In this review, most of cut throat injury patients were young in their third decade of life and tended to affect more males than females, a finding which agrees with findings reported elsewhere [3, 9, 11]. Male preponderance in this age group is attributable to their active participation in risk taking behaviors and their frequent involvement in interpersonal violence. This has great economic impact since these are people in their most productive years and the injuries impose a considerable burden on their families and the society as a whole.
In agreement with other studies ( 3, 9, 11), most of patients in this study were unemployed and uneducated and the majority of them came from low-income areas of the city and only few had definable source of health care insurance at the time of their injury. This observation has an implication on accessibility to health care facilities. Unemployment can act as a stressful life event leading to suicide  with studies suggesting an increase in the parasuicide and suicide rates among unemployed individuals than in the general population . Socioeconomic improvement of otherwise normal individuals by provision of jobs for example and family planning education can eliminate the triggering factor of unemployment.
Regarding the causes of cut throat injuries, the majority of patients in this study were due to homicidal injury and the remaining patients were due to suicidal attempt and accidental injury. Interpersonal conflict was the most common motivating factor for homicidal injury whereas psychiatric illness and road traffic accidents were the most frequent motivating factors of suicidal attempt and accidental injuries respectively. Similar finding was also reported in Bangladesh by Manilal et al. . On the contrary, cut throat was reported to be suicidal in majority of cases in western studies [20, 21].
In this study, associated medical co-morbidities were reported in 22.4% of cases. Of these, psychiatric illness accounted for more than seventy percent of cases. This observation agrees with other studies done elsewhere [3, 9, 11]. As found in our study, psychiatric illness has been reported in literature to be associated with suicidal attempt [22, 23]. Psychiatric illnesses are the strongest predictors of suicide . Suicide occurs 20.4 times more frequently in individuals with psychiatric illness than the general population [22–24].
The prehospital care of trauma patient has been reported to be the most important factor in determining the ultimate outcome after the injury . None of our patients had pre-hospital care; as a result the majority of them were brought in by relatives, Good Samaritan and police who are not trained on how to take care these patients during transportation. Only 6.2% of patients in this study were brought in by ambulance. This observation is common to many other developing countries [25, 26]. The lack of advanced pre-hospital care and ineffective ambulance system for transportation of patients to hospitals are a major challenges in providing care for trauma patients in our environment and have contributed significantly to poor outcome of these patients.
The majority of injuries in this study were in Zone II and most of them had laryngeal injury which is in keeping with other studies [9–11]. Zone ll injuries are those occurring in the region between the cricoid cartilage and the angle of the mandible. The predominance of zone II injuries in this study may be attributable to the fact that unlike zones l and lll, zone II is not protected by bony structures making it more vulnerable to injuries. Injuries in this zone are the easiest to expose and evaluate [9–13].
As reported by others [3, 9], majority of patients in this study presented with open wounds and active bleeding. Hemorrhagic shock and respiratory distress were reported in only 22.4% and 16.3% of cases. Exposed hypopharynx and or larynx following cut throat, hemorrhage, shock and asphyxia from aspirated blood are commonest cause of death following cut throat injury. A good knowledge of the nature and type of cut throat wounds allows the clinicians to understand the type weapon used and this is of great importance for medico-legal purposes and surgical treatment.
In this study, surgical debridement, laryngeal/hypopharynx repair and tracheostomy were the most common surgical procedures performed. Similar treatment patterns were reported by other authors [3, 9–11]. Cut throat injuries require a multidisciplinary approach involving the anesthetist and psychiatrists working in conjunction with the Otolaryngologist and could be managed with better prognosis if the patients present early to the hospital and are given prompt attention [11, 14, 15]. In this study, all patients that attempted suicide were considered for the psychiatric consultation. This was because the act of suicide is a sign of underlying mental illness and there is possibility of a second attempt [9, 22].
The presence of complications has an impact on the final outcome of patients presenting with cut throat injuries as supported by the present study. In keeping with other studies [3, 9, 11], more than fifty percent of patients developed complications of which surgical site infections was the most common complications. Complication rate was significantly associated with delayed presentation and anatomical zones. Early recognition and management of complications following cut throat injury is of paramount in reducing the morbidity and mortality resulting from these injuries.
Prevention of these complications depends upon immediate resuscitation by securing the airway by tracheostomy or intubation, prompt control of external hemorrhage and blood replacement, protection of the head and neck, accurate and rapid diagnosis, and prompt intervention or operative treatment when indicated.
The length of hospital stay has been reported to be an important measure of morbidity among trauma patients. Prolonged hospitalization is associated with an unacceptable burden on resources for health and undermines the productive capacity of the population through time lost during hospitalization and disability [1, 2, 9]. The median duration of hospital stay in this study was found to be longer than that reported by other authors [3, 9]. This can be explained by large number of patients with postoperative complications which usually need long duration of hospitalization.
The present study had a mortality rate of 11.2%, which is higher than the rate quoted by Manilal et al. . Factors responsible for the high mortality rate in our study were associated co-morbidities, delayed presentation and presence of complications.
In our study, the cut throat injuries were successfully without complications in 89.7% of cases which is similar to other studies reported elsewhere [9, 11].
Self discharge by patient against medical advice is recognized problem in our setting and this is rampant, especially amongst surgical patients. Similarly, poor follow up visits after discharge from hospitals remain a cause for concern. In the present study, only 36.8% of survivors were available for follow up which is in keeping with other studies done in developing countries [3, 9, 11].
The potential limitation of this study is the fact that information about some patients was incomplete in view of the retrospective nature of the study. This might have introduced some bias in our findings.