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Gupta J, Kshirsagar S, Naik S, Pande A. Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores. Indian J Crit Care Med 2024; 28:475-482. [PMID: 38738209 PMCID: PMC11080098 DOI: 10.5005/jp-journals-10071-24664] [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: 01/01/2024] [Accepted: 02/03/2024] [Indexed: 05/14/2024] Open
Abstract
Aim This prospective cohort study aimed to compare the predictive accuracy of outcome (survival/death) among trauma patients using various prognostic scores. Methods Over 3 months, 240 trauma patients in a tertiary care hospital were assessed for demographic details, trauma characteristics, vital signs, Glasgow coma scale, arterial blood gas values, and lab markers. Injury severity score (ISS), revised trauma score (RTS), trauma and injury severity score (TRISS), and acute physiology and chronic health evaluation II (APACHE II) were applied at admission, 24 hours, and 48 hours post-admission. Results Road traffic accidents (55.83%) were the primary cause of trauma, followed by falls (33.75%) and violence (10.41%). The all-cause mortality rate was 23.33%, with 34.16% requiring ICU admission. Head injuries (65.83%) were both the most frequent injury site and cause of mortality. Conclusion Analysis indicated that APACHE II outperformed other scores in predicting outcomes, with ISS following closely. The study concludes that trauma severity correlates with ICU admission and mortality, emphasizing APACHE II as a superior predictor, particularly for traumatic brain injuries leading to ICU admission and mortality. Clinical significance This study contributes to the existing body of knowledge by addressing the gap in comparing prognostic abilities among scoring systems for trauma patients. The unexpected superiority of APACHE II suggests its potential as a valuable tool in predicting outcomes in this specific patient population. How to cite this article Gupta J, Kshirsagar S, Naik S, Pande A. Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores. Indian J Crit Care Med 2024;28(5):475-482.
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Affiliation(s)
- Janhvi Gupta
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Sujit Kshirsagar
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Sanyogita Naik
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Anandkumar Pande
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
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Amato S, Culbreath K, Dunne E, Sarathy A, Siroonian O, Sartorelli K, Roy N, Malhotra A. Pediatric trauma mortality in India and the United States: A comparison and risk-adjusted analysis. J Pediatr Surg 2023; 58:99-105. [PMID: 36328820 DOI: 10.1016/j.jpedsurg.2022.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is a paucity of research comparing pediatric risk-adjusted trauma mortality between high-income and low- and middle-income countries. This limits identification of populations and injury patterns for targeted interventions. We aim to compare independent predictors of pediatric trauma mortality between India and the United States (US). METHODS A retrospective cohort study was conducted for pediatric patients (age <18 years) in India's Towards Improved Trauma Care Outcomes (TITCO) project database and the US National Trauma Data Bank (NTDB) from 2013 to 2015. Demographic, injury, physiologic, anatomic and outcome data were analyzed. Multivariable regressions were used to determine independent predictors of mortality. RESULTS 126,678 pediatric trauma patients were included (India 3,373; US 123,305). Pediatric patients in India were on average significantly younger, with a higher median injury severity score (ISS), had lower systolic blood pressure, and suffered a higher case fatality rate (13.0% vs. 1.0%). When controlling for demographic, mechanism, physiologic, and anatomic injury characteristics, sustaining an injury in India was the strongest predictor of mortality (OR 22.70, 95% CI 18.70-27.56). On subgroup analysis, the highest relative odds of mortality in India was seen in children with lower injury and physiologic severity. CONCLUSIONS Risk-adjusted pediatric trauma-related mortality is significantly higher in India compared to the US. The comparative odds of mortality are highest among children with lower injury and physiologic severity. This suggests that low-cost targeted interventions focused on standard timely trauma care, protocols, training and early imaging could improve pediatric injury mortality in India. TYPE OF STUDY Retrospective Prognosis Study LEVEL OF EVIDENCE: II.
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Affiliation(s)
- Stas Amato
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA.
| | - Katherine Culbreath
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA; Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Emma Dunne
- University of Vermont, Larner College of Medicine, 89 Beaumont Ave, Burlington, VT 05401, USA
| | - Ashwini Sarathy
- University of Vermont, Larner College of Medicine, 89 Beaumont Ave, Burlington, VT 05401, USA
| | - Olivia Siroonian
- Department of Pharmacology, University of Vermont, Larner College of Medicine, 89 Beaumont Ave, Burlington, VT 05401, USA
| | - Kennith Sartorelli
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Nobhojit Roy
- The George Institute for Global Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India; WHO Collaborating Centre for Research in Surgical Care Delivery, Anushakti Nagar, Mumbai, MH 400094, India
| | - Ajai Malhotra
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
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Kim EK, Suri D, Mahajan A, Bhandarkar P, Khajanchi M, Gadgil A, Ranganathan K, Gerdin Warnberg M, Roy N, Raykar NP. Patterns of Head and Neck Injuries in Urban India: A Multicenter Study. OTO Open 2022; 6:2473974X221128217. [PMID: 36247657 PMCID: PMC9558877 DOI: 10.1177/2473974x221128217] [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: 06/01/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022] Open
Abstract
Objective The pattern of head and neck injuries has been well studied in high-income
countries, but the data are limited in low- and middle-income countries,
which are disproportionately affected by trauma. We examined a prospective
multicenter database to describe patterns and outcomes of head and neck
injuries in urban India. Study Design Retrospective review of trauma registry. Setting Four tertiary public hospitals in Mumbai, Delhi, Kolkata. Methods We identified patients with isolated head and neck injuries using
International Classification of Diseases, 10th Revision
(ICD-10) codes and excluded those with traumatic brain
and/or ophthalmic injuries and injuries in other body regions. Results Our cohort included 171 patients. Most were males (80.7%) and adults aged 18
to 55 years (60.2%). Falls (36.8%) and road traffic accidents (36.3%) were
the 2 predominant mechanisms of injury. Overall, 35.7% required intensive
care unit (ICU) admission, and 11.7% died. More than 20% of patients were
diagnosed with “unspecified injury of neck.” Those with the diagnosis had a
higher ICU admission rate (51.4% vs 31.3%, P = .025) and
mortality rate (27.0% vs 7.5%, P = .001) than those without
the diagnosis. Conclusion Isolated head and neck injuries are not highly prevalent among Indian trauma
patients admitted to urban tertiary hospitals but are associated with high
mortality. Over a fifth of patients were diagnosed with “unspecified injury
of neck,” which is associated with more severe clinical outcomes. Exactly
what this diagnosis entails and encompasses remains unclear.
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Affiliation(s)
- Eric K. Kim
- University of California San Francisco,
School of Medicine, San Francisco, California, USA,Program in Global Surgery and Social
Change, Harvard Medical School, Boston, Massachusetts, USA,Eric K. Kim, School of Medicine, University
of California San Francisco, 513 Parnassus Ave, Suite S-245, San Francisco, CA
94143-0454, USA.
| | - Deepak Suri
- Harvard School of Dental Medicine,
Boston, Massachusetts, USA
| | | | - Prashant Bhandarkar
- Tata Institute of Social Sciences
School of Health Systems Studies, Deonar, Maharashtra, India
| | - Monty Khajanchi
- Department of Surgery, King Edward
Memorial Hospital, Mumbai, Maharashtra, India
| | - Anita Gadgil
- World Health Organization Collaborating
Centre for Research in Surgical Care Delivery in Low-and-Middle Income Countries,
Mumbai, India
| | - Kavitha Ranganathan
- Program in Global Surgery and Social
Change, Harvard Medical School, Boston, Massachusetts, USA,Division of Plastic Surgery, Brigham
and Women's Hospital, Boston, Massachusetts, USA
| | | | - Nobhojit Roy
- World Health Organization Collaborating
Centre for Research in Surgical Care Delivery in Low-and-Middle Income Countries,
Mumbai, India,Department of Global Public Health,
Karolinska Institutet, Stockholm, Sweden
| | - Nakul P. Raykar
- Program in Global Surgery and Social
Change, Harvard Medical School, Boston, Massachusetts, USA,Division of Trauma, Emergency
Surgery, Surgical Critical Care, Department of Surgery, Brigham and Women's
Hospital, Boston, Massachusetts, USA,Center for Surgery and Public Health,
Brigham and Women's Hospital, Boston, Massachusetts, USA
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