Clinical Presentation, Referral and Management of Pediatric Surgical Emergencies

This study was conducted in Khartoum pediatric surgery units during period from April -November 2004. The main objectives were: to study the clinical presentation, referral and management of pediatric surgical emergencies. To assess the preoperative care offered to the child with suspected surgical problem and to evaluate the referral system of the surgical cases. It is a prospective descriptive study of 136 children with emergency surgical problems. Males were 81(59.6%), where as females were 55(40.4%). The male to female ratio was 1.4:1. Newborns were the most reported age group constituting 35 (25.7%) of the study group. The common presentations of pediatric surgical emergencies were appendicitis 37(27.2%), accidental injuries 33(24.2%) and intestinal obstruction 31(22.8%). Hydrocephalus with meningomyelocele was the commonest surgical emergencies in the newborns 12(8.8%). The majority of children 96(70%) were referred from pediatric emergency units to surgery emergency units. In these cases first line doctors in pediatric emergency units were house officers 74(77.1%) and registrars 22(22.9%). Pediatric registrar assessed 84(87.5%) during 30 min and 12(12.5%) in more than 30 min. The pediatric consultants were informed in V about 62(64.6%) of 96 referred children, of whom 38(61.3%) were seen by the consultants Out of 96 cases referred for pediatric emergency, 49 (51%) were referred immediately to the surgical emergency units. The remaining 47 (49%) were referred after admission for 24 hour or more. Resuscitation equipments were available in 18(13.2%) during transportation. The first line doctor in surgery emergency units were house officers in 103(75.7%), medical officers in 25(18.4%) and registrars in 8(5.9%). Registrars or medical officers evaluated 62(45.6%) during 30 min and 74(54.4%) in more than 30 min. The consultant surgeon was notified in 111(81.6%) children. Ninety-eight children (72.15%) of the total studied population needed operative treatment. Authorization by consultant surgeon given in 86(87.8%). Immediate post-operative care was in I.C.U for 24 (17.6%) and in the ward for others 112(82.4%). The outcome of study showed 123 (90%) were discharged in good condition and 13 (9.6%) died. Eight newborns died constituting (61%) of the total mortality. Intestinal obstruction was the commonest cause of death (38.5%). The outcome depended on several factors including: time before the registrars saw the child, duration of stay in pediatric causality, and transportation