Management of Acute Traumatic Wounds in an Emergency Structure in a Developing Country, Case of University Clinics of Kinshasa in the Democratic Republic of Congo
The objective of this descriptive study is to present the management of acute traumatic wounds in an emergency structure in a developing country, the case of the Democratic Republic of Congo. Sampling was exhaustive and covered a total of 232 patients, each presenting a single wound and meeting our inclusion criteria. The age group of 20 to 29 years was the most represented, with a proportion of 27.2%. A delay of <6 hours between the trauma and arrival at the hospital was present in 134 patients (57.8%). The lesions observed were contused wounds in 180 patients (77.6%). The wounds were localized to the lower limbs in 139 patients (59.9%), to the trunk in 35 patients (15.1%), to the head and neck for 34 patients (14.2%), and to the upper limbs in 24 patients (10.3%). Surgical trimming, whether or not associated with wound suturing (84%), was the most performed surgical procedure. Monoantibiotic therapy and tetanus seroprophylaxis supervised the surgery. Only one patient out of the 134 (0.4%) who consulted before the 6 experienced an infection compared to 5 out of 69 patients (2.2%) who consulted between 12 and 24 hours. The infection rate remains very low (<3%), and the lesions generally heal by first intention.
References
[1]
French-Speaking Society of Emergency Medicine (2005) Wound Management in the Emergency Room. http://www.infectiologie.com/site/medias/_documents/consensus-LONGplaies2006.pdf
[2]
Prevaldi, C., Paolillo, C., Locatelli, C., Ricci, G., Catena, F., Ansaloni, L., et al. (2016) Management of Traumatic Wounds in the Emergency Department: Position Paper from the Academy of Emergency Medicine and Care (AcEMC) and the World Society of Emergency Surgery (WSES). World Journal of Emergency Surgery, 11, Article No. 30. https://doi.org/10.1186/s13017-016-0084-3
[3]
Pierre, L.M. (2019) Evaluation of Professional Practices Concerning the Management of Acute Wounds in the Cayenne Emergency Room. Thesis.
[4]
von Baeyer, C.L. and Spagrud, L.J. (2007) Systematic Review of Observational (Behavioral) Measures of Pain for Children and Adolescents Aged 3 to 18 Years. Pain, 127, 140-150. https://doi.org/10.1016/j.pain.2006.08.014
[5]
Singer, A.J. and Dagum, A.B. (2008) Current Management of Acute Cutaneous Wounds. New England Journal of Medicine, 359, 1037-1046. https://doi.org/10.1056/nejmra0707253
[6]
Diarra, A. (2003) Approche epidemiologique des accidents de la route. A propos de 322 cas recus au service des urgences chirurgicales de l’hopital gabriel toure de juillet a decembre 2001. https://bibliosante.ml/handle/123456789/7538
[7]
Touré, A. (2002-2003) Epidemio-Clinical Study of Accidental Wounds in the Emergency Room of the Nianankoro FOMBA Hospital in Ségou. Master’s Thesis, University of Bamako.
[8]
Quinn, J.V., Polevoi, S.K. and Kohn, M.A. (2013) Traumatic Lacerations: What Are the Risks for Infection and Has the ‘Golden Period’ of Laceration Care Disappeared? Emergency Medicine Journal, 31, 96-100. https://doi.org/10.1136/emermed-2012-202143
[9]
Ehlissou Kolima, A.K., Kanfitine, K.N., Damessane, L., Fare, G., Dolès, S.H., Yaovi, A.M., et al. (2018) Prise en charge des lésions traumatiques de membres au cours des missions de pacification au Nord du Mali. Pan African Medical Journal, 30, Article 295. https://doi.org/10.11604/pamj.2018.30.295.16648
[10]
Bowler, P.G., Duerden, B.I. and Armstrong, D.G. (2001) Wound Microbiology and Associated Approaches to Wound Management. Clinical Microbiology Reviews, 14, 244-269. https://doi.org/10.1128/cmr.14.2.244-269.2001
[11]
Stamou, S.C., Maltezou, H.C., Psaltopoulou, T., Tsaroucha, A., Kaseta, M., Skondras, C., et al. (1999) Wound Infections after Minor Limb Lacerations: Risk Factors and the Role of Anti-Microbial Agents. The Journal of Trauma: Injury, Infection, and Critical Care, 46, 1078-1081. https://doi.org/10.1097/00005373-199906000-00020
[12]
Fatouma, M. (2011) Plaies traumatiques des membres: Prise en charge dans le Service de Chirurgie Orthopédiqe et Traumatologique du CHU Gabriel Touré de Bamako. 13.
[13]
Khan, M.N. and Naqvi, A.H. (2006) Antiseptics, Iodine, Povidone Iodine and Traumatic Wound Cleansing. Journal of Tissue Viability, 16, 6-10. https://doi.org/10.1016/s0965-206x(06)64002-3
[14]
Ghafouri, H.B., Zare, M., Bazrafshan, A., Abazarian, N. and Ramim, T. (2016) Randomized, Controlled Trial of Povidone-Iodine to Reduce Simple Traumatic Wound Infections in the Emergency Department. Injury, 47, 1913-1918. https://doi.org/10.1016/j.injury.2016.05.031
[15]
Nicolai, D., Farcet, A., Molines, C., Delalande, G. and Retornaz, F. (2015) Management and New Current French Recommendations for Tetanus Care. Gériatrie et PsychologieNeuropsychiatrie du Viellissement, 13, 141-146. https://doi.org/10.1684/pnv.2015.0529