Delayed definitive treatment among trauma patients attending oral and maxillofacial surgery unit of Mulago Hospital, Uganda : prevalence and associated factors

Abstract

Oral and maxillofacial (OMF) trauma or injuries are common presentations in hospital emergency rooms and account for about 50% of all deaths globally. The definitions of delayed definitive treatment of OMF injuries vary and remain a source of debate based on different anecdotal criteria, the experience of the surgeon, wound healing principles, or local factors such as logistics. The impact of delayed definitive treatment on the healthcare delivery systems and the patient is very severe, resulting in prolonged hospitalization, complex medical treatments, increased rate of infections and postoperative complications, frequent readmissions, and outpatient visits. To investigate definitive treatment delays and associated factors among trauma patients attending the oral and maxillofacial unit of Mulago Hospital. This was a cross-sectional study based on the time taken between trauma and definitive treatment among oral and maxillofacial patients at Mulago Hospital. The data were collected using both qualitative and quantitative research approaches from 78 patients who gave informed consent to participate in the study following ethical approval from Makerere University School of Health Sciences Institutional Review Board. Case Report Forms of 78 patients with OMF trauma and key informant interviews of 8 health workers were used in data collection. STATA version 14 was used to analyze the data. Descriptive statistics were used to summarize the data. Modified Poisson Regression analysis was used to determine significant factors associated with delayed treatment. The mean age of the participants was 27.54 (range, 0 to 72) years. The majority (66.7%) were males and resided in urban areas (88.5%). Most (88.5%) presented with OMF fractures and with one type of trauma (83.3%). About 39.7% had maxillary fractures. Inter-maxillary fixation was the most (50.0%) common definitive treatment. About 74.4% of the patients had been injured through road traffic accidents, the most (79.5%) were referred to the OMF unit from lower health facilities. Most (56.4%) of the patients had polytrauma injuries and especially (38.6%) head or neural injuries. The maximum and minimum time taken by the participants to receive definitive treatment was 1 and 21 days, respectively. The average time to definitive treatment among patients who received treatment within 10 days of being injured was 2 days while for those who received treatment after more than 10 days following trauma, was 16 days. The prevalence of delayed definitive treatment among OMF trauma patients at Mulago hospital was 30.8% (95% CI: 21.4 – 42.1). Patients who had polytrauma were more likely to experience delayed treatment compared to those who only had OMF injuries [PR= 4.14, (CI: 1.20 – 14.80)], the rest of the factors considered in the study were not significantly associated with the delayed definitive treatment. The prevalence of delayed definitive treatment among OMF trauma patients attending Mulago Hospital was relatively low, associated with polytrauma. Interventions focusing on improving care for patients with polytrauma should be identified utilized and strengthened to further shorten the time to definitive treatment.