A review of the complications encountered in a quaternary trauma intensive care unit in South Africa

  • M Gounder University of KwaZulu-Natal
  • Timothy Hardcastle University of KwaZulu-Natal
  • David JJ Muckart University of KwaZulu-Natal
Keywords: trauma intensive care unit, complications, South Africa

Abstract

Background: Due to the invasive nature required for support and multiple therapeutic interventions, critically ill patients are at high risk of complications unrelated to their underlying illness or injury. This audit aimed to describe the spectrum of complications in a trauma intensive care unit, to identify potential remedial interventions to improve quality of care and reduce morbidity Methods: Complications in the Trauma Intensive Care Unit at Inkosi Albert Luthuli Central Hospital are documented prospectively on a specific proforma. A 12-month audit was performed between 2012–2013. Complications were divided into septic and non-septic adverse events and the relationship to injury severity, time of onset and outcome were analysed.

Results: Of 283 patients admitted during the study period, 77 (32.5%) suffered a total of 161 adverse events. Ninety-seven (60.2%) complications were sepsis-related and 64 (39.2%) were unrelated to sespis. Ventilator-associated pneumonia was the commonest septic event (38.1%) and extubation-related events the most frequent non-septic complication (45.3%). The number of complications ranged from one in the majority of patients (49.4%) to 6 (3.9%) in 3 patients. There was no significant difference in mortality between those with (24.7%) or without (17.4%) complications (p = 0.22) however, those with complications had a significantly longer length of ICU stay (p < 0.001).

Conclusion: Complications are common in the critically injured who necessitate admission to an intensive care unit. The vast majority arise from infective causes, especially ventilator-associated pneumonia. Adverse events related to the endotracheal tube are the commonest non-infective events. The identification of these adverse events should prompt interventions aimed at reducing the incidence.

Author Biographies

M Gounder, University of KwaZulu-Natal

Department of Urology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban; and Trauma Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa & Department of Surgery, University of
KwaZulu-Natal, Congella, Durban

Timothy Hardcastle, University of KwaZulu-Natal

Trauma Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa & Department of Surgery, University of KwaZulu-Natal, Congella, Durban

David JJ Muckart, University of KwaZulu-Natal

Trauma Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa & Department of Surgery, University of KwaZulu-Natal, Congella, Durban

Published
2019-02-14
How to Cite
Gounder, M., Hardcastle, T., & Muckart, D. (2019). A review of the complications encountered in a quaternary trauma intensive care unit in South Africa. South African Journal of Surgery, 57(1), 43-48. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2733
Section
Trauma