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O'Neill M, Cheskes S, Drennan I, Keown-Stoneman C, Lin S, Nolan B. Injury severity bias in missing prehospital vital signs: Prevalence and implications for trauma registries. Injury 2024:111747. [PMID: 39054233 DOI: 10.1016/j.injury.2024.111747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/17/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Vital signs are important factors in assessing injury severity and guiding trauma resuscitation, especially among severely injured patients. Despite this, physiological data are frequently missing from trauma registries. This study aimed to evaluate the extent of missing prehospital data in a hospital-based trauma registry and to assess the associations between prehospital physiological data completeness and indicators of injury severity. METHODS A retrospective review was conducted on all adult trauma patients brought directly to a level 1 trauma center in Toronto, Ontario by paramedics from January 1, 2015, to December 31, 2019. The proportion of missing data was evaluated for each variable and patterns of missingness were assessed. To investigate the associations between prehospital data completeness and injury severity factors, descriptive and unadjusted logistic regression analyses were performed. RESULTS A total of 3,528 patients were included. We considered prehospital data missing if any of heart rate, systolic blood pressure, respiratory rate or oxygen saturation were incomplete. Each individual variable was missing from the registry in approximately 20 % of patients, with oxygen saturation missing most frequently (n = 831; 23.6 %). Over 25 % (n = 909) of patients were missing at least one prehospital vital sign, of which 69.1 % (n = 628) were missing all four of these variables. Patients with incomplete data were more severely injured, had higher mortality, and more frequently received lifesaving interventions such as blood transfusion and intubation. Patients were most likely to have missing prehospital physiological data if they died in the trauma bay (unadjusted OR: 9.79; 95 % CI: 6.35-15.10), did not survive to discharge (unadjusted OR: 3.55; 95 % CI: 2.76-4.55), or had a prehospital GCS less than 9 (OR: 3.24; 95 % CI: 2.59-4.06). CONCLUSION In this single center trauma registry, key prehospital variables were frequently missing, particularly among more severely injured patients. Patients with missing data had higher mortality, more severe injury characteristics and received more life-saving interventions in the trauma bay, suggesting an injury severity bias in prehospital vital sign missingness. To ensure the validity of research based on trauma registry data, patterns of missingness must be carefully considered to ensure missing data is appropriately addressed.
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Affiliation(s)
- Melissa O'Neill
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Sheldon Cheskes
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Sunnybrook Centre for Prehospital Medicine, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Science Centre, Toronto, ON, Canada; Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Ian Drennan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Sunnybrook Centre for Prehospital Medicine, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Science Centre, Toronto, ON, Canada; Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Charles Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Steve Lin
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brodie Nolan
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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2
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Gyedu A, Issaka A, Donkor P, Mock C. Assessment and reassessment of injured patients at non-tertiary hospitals in Ghana: A stepped-wedge cluster randomized trial. Afr J Emerg Med 2024; 14:122-127. [PMID: 38799078 PMCID: PMC11127473 DOI: 10.1016/j.afjem.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Frequent reassessment of injured patients is an important component of trauma and emergency care. How frequently such reassessment is done in African hospitals has been minimally addressed. We sought to address this gap, as well as to assess the effectiveness of a standardized trauma intake form (TIF) to improve assessment and reassessment rates. Methods We undertook a stepped-wedge cluster randomized trial with research assistants observing trauma care before and after introducing the TIF at emergency units of eight non-tertiary Ghanaian hospitals for 17.5 months. Differences in seven key performance indicators (KPIs) of assessment and reassessment were evaluated using generalized linear mixed regression. KPIs included: respiratory rate, heart rate, blood pressure, level of consciousness, mobility, temperature, and oxygen saturation. Results Management of 4077 patients was observed: 2067 before TIF initiation and 2010 after. In the before period, completion of KPIs of initial assessment ranged from 55% (oxygen saturation) to 88% (level of consciousness). KPIs for reassessment for patients still in the EU after 30 min (n = 1945, in before period) were much lower than for initial assessment, ranging from 10% (respiratory rate and oxygen saturation) to 13% (level of consciousness). The TIF did not significantly improve performance of any KPI of assessment or reassessment. Similar patterns pertained for the subgroup of seriously injured patients (Injury Severity Score ≥9). Conclusion At non-tertiary hospitals in Ghana, performance of KPIs of initial assessment were mostly adequate, but with room for improvement. Performance of KPIs for reassessment were very low, even for seriously injured patients. The intervention (trauma intake form) did not impact reassessment rates, despite previously having been shown to impact many other KPIs of trauma care. Potential avenues to pursue to improve reassessment rates include other quality improvement efforts and increased emphasis on reassessment in training courses.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adamu Issaka
- Department of Surgery, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, United States
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Zadey S, Rao S, Gondi I, Sheneman N, Patil C, Nayan A, Iyer H, Kumar AR, Prasad A, Finley GA, Prasad CRK, Chintamani, Sharma D, Ghosh D, Jesudian G, Fatima I, Pattisapu J, Ko JS, Bains L, Shah M, Alam MS, Hadigal N, Malhotra N, Wijesuriya N, Shukla P, Khan S, Pandya S, Khan T, Tenzin T, Hadiga VR, Peterson D. Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia. Front Public Health 2024; 12:1325922. [PMID: 38450144 PMCID: PMC10915281 DOI: 10.3389/fpubh.2024.1325922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- GEMINI Research Center, Duke University School of Medicine, Durham, NC, United States
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Shirish Rao
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Isha Gondi
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Natalie Sheneman
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
| | - Chaitrali Patil
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Biology and Statistics, George Washington University, Washington, DC, United States
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Arti Raj Kumar
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Arun Prasad
- Indraprastha Apollo Hospital, New Delhi, India
| | - G. Allen Finley
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | | | - Chintamani
- Department of Surgery, Vardhman Mahavir Medical College Safdarjung Hospital, New Delhi, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Dhruva Ghosh
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Gnanaraj Jesudian
- Karunya Rural Community Hospital Karunya Nagar, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India, Wardha, India
- International Federation of Rural Surgeons, Ujjain, India
- Rural Surgery Innovations Private Limited, Dimapur, Nagaland, India
| | - Irum Fatima
- IRD Pakistan and the Global Surgery Foundation, Karachi, Sindh, Pakistan
| | - Jogi Pattisapu
- University of Central Florida College of Medicine, Orlando, FL, United States
| | - Justin Sangwook Ko
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, Maharashtra, India
| | - Mashal Shah
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Shadrul Alam
- Department of Pediatric Surgery, Mugda Medical College, Dhaka, Bangladesh
- American College of Surgeons: Bangladesh Chapter, Dhaka, Bangladesh
- Bangladesh Health Economist Forum, Dhaka, Bangladesh
- Association of Pediatric Surgeons of Bangladesh (APSB), DMCH, Dhaka, Bangladesh
| | - Narmada Hadigal
- Narmada Fertility Centre, Hyderabad, Telangana, India
- International Trauma Anesthesia and Critical Care Society, Stavander, Stavanger, Norway
| | - Naveen Malhotra
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nilmini Wijesuriya
- College of Anaesthesiologists and Intensivists of Sri Lanka, Rajagiriya, Sri Lanka
| | - Prateek Shukla
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sunil Pandya
- Department of Anaesthesia, Perioperative Medicine and Critical Care, AIG Hospitals, Hyderabad, Telangana, India
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tashi Tenzin
- Army Medical Services, Military Hospital, Thimphu, Bhutan
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Daniel Peterson
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
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Soni KD, Bansal V, Arora H, Verma S, Wärnberg MG, Roy N. The State of Global Trauma and Acute Care Surgery/Surgical Critical Care. Crit Care Clin 2022; 38:695-706. [PMID: 36162905 DOI: 10.1016/j.ccc.2022.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma is a leading cause of morbidity and mortality globally, with a significant burden attributable to the low- and middle-income countries (LMICs), where more than 90% of injury-related deaths occur. Road injuries contribute largely to the economic burden from trauma and are prevalent among adolescents and young adults. Trauma systems vary widely across the world in their capacity of providing basic and critical care to injured patients, with delays in treatment being present at multiple levels at LMICs. Strengthening existing systems by providing cost-effective and efficient solutions can help mitigate the injury burden in LMICs.
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Affiliation(s)
- Kapil Dev Soni
- Critical & Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, Ring Road, Raj Nagar, Safdarjung Enclave, New Delhi, Delhi 110029, India
| | - Varun Bansal
- Department of General Surgery, 2nd Floor Registration Building, Seth G.S.M.C. and K.E.M. Hospital, Parel, Mumbai 400012, India
| | - Harshit Arora
- Department of Surgery, Punjab Institute of Medical Sciences, Gadha Road, Jalandhar, Punjab 144006, India
| | - Sukriti Verma
- Department of Blood Bank, Guru Teg Bahadur Hospital, Tahirpur Rd, GTB Enclave, Dilshad Garden, New Delhi, Delhi 110095, India; WHO Collaborating Center for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, Anushaktinagar, Mumbai 400094, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18, 171 65 Solna, Stockholm 171 65, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, SE - 171 76, Stockholm, Sweden
| | - Nobhojit Roy
- WHO Collaborating Center for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, Anushaktinagar, Mumbai 400094, India; The George Institute of Global Health India, F-BLOCK, 311-312, Third Floor, Jasola Vihar, New Delhi, Delhi 110025, India.
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5
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Pendleton AA, Sarang B, Mohan M, Raykar N, Wärnberg MG, Khajanchi M, Dharap S, Fitzgerald M, Sharma N, Soni KD, O'Reilly G, Bhandarkar P, Misra M, Mathew J, Jarwani B, Howard T, Gupta A, Cameron P, Bhoi S, Roy N. A cohort study of differences in trauma outcomes between females and males at four Indian Urban Trauma Centers. Injury 2022; 53:3052-3058. [PMID: 35906117 DOI: 10.1016/j.injury.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 06/21/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023]
Abstract
Background Studies from high income countries suggest improved survival for females as compared to males following trauma. However, data regarding differences in trauma outcomes between females and males is severely lacking from low- and middle-income countries. The objective of this study was to determine the association between sex and clinical outcomes amongst Indian trauma patients using the Australia-India Trauma Systems Collaboration database. Methods A prospective multicentre cohort study was performed across four urban public hospitals in India April 2016 through February 2018. Bivariate analyses compared admission physiological parameters and mechanism of injury. Logistic regression assessed association of sex with the primary outcomes of 30-day and 24-hour in-hospital mortality. Secondary outcomes included ICU admission, ICU length of stay, ventilator requirement, and time on a ventilator. Results Of 8,605 patients, 1,574 (18.3%) were females. The most common mechanism of injury was falls for females (52.0%) and road traffic injury for males (49.5%). On unadjusted analysis, there was no difference in 30-day in-hospital mortality between females (11.6%) and males (12.6%, p = 0.323). However, females demonstrated a lower mortality at 24-hours (1.1% vs males 2.1%, p = 0.011) on unadjusted analysis. Females were also less likely to require a ventilator (17.3% vs 21.0% males, p = 0.001) or ICU admission (34.4% vs 37.5%, p = 0.028). Stratification by age or by ISS demonstrated no difference in 30-day in-hospital mortality for males vs females across age and ISS categories. On multivariable regression analysis, sex was not associated significantly with 30-day or 24-hour in-hospital mortality. Conclusion This study did not demonstrate a significant difference in the 30-day trauma mortality or 24-hour trauma mortality between female and male trauma patients in India on adjusted analyses. A more granular data is needed to understand the interplay of injury severity, immediate post-traumatic hormonal and immunological alterations, and the impact of gender-based disparities in acute care settings.
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Affiliation(s)
- Anna Alaska Pendleton
- Harvard Program for Global Surgery and Social Change, Harvard Medical School, Boston, United States
| | - Bhakti Sarang
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Monali Mohan
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Nakul Raykar
- Trauma and Emergency General Surgery, Brigham and Women's Hospital, Boston, United States
| | | | - Monty Khajanchi
- Harvard Program for Global Surgery and Social Change, Harvard Medical School, Boston, United States
| | - Satish Dharap
- Department of General Surgery, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
| | | | - Naveen Sharma
- Department of Surgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Gerard O'Reilly
- Department of Epidemiology and Biostatistics, National Trauma Research Institute, The Alfred, Melbourne, Australia
| | - Prashant Bhandarkar
- Department of Statistics, Bhabha Atomic Research Centre Hospital, Mumbai, India
| | - Mahesh Misra
- JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Joseph Mathew
- The Alfred Hospital, Emergency and Trauma Centre, Melbourne, Australia
| | | | | | - Amit Gupta
- Division of Trauma Surgery & Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Peter Cameron
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne Australia
| | - Sanjeev Bhoi
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nobhojit Roy
- Harvard Program for Global Surgery and Social Change, Harvard Medical School, Boston, United States; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden SE-171 77; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Gyedu A, Quainoo E, Nakua E, Donkor P, Mock C. Achievement of Key Performance Indicators in Initial Assessment and Care of Injured Patients in Ghanaian Non-tertiary Hospitals: An Observational Study. World J Surg 2022; 46:1288-1299. [PMID: 35286419 PMCID: PMC9058212 DOI: 10.1007/s00268-022-06507-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION We aimed to determine the level of achievement of key performance indicators (KPIs) during initial assessment and management of injured persons, as assessed by independent observers, at district and regional hospitals in Ghana. METHODS Trained observers were stationed at emergency units of six district (first level) and two regional (referral) hospitals, from October 2020 to February 2021, to observe management of injured patients by health service providers. Achievement of KPIs was assessed for all injured patients and for seriously injured patients (admitted for ≥ 24 h, referred, or died). RESULTS Management of 1006 injured patients was observed. Road traffic crash was the most common mechanism (63%). Completion of initial triage ranged from 65% for oxygen saturation to 92% for mobility assessment. For primary survey, airway was assessed in 77% of patients, chest examination performed in 66%, and internal abdominal bleeding assessed in 43%. Reassessment rates were low, ranging from 16% for respiratory rate to 23% for level of consciousness. Thirty-one percent of patients were seriously injured. Completion of KPIs was higher for these patients, but reassessment remained low, ranging from 25% for respiratory rate to 33% for level of consciousness. CONCLUSION KPIs were performed at a high level, but several specific elements should be performed more frequently, such as oxygen saturation and assessment for internal abdominal bleeding. Reassessment needs to be performed more frequently, especially for seriously injured patients. Overall, care for the injured at non-tertiary hospitals in Ghana could be improved with a more systematic approach.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, KNUST, Private Mail Bag, University Post Office, Kumasi, Ghana.
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Emmanuel Quainoo
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, KNUST, Private Mail Bag, University Post Office, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA
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Iezadi S, Gholipour K, Khanijahani A, Alizadeh M, Samadirad B, Azizi H, Azizinia F. Development, validation, and pilot implementation of the minimum datasheet for a domestic violence registry system: The case of a developing country. PLoS One 2022; 16:e0261460. [PMID: 34972149 PMCID: PMC8719697 DOI: 10.1371/journal.pone.0261460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background Domestic violence (DV) is a universal issue and an important public health priority. Establishing a DV Registry System (DVRS) can help to systematically integrate data from several sources and provide valid and reliable information on the scope and severity of harms. The main objective of this study was to develop, validate, and pilot-test a minimum datasheet for a DVRS to register DV victims in medical facilities. Materials and methods This study was conducted in two main phases. Phase one includes developing the datasheet for registration of DV in the DVRS. In phase two, the datasheet designed in the previous step was used in a pilot implementation of the DVRS for 12 months to find practical challenges. The preliminary datasheet was first developed using information on similar registry programs and guidelines of the World Health Organization (WHO) and then reviewed by four expert panels. Through a two-round Delphi technique, experts evaluated the instrument using the Content Validity Index (CVI) and Content Validity Ratio (CVR). The consistency of the responses was evaluated by test-retest analysis. Finally, two physicians in two forensic medical clinics registered the victims of physical and/or sexual violence perpetrated by a family member. Results Preliminary datasheet consisted of 31 items. In the first round of Delphi, fifteen items had good content validity (I-CVI and CVR) and were kept, and seven items were moved to the next round. Also, in the first round of Delphi, experts suggested adding three items, including history of the violence, custody of the child, and custody of the elderly. All items evaluated in the second round were kept due to good CVR and CVI scores. As a result of Test-retest correlation coefficients for self-reprted items, two items including perpetrator’s alcohol and drug use status were excluded (r(30) = +.43, and +.38, p< .01, two-tailed, respectively). Finally, 24 items were included in the datasheet including 15 items for individuals’ characteristics (victims’ characteristics and perpetrators’ characteristics), eight items for incidents’ characteristics, and one item for past history of violence experience. A total of 369 cases were registered from September 23, 2019, to July 21, 2020. The majority of the reported cases were female (82%) and were 19–40 years old. No physical and/or sexual violence was reported from rural areas, which calls upon researchers to explore how services for detecting and treating the victims can be made accessible to these areas. Conclusion DVRS can show trends in DV by age, sex, the context of the violence, and incidence characteristics at every point in time. This is particularly valuable in planning and prioritizing research areas and interventions for DV prevention. Additionally, DVRS can be linked to other disease registry programs which can contribute to continuity and coordination of care, and major research in the future. Although a DVRS can be a promising initiative in identifying the areas in need of urgent interventions, there is no guarantee for its proper implementation due to limited resources and other challenges.
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Affiliation(s)
- Shabnam Iezadi
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Kamal Gholipour
- Social Determinants of Health Research Center, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Science, Tabriz, Iran
- * E-mail: ,
| | - Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, United States of America
| | - Mahasti Alizadeh
- Social Determinants of Health Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Bahram Samadirad
- Forensic Medicine research center, Iranian Legal Medicine Organization, Tehran, Iran
| | - Hanie Azizi
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Azizinia
- School of medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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8
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What is Known About Burns in East Africa? A Scoping Review. J Surg Res 2021; 266:113-124. [PMID: 33989890 DOI: 10.1016/j.jss.2021.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/27/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Burns are a global public health concern, with the majority of the disease burden affecting low- and middle-income countries. Yet, as suggested by previous publications, there is a widespread belief that literature about burns in low- and middle-income countries is lacking. Therefore, we aimed to assess with a scoping review, the extent of the literature output on burns in East Africa, and to investigate patient demographics, injury characteristics, treatment and outcomes, as reported from the existing publications. METHODS Studies discussing burns in East Africa were identified by searching PubMed / Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO), and Global Index Medicus on December 12, 2019. Controlled vocabulary terms (i.e., MeSH, EMTREE, Global Health thesaurus terms) were included when available and appropriate. No year restrictions were applied. RESULTS A total of 1,044 records were retrieved from the database searches, from which 40 articles from 6 countries published between 1993 and 2019 were included in the final review. No studies were found from five East African countries with the lowest GDP. Most papers focused on pediatric trauma patients or tertiary hospital settings. The total number of burn patients recorded was 44,369, of which the mean proportion of males was 56%. The most common cause of injury was scalds (61%), followed by open flame (17%). Mortality rate ranged from 0-67%. The mean length of stay in hospital was between 9-60 d. CONCLUSIONS Burn data is limited in the East African region, with socio-economically weak countries being particularly underrepresented. This scoping review has identified the largest set of literature on burns in East Africa to date, indicating the importance of reviewing data at a regional or local level, as "global" studies tend to be dominated by high-income country data. Data collection in specific registries is needed to better characterize the exact burden of burn injuries in East Africa.
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Miranda E, Velin L, Ntirenganya F, Riviello R, Mukagaju F, Shyaka I, Nezerwa Y, Pompermaier L. Recording Patient Data in Burn Unit Logbooks in Rwanda: Who and What Are We Missing? J Burn Care Res 2021; 42:526-532. [PMID: 33128370 PMCID: PMC8104069 DOI: 10.1093/jbcr/iraa198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Systematic data collection in high-income countries has demonstrated a decreasing burn morbidity and mortality, whereas lack of data from low- and middle-income countries hinders a global overview of burn epidemiology. In low- and middle-income countries, dedicated burn registries are few. Instead, burn data are often recorded in logbooks or as one variable in trauma registries, where incomplete or inconsistently recorded information is a known challenge. The University Teaching Hospital of Kigali hosts the only dedicated burn unit in Rwanda and has collected data on patients admitted for acute burn care in logbooks since 2005. This study aimed to assess the data registered between January 2005 and December 2019, to evaluate the extent of missing data, and to identify possible factors associated with “missingness.” All data were analyzed using descriptive statistics, Fisher’s exact test, and Wilcoxon Rank Sum test. In this study, 1093 acute burn patients were included and 64.2% of them had incomplete data. Data completeness improved significantly over time. The most commonly missing variables were whether the patient was referred from another facility and information regarding whether any surgical intervention was performed. Missing data on burn mechanism, burn degree, and surgical treatment were associated with in-hospital mortality. In conclusion, missing data is frequent for acute burn patients in Rwanda, although improvements have been seen over time. As Rwanda and other low- and middle-income countries strive to improve burn care, ensuring data completeness will be essential for the ability to accurately assess the quality of care, and hence improve it.
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Affiliation(s)
- Elizabeth Miranda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA.,Division of Vascular Surgery, University of Southern California, Los Angeles, CA
| | - Lotta Velin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA.,Surgery and Public Health, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Faustin Ntirenganya
- Plastic Surgery Unit, Department of Surgery, University Teaching Hospital Kigali (CHUK), Kigali, Rwanda
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | | | - Ian Shyaka
- Plastic Surgery Department, Rwanda Military Hospital, Kigali, Rwanda
| | - Yves Nezerwa
- Plastic Surgery Department, Rwanda Military Hospital, Kigali, Rwanda
| | - Laura Pompermaier
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA.,Linköping University Hospital, Linköping, Sweden
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Sarang B, Bhandarkar P, Raykar N, O'Reilly GM, Soni KD, Wärnberg MG, Khajanchi M, Dharap S, Cameron P, Howard T, Gadgil A, Jarwani B, Mohan M, Bhoi S, Roy N. Associations of On-arrival Vital Signs with 24-hour In-hospital Mortality in Adult Trauma Patients Admitted to Four Public University Hospitals in Urban India: A Prospective Multi-Centre Cohort Study. Injury 2021; 52:1158-1163. [PMID: 33685640 DOI: 10.1016/j.injury.2021.02.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In India, more than a million people die annually due to injuries. Identifying the patients at risk of early mortality (within 24 hour of hospital arrival) is essential for triage. A bilateral Government Australia-India Trauma System Collaboration generated a trauma registry in the context of India, which yielded a cohort of trauma patients for systematic observation and interventions. The aim of this study was to determine the independent association of on-arrival vital signs and Glasgow Coma Score (GCS) with 24-hour mortality among adult trauma patients admitted at four university public hospitals in urban India. METHODS We performed an analysis of a prospective multicentre observational study of trauma patients across four urban public university hospitals in India, between April 2016 and February 2018. The primary outcome was 24-hour in-hospital mortality. We used logistic regression to determine mutually independent associations of the vital signs and GCS with 24-hour mortality. RESULTS A total of 7497 adult patients (18 years and above) were included. The 24-hour mortality was 1.9%. In univariable logistic regression, Glasgow Coma Score (GCS) and the vital signs systolic blood pressure (SBP), heart rate (HR), respiratory rate (RR) and peripheral capillary oxygen saturation (SpO2) had statistically significant associations with 24-hour mortality. These relationships held in multivariable analysis with hypotension (SBP<90mm Hg), tachycardia (HR>100bpm) and bradycardia (HR<60bpm), hypoxia (SpO2<90%), Tachypnoea (RR>20brpm) and severe (3-8) and moderate (9-12) GCS having strong association with 24-hour mortality. Notably, the patients with missing values for SBP, HR and RR also demonstrated higher odds of 24-hour mortality. The Injury Severity Scores (ISS) did not corelate with 24-hour mortality. CONCLUSION The routinely measured GCS and vital signs including SBP, HR, SpO2 and RR are independently associated with 24-hour in-hospital mortality in the context of university hospitals of urban India. These easily measured parameters in the emergency setting may help improve decision-making and guide further management in the trauma victims. A poor short-term prognosis was also observed in patients in whom these physiological variables were not recorded.
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Affiliation(s)
- Bhakti Sarang
- Trauma Research group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India; Associate Professor, Terna Medical College & Hospital, Nerul, New Mumbai, India
| | - Prashant Bhandarkar
- Trauma Research group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India; School of Health System Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Nakul Raykar
- Trauma Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Gerard M O'Reilly
- NHMRC Research Fellow & Head of Epidemiology & Biostatistics, National Trauma Research Institute, The Alfred, Melbourne, Australia; Adjunct Clinical Associate Professor, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Emergency Physician & Head of Global programs, Emergency & Trauma Centre, The Alfred, Melbourne, Australia
| | - Kapil Dev Soni
- Additional Professor, Critical & Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi
| | | | - Monty Khajanchi
- Trauma Research group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India; Associate Professor, Seth.G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, India
| | - Satish Dharap
- Professor & Head of General Surgery, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
| | - Peter Cameron
- Academic Director, Emergency & Trauma Centre, The Alfred Hospital, Melbourne Australia; Professor, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Teresa Howard
- Central Clinical School, Monash University, Melbourne, Australia; Burnet Institute, Melbourne, Australia; National Trauma Research Institute, Alfred Hospital and Monash University, Melbourne, Australia
| | - Anita Gadgil
- Trauma Research group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Bhavesh Jarwani
- Associate Professor, Emergency Medicine Department, Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India
| | - Monali Mohan
- Trauma Research group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Nobhojit Roy
- Trauma Research group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India; Affiliate, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Adjunct Professor (Research), School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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Mohammed Z, Arafa A, Senosy S, El-Morsy EMA, El-Bana E, Saleh Y, Hirshon JM. Completeness of Medical Records of Trauma Patients Admitted to the Emergency Unit of a University Hospital, Upper Egypt. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E83. [PMID: 33374262 PMCID: PMC7795587 DOI: 10.3390/ijerph18010083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
Trauma records in Egyptian hospitals are widely suspected to be inadequate for developing a practical and useful trauma registry, which is critical for informing both primary and secondary prevention. We reviewed archived paper records of trauma patients admitted to the Beni-Suef University Hospital in Upper Egypt for completeness in four domains: demographic data including contact information, administrative data tracking patients from admission to discharge, clinical data including vital signs and Glasgow Coma Scale scores, and data describing the causal traumatic event (mechanism of injury, activity at the time of injury, and location/setting). The majority of the 539 medical records included in the study had significant deficiencies in the four reviewed domains. Overall, 74.3% of demographic fields, 66.5% of administrative fields, 55.0% of clinical fields, and just 19.9% of fields detailing the causal event were found to be completed. Critically, oxygen saturation, arrival time, and contact information were reported in only 7.6%, 25.8%, and 43.6% of the records, respectively. Less than a fourth of the records provided any details about the cause of trauma. Accordingly, the current, paper-based medical record system at Beni-Suef University Hospital is insufficient for the development of a practical trauma registry. More efforts are needed to develop efficient and comprehensive documentation of trauma data in order to inform and improve patient care.
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Affiliation(s)
- Zeinab Mohammed
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt; (Z.M.); (A.A.); (S.S.); (E.-M.A.E.-M.)
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Ahmed Arafa
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt; (Z.M.); (A.A.); (S.S.); (E.-M.A.E.-M.)
- Department of Public Health, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Shaimaa Senosy
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt; (Z.M.); (A.A.); (S.S.); (E.-M.A.E.-M.)
| | - El-Morsy Ahmed El-Morsy
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt; (Z.M.); (A.A.); (S.S.); (E.-M.A.E.-M.)
| | - Emad El-Bana
- Department of Orthopedic Surgery, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt;
| | - Yaseen Saleh
- College of Medicine, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Soni KD, Khajanchi M, Raykar N, Sarang B, O'Reilly GM, Dharap S, Cameron P, Sharma N, Howard T, Farrow N, Roy N. Does in-hospital trauma mortality in urban Indian academic centres differ between "office-hours" and "after-hours"? J Crit Care 2020; 62:31-37. [PMID: 33242732 DOI: 10.1016/j.jcrc.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/07/2020] [Accepted: 11/13/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Trauma services within hospitals may vary considerably at different times across a 24 h period. The variable services may negatively affect the outcome of trauma victims. The current investigation aims to study the effect of arrival time of major trauma patients on mortality and morbidity. METHOD Retrospective analysis of the Australia-India Trauma Systems Collaboration (AITSC) registry established in four public university teaching centres in India Based on hospital arrival time, patients were grouped into "Office-hours" and "After-hours". Outcome parameters were compared between the above groups. RESULTS 5536 (68.4%) patients presented "after-hours" (AO) and 2561 (31.6%) during "office-hours" (OH). The in-hospital mortality for "after-hours" and "office-hours" presentations were 12.1% and 11.6% respectively. On unadjusted analysis, there was no statistical difference in the odds of survival for OH versus AH presentations. (OR,1.05, 95% CI 0.9-1.2). Adjusting for potential prognostic factors (injury severity, presence of shock on arrival, referral status, sex, or extremes of age), there was no statistically significant odds of survival for OH versus AH presentations (OR,1.02, 95%CI 0.9-1.2).ICU length of stay and duration of mechanical ventilation was longer in the AH group. CONCLUSION The in-hospital mortality did not differ between trauma patients who arrived during "after-hours" compared to '"office-hours".
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Affiliation(s)
- Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Monty Khajanchi
- Seth. G. S. Medical College & K.E.M. HospitalParel, Mumbai, India
| | - Nakul Raykar
- Division of Trauma and Emergency Surgery, Brigham and Women's Hospital, Boston, USA
| | - Bhakti Sarang
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Gerard M O'Reilly
- NHMRC Research, Head of Epidemiology and Biostatistics, National Trauma Research Institute, The Alfred, Melbourne, Australia
| | - Satish Dharap
- Dept of General Surgery, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
| | - Peter Cameron
- The Alfred Hospital, Emergency and Trauma Centre, Prehospital Emergency and Trauma Research, Health Services Research, Australia
| | | | - Teresa Howard
- Central Clinical School, Monash University, Melbourne, Australia-The Burnet Institute, Melbourne, Australia
| | - Nathan Farrow
- Monash University-Alfred Health, National Trauma Research Institute, Patient Safety Review, Safer Care Victoria, Australia
| | - Nobhojit Roy
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India; Dept of Global Public Health, Karolinska Institutet, Stockholm, Sweden; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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Bhandarkar P, Patil P, Soni KD, O'Reilly GM, Dharap S, Mathew J, Sharma N, Sarang B, Gadgil A, Roy N. An Analysis of 30-Day in-Hospital Trauma Mortality in Four Urban University Hospitals Using the Australia India Trauma Registry. World J Surg 2020; 45:380-389. [PMID: 33084947 PMCID: PMC7773616 DOI: 10.1007/s00268-020-05805-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 01/10/2023]
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 on-admission vitals, and process-of-care parameters with early (0–24 h), delayed (1–7 days), and late (8–30 days) in-hospital 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.
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Affiliation(s)
- Prashant Bhandarkar
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
- School of Health System Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Priti Patil
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Gerard M O'Reilly
- National Trauma Research Institute, The Alfred, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Satish Dharap
- Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
| | - Joseph Mathew
- National Trauma Research Institute, The Alfred, Melbourne, Australia
| | - Naveen Sharma
- Department of Surgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Bhakti Sarang
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Anita Gadgil
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Nobhojit Roy
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India.
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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