An Analysis of 30-Day in-Hospital Trauma Mortality in Four Urban University Hospitals Using the Australia India Trauma R
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ORIGINAL SCIENTIFIC REPORT
An Analysis of 30-Day in-Hospital Trauma Mortality in Four Urban University Hospitals Using the Australia India Trauma Registry Prashant Bhandarkar1,4 • Priti Patil1 • Kapil Dev Soni2 • Gerard M. O’Reilly3,8 • Satish Dharap5 • Joseph Mathew3 • Naveen Sharma6 • Bhakti Sarang1 • Anita Gadgil1 • Nobhojit Roy1,7,8 on behalf of Australia-India Trauma System Collaboration
Accepted: 20 September 2020 Ó The Author(s) 2020
Abstract Background India has one-sixth (16%) of the world’s population but more than one-fifth (21%) of the world’s injury mortality. A trauma registry established by the Australia India Trauma Systems Collaboration (AITSC) Project was utilized to study 30-day in-hospital trauma mortality at high-volume Indian hospitals. Methods The AITSC Project collected data prospectively between April 2016 and March 2018 at four Indian university hospitals in New Delhi, Mumbai, and Ahmedabad. Patients admitted with an injury mechanism of road or rail-related injury, fall, assault, or burns were included. The associations between demographic, physiological onadmission vitals, and process-of-care parameters with early (0–24 h), delayed (1–7 days), and late (8–30 days) inhospital trauma mortality were analyzed. Results Of 9354 patients in the AITSC registry, 8606 were subjected to analysis. The 30-day mortality was 12.4% among all trauma victims. Early (24-h) mortality was 1.9%, delayed (1–7 days) mortality was 7.3%, and late (8–30 days) mortality was 3.2%. Abnormal physiological parameters such as a low SBP, SpO2, and GCS and high HR and RR were observed among non-survivors. Early initiation of trauma assessment and monitoring on arrival was an important process of care indicator for predicting 30-day survival. Conclusions One in ten admitted trauma patients (12.4%) died in urban trauma centers in India. More than half of the trauma deaths were delayed, beyond 24 h but within one week following injury. On-admission physiological vital signs remain a valid predictor of early 24-h trauma mortality.
& Nobhojit Roy [email protected] 1
2
Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
3
National Trauma Research Institute, The Alfred, Melbourne, Australia
4
School of Health System Studies, Tata Institute of Social Sciences, Mumbai, India
5
Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
6
Department of Surgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
7
Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
8
School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
123
World J Surg
Introduction
Materials and methods
Globally, injuries claim more lives than HIV/AIDS, TB, and malaria together [1]. India has one-sixth (16%) of the world’s population but over one-fifth (21%) of the world’s injury mortality. There are more tha
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