Epidemiological profile of trauma at the University Hospital Trauma & Military Hospital in Tirana, Albania.

Introduction

University Hospital of Trauma & Military Hospital (UHT&MH), is a continuation of the Central University Military Hospital (CUMH coming). By government decision from January 2013 UHT is depending from the Ministry of Health. Military medical personnel is dependent from the Ministry of Defense, but is included in the structure of trauma and is part of the mission. UHT&MHis a tertiary hospital, the second in the country, qualified the mission "trauma management at the national level". UHT&MH has specialty basis, Emergency, Surgery, Orthopedics, Neurosurgery, ENT, Ophthalmology and Maxillofacial, ICU, Reconstructive Surgery, Therapy and Rehabilitation services. Has a capacity of 192 beds, but in emergencies, disasters and catastrophes has capacity for 250 beds. Total personnel321 (81doctor, 200 nurse, technician pharmacist) 40 administration & logistics. In the history of the UHT&MH as the National Trauma Centre since 1993, has some culminating moments in emergencies and disasters such as the treatment of wounded in riots in 1997 in Albania, Kosovo war in 1998-1999,the car crash with students from Kosovo 2004 Fushe-Arez, treating injured by the explosion of munitions in Gërdec 2008 (Picture 3,4) and thebus crash with students in south, Himara 2009 (Picture 2,5). 

UTHMH is located in a strategic positionbecause It is nearby crucifying the national road north-south, which makes possible the transportation of the wounded in a car accident on time.

Methods: Study material consists of all statistical cases presented in UHTMH us for a five-year period 2010-2014, which include emergencies, admissions, operations, automobile accidents analyzed in an analytical manner arranged in tables and graphics are subject to statistical analysis to find rate of change comparable indicators.

General Remarks

In the world today, trauma occupies a special place with the growing trend and due to high rate of death with impact on society and the economy. Every year in the world are estimated about 5-6 million people who die as a result of trauma. Trauma affected the productive part of society, young.Between0-45 ages, trauma is calculated second behind HIV / AIDS as a cause of death. Head trauma takes the first place in early and later mortality. 

The road safety is among the most debated issues worldwide as road traffic deaths and injuries are considered a major public health and development issue. More than 1.2 million people are killed and up to 50 million are injured, every year, in road crashes. The World Health Organization's Global Status Report on Road Safety, 2013, recognizes road traffic injury eighth leading cause of death globally. Current trends suggest that road traffic injuries will become the fifth leading cause of death by 2030, unless urgent action is taken. Half of the world’s road traffic deaths occur among vulnerable road users, including motorcyclists (23%), pedestrians (22%) and cyclists (5%).In charts 1 and 2 Albania rates very poorly in both indicators, compared with other countries. Limited road safety constitutes a major problem for Albania, as the number of road crashes with either fatal casualties, serious or light injuries have increased significantly over years. 

YEARS	TOTAL	SYRGERY	INTERNAL  MEDICINE
2010	42336(21%)	24849(21.5%)	17487(19 %)
2011	38812(19.7%)	22173(19.2%)	16639(18.1%)
2012	32739(16.5%)	19312(16.7%)	13427(14.6%)
2013	44481(22.5%)	22100(19.1%)	22381(24.3%)
2014	38691(19.6%)	26847(23.2%)	11844(13%)
Total	197059(100%)	115281(58.5%)	91778(46.%)
AM	39411 ˜40.000	˜24.000	˜17.000

Table 1.Emergency Case2010-2014

Tab.1 During the period 2010-2014 medical emergenciesoccupied a significant place where are counted 40,000 patients per year (averaged over 100 per day) and the main share of surgical emergencies 59-60%, the rest are therapeutic urgency. (Table 1). 

According to the census in medical emergencies during the past three years, etiology of trauma in UTMH emergency are: 

• Car accidents12%
• Gunshot     wound4.8%
• Work     trauma 38.8%
• Wound     caused by blind and sharp tools19.4%

Statistical Data, Ammunition Explosion GERDECI-2008

No	DATA	AGE			SEX		TOTAL	%
		0-14	14-30	>30	M	F
1	TOTAL CASES	27	44	105	87	89	176	100
2	VLC						99	56.2
3	FRACTURES						20	11.3
4	COMMOTIONS &  CONTUSIONS						43	24.4
5	ARM AMPUTATION	1				1	1	0.5
6	DIFF. BURNS						13	7.3
7	TOTAL (2+6)						176	100
8	HOSPITALIZED						66	100
9	EVACUATEDABROAD	Greece					6	9%
		Italy					4	6%
		Turkey					1	1%
		TOTAL					11	16.6%

During Ammunition 

Chart 3: Number of crashes, casualties and fatalities, by year

Explosion in the demolition center in Gërdec on march 15, 2008 at 12:15 h, 10 km NW of Tirana, near the Tirana-Durrës national highway, in a distance of 3-4 km from National Airport (Foto)….in less than two hours UTHMH 176 wounded were presented with severe medium and heavy, which was managed professionally by medical personnel. Gerdec case shows that trauma hospital can face at any moment with the trauma of tragic proportions.

The issue of road traffic crashes and the high number of victims is highly debated in Albania 

Chart 4: Number of road crash victims by type of injury and year

as well.While efforts are made in years to make the roads safe, data show that crash victims are huge concern for the Albanian public health.The chart 3 show the trend of all types of road crashes, number of casualties and fatalities. During the last five years (2009-2013) fatalities have remained within a band ranging between 300 and 390 per year, equivalent to a rate of between 10 and 12 fatalities per 100,000 persons. However, from 2009, the number of those seriously injured is increasing every year compared to fatalities (chart 4).

Source: INSTATAlbania 

Source: Ministry of Transportation and Infrastructure, Annual Report on Road Safety, 2013

YEARS	RECOVERY (Surgery  & Internal)	%	INTERVENT	%	INTERVENT & MICROSURGERY IN  EMERGENCY
2010	7423	24.8	3739	50.4	600 Surgery  intervene 28-30.000 Microsurgery
2011	6023	20	2993	49,7
2012	5770	19.3	2870	49.7
2013	4863	16.2	3117	64
2014	5827	19.4	3158	54.1
Total	29906 (25048-4858)	100%	15877	100%
AM	5980 (5000-970)	84%  S - 16% I	3100	53%

Table 2. RECOVERY ANDSURGICAL INERVENT 2010-2014

There are 5000 to 6000 patients per year in the UHTMH where the traumatic surgical admission predominates by 84% and therapeutic by 16 %. Surgical intervention are on 53 %. The Hospital conducted 600 operations per year and 28-30 thousand microsurgery.

This data is typical for an hospital of national emergency. The data are typical of traumatic surgical hospital.(Tab.2)

INDICATORS/YEARS	2010	2011	2012	2013	2014	TOTAL (n-%)	MALE/FEMALE
Total       hospitalized	7423	6023	5770	4835	5827	29906
Surgical       hospitalized	5421	4639	4516	4108	5033	23717
TRAUMA	2597	2272	2418	2354	2432	12073   (40.3% A.-51% B.)	M 74% F 26%
Fractures  (head, neck, extremities, luxations)	172	98	87	935	1097	2389(20%)
Trauma within the skull	1563	739	766	803	737	4608(38%)
Trauma chest, abdomen, pelvis	752	381	118	392	213	1856(15.3%)
Vulnus (head, neck, torso, limbs)	110	53	57	90	121	431(4%)
Age0-1	18	9	16	11	17	71(0.6%)
Age 1-14	47	21	21	261	261	611(5%)
Age 15-65+	2532	1241	991	2082	2154	9000(74.5%)
INCIDENCE‰ (Trauma÷Emergency case)	61 ‰	58.5 ‰	73.8 ‰	53 ‰	62.8 ‰	1207361.8 ‰

Table 3. BASIC INDICATORS OF TRAUMA IN UHTMH

Data for basic morbidity show that cases of "trauma"hospitalized are40.3% of surgical and 51% of emergencies that occur in the hospital. Head trauma has higher figures, 38%, fractures 20%, 15.3% abdominal trauma. By age group at 74.5% are active ages 15 to +65 years, at 74% are males and 26% females. with an incidence 61-62 per thousand (Tab.3)

YEARS	RECOVERY	% Mortality  UTMH	PATINETS ICU	CASE  MORTALITY ICU	%
2010	7423	2.1%	802	163	20.3%
2011	6023	2.5%	756	155	20.5%
2012	5770	2.1%	719	123	17.1%
2013	4835	2.2%	619	110	17.7%
2014	5827	2%	672	116	17.2%
Total  AM	5975	2.2%	713	133	18.5%

Table 4. Mortality UHTMH 2010-2014

Based on the number of recovery and registered of deaths,total mortality in UTMH resulting 2.2%, while in ICUwhere other estimates average mortality in the years to survey results 18%. This shows that and cases that are treated in intensive care with serious cases of high mortality. (Tab.4)

YEARS	UHTMH		UHC “Mother Teresa”		DISTRICT  HOSPITALS		TOTAL
	CASES	%	CASES	%	CASES	%	CASES	%
2010	4750	41.5	612	5.3	6090	53.1	11452	100
2011	4367	32.4	550	4.0	8557	63	13474	100
2012	3518	30.6	885	7.7	7076	61	11479	100
2013	4961	40.4	701	5.7	6617	53.8	12279	100
2014	4705	41.2	680	5.9	6025	52.8	11410	100
TOTAL	22301	37.1	3428	5.7	34365	57	60094	100

Table 6. TRAUMA TREATMENTIN UHT&MH, UHC "Mother Teresa“& DISTRICT HOSPITAL

The comparison of the data for the treatment of trauma as UTHMH tertiary hospitals of the University Hospital Center, resulting trauma to the gravity of the medium and heavy was treated at our hospital in 40% of cases and in the University Hospital Centre in Tirana is only 5.7-6% . About hospitals treat minor trauma. The data shows that it has UTHMH weight in the proper treatment of trauma (Tab.6)

Conclusions

• Nowadays the "epidemic of     trauma" is evident in Albania, its treatment in UTHMH remains of     primary importance.
• The statistical data and the     volume of work, give full profile ofUTHMH as tertiary hospital that treats trauma at national level.
• Work trauma, car accident     occupy a leading place in the epidemiological profile.
• Further modernization,     personnel training in UTHMH is and should be the attention of health     policy at the Ministry of Health, to set up a national program for the     treatment of trauma in the whole country. 
• Creating     national trauma registry and computerization, currently lacking

References

1. Poverty and Social Impact Analysis (PSIA): road safety and poverty: Assessing the social costs and benefits of better and safer roads to vulnerable groups Albanian Case
2. The World Health Organization's Global Status Report on Road Safety, 2013
3. Mishra B, Sinha Mishra ND, Sukhla S, Sinha A. Epidemiological study of road traffic accident cases from Western Nepal. Indian J Community Med 2010;35:115-21.
4. Raymond S.Greenberg, SecondEdition“Medical Epidemiology” f.16-17

Col.(R) Ph.D.Luan Nikollari

Epidemiologist

Chief of Statistical Service

University Hospital Trauma & Military Hospital in Tirana, Albania

Colonel (r) Phd Luan Nikollari, Albanian Armed Forces

1972– 1976 High Medical School, Pharmacy Technician; 1977– 1983 Uni -

ver sity of Tirana, Faculty of Medicine, Branch GP, Tirana; 1991– 1992 Spe -

cia lization in Public Health, Epidemiology Branch, Public Health Institute, Tirana;

1995 Course on HIV / AIDS, “Instituto Superiore di Sanita” Rome, Italy. 1997 Course on

Epidemiology, Military Medical Academy “GATA” Ankara, Turkey; 1998 Training at the

Military Hospital “CELIO” and Study Center of Medical Research in Military Preventive

Medicine, Rome, Italy.

1983– 1993 Chief of Medical Service Fantery Brigade in South Albania; 1993– 1998

Head of Service of Preventive Medicine and Health preparation, Department of Health,

SHPFA, Ministry of Defence; 1999– 2000 University Central Military Hospital (SUQU),

Head of the Department of epidemiology; 2000– 2006 Ministry of Defense, GSAAF,

Director of Medical Service Albanian Armed Forces; 2006-2012 Director of Medical

Military Institute at Central University Military Hospital.

2013 onwards: Chief of Statistical Service at University Hospital Trauma& Military Hospital in Tirana, Albania

Address for the authors:

Spitali Ushtarak 

Rruga “Lord Bajron” Laprakë

Tirana-ALBANIA

++355 664010141 (Mobile)

e-mail: lnikollari@yahoo.it

(First and Corresponding Author)

CO-AUTHOR

Pharmacist. E. Nikollari

Date: 07/16/2015

Source: MCIF 3/15