Browsing by Author "Wangoda, Robert"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Acid-Base disorders as predictors of early outcomes in major Trauma in a resource limited setting: An observational prospective study
    (Pan African Medical Journal, 2014) Asiimwe, Ian S.; Wangoda, Robert; Kwizera, Arthur; Makobore, Patson; Galukande, Moses
    Mortality from trauma remains a major challenge despite recent substantial improvements in acute trauma care. In trauma care patient resuscitation to correct hypotension from volume loss still majorly relies on use of physiological parameters such as blood pressure, pulse rate, respiratory rate, urine output and oxygen saturation. In resource limited settings these methods may not be sufficient to detect occult tissue hypoxia and the accompanying metabolic derangements. Methods: A prospective observational study carried out at a level I urban Trauma centre; Accident and Emergency unit. Major trauma patients were consecutively recruited into the study. Venous blood samples were drawn foranalysis of serum electrolytes, serum PH and anion gap. The venous blood gas findings were correlated with patients' clinical outcome at two weeks. Ethical approval was obtained. Results: Ninety three major trauma patients were recruited, patients' age ranged from 12 months to 50 years. Forty nine patients (53%) were acidotic (PH less than 7.32), 39 patients (42%) had low bicarbonate (bicarbonate level less than 21 mmol), 54 patients (58%) had high corrected anion gap (anion gap corrected of 16 or more). Fourteen patients (15%) developed secondary organ failure and 32 (34%) patients died. Conclusion: Metabolic acidosis is common among major trauma patients, its severity may be related to delay in initiating care. Acid base derangements were predictors of mortality among major trauma patients in this resource limited setting
  • Thumbnail Image
    Item
    Serum lactate as a predictor of early outcomes among trauma patients in Uganda
    (International journal of emergency medicine, 2014) Okello, Michael; Makobore, Patson; Wangoda, Robert; Upoki, Alex; Galukande, Moses
    Trauma is the leading cause of death in the developed world. Accurate assessment of severity of injuries is critical in informing treatment choices. Current models of assessing severity of injury are not without limitations. The objective of this study therefore was to determine the diagnostic accuracy of serum lactate assays in assessing injury severity and prediction of early outcomes among trauma patients. Methods: This was a cross-sectional analytical study. Consecutive series of all eligible patients had a single venous blood sample drawn for lactate assay analysis (index test) and a concurrent Kampala Trauma Score (KTS) II value determination (reference test). Admitted patients were followed up to assess early outcomes (length of hospital stay and mortality). Results: Out of the 502 trauma patients recruited, 108 (22%) were severely injured, 394 (78%) had non-severe injuries, and 183 were admitted. There was a significant difference between median (interquartile range (IQR)) lactate levels among the severely injured (4.3 (2.6, 6.6)) and the non-severely injured (2.4 (1.6, 3.5), p < 0.001). After a 72-h follow-up of the admitted patients, 102 (56%) were discharged, 61 (33%) remained in the hospital, 3 (2%) remained in the ICU, and 17 (3%) had died. The area under the receiver operator characteristic (ROC) curve was 0.75 for injury severity. Serum lactate ≥2.0 mmol/l had a hazard ratio of 1.10 (p < 0.001) for emergency department disposition, 4.33 (p = 0.06) for the 72-h non-discharge disposition, and 1.19 (p < 0.001) for 72-h mortality. Serum lactate ≥2.0 mmol/l at admission was useful in discriminating severe from non-severe injuries with a sensitivity of 88%, specificity of 38%, PPV of 30%, and NPV of 92%.