH) receives the bulk of Road traffic accident patients due to its public status and proximity to major highways and has a 21 bed general Critical Care Unit (CCU). Despite prevention measures, RTAs have increased sharply placing a heavy toll on KNH. It is likely that CCU services are overstretched. The aim of this study was to determine adequacy of critical care services and health outcomes of RTA patients managed at KNH. A retrospective cohort study was adopted. Qualitative data was collected through in-depth interviews with CCU managers. Quantitative data was collected through a desktop review of patients’ files, admission and discharge record book using a data collection sheet. The study was carried out in the Critical care unit at KNH on RTA patients admitted to the CCU in 2013. Quantitative data was analyzed using SPSS version 21 and Chi square tests, while qualitative data was analyzed using thematic analysis. Descriptive statistics, pie charts and bar graphs were used to present data. Head Injuries accounted for up to 97.5% of all RTA patients in CCU. The number of males was significantly higher (78.9%) compared to female, 2  0.05, 1, = 23.7, P <0.005. The mean age of the RTA patients was 30 years. Age below 40 years was significantly associated with GCS below 8 on admission, P< 0.01. Majority of the patients (49.3%) had primary school level of education while 36.6% had secondary school level of education. Those who were self-employed accounted for 40.8% of the total patients while 38% were unemployed. Most patients (69%) were referred from other hospitals which was significantly associated with GCS below 8 (p<0.05). The average waiting time to CCU admission was 80.2 minutes. The mean CCU stay was 18 days. Mortality rate among the RTA patients was 36.6%. Complications recorded among the patients included Sepsis (35.2%), electrolyte imbalances (35.2 %) and anemia (22.5%). The overall CCU services included CT scans (95.8%), X-Rays, Blood work up, Physiotherapy, Surgery, Nursing, Nutritional and Medical. The most common consultations were Neurosurgical (57.7%) and Orthopedic (31%). Challenges of caring for RTA patients included; Shortages of equipment like beds, suction machines, infusion pumps, patient feeds and drugs. Lack of team work, low staff to patient ratios, long stay patients and inability to pay for services were reported. The mean cost of CCU management was Ksh .450, 195.67. Road traffic injuries remain a huge burden in CCU’s in Kenya due to high morbidity, high cost of management and mortality. More resource allocation to referral and county CCU’s, team work, decentralization of CCU’s and enhanced evacuation can improve the outcomes of the patients.