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Virk S, Arora H, Patil P, Sarang B, Khajanchi M, Bains L, Kizhakke DV, Jain S, Nathani P, Dev Y, Gadgil A, Roy N. An Indian surgeon's perspective on management of asymptomatic gallstones. Asian J Endosc Surg 2024; 17:e13297. [PMID: 38439130 DOI: 10.1111/ases.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/27/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Cholelithiasis is widely prevalent in India, with a majority of patients being asymptomatic while a small proportion experiencing mild complications. In the laparoscopic era, the rate of cholecystectomies has increased owing to early recovery and fewer complications. In asymptomatic patients, the risk of complications must be balanced against the treatment benefit. Recent guidelines suggest no prophylactic cholecystectomy in asymptomatic patients. We aimed to find out the Indian surgeons' perspective on asymptomatic gallstone management. METHODS A cross-sectional e-survey was conducted of practicing surgeons, onco-surgeons and gastrointestinal-surgeons in India. The survey had questions regarding their perspective on laparoscopic cholecystectomy and treatment modalities in asymptomatic gallstones. RESULTS A total of 196 surgeons responded to the survey. Their mean age was 42.3 years. Overall, 111 (57%) respondents worked in the private sector. Most surgeons (164) agreed that the rate of cholecystectomy has increased since the advent of laparoscopy; 137 (70%) respondents agreed that they would not operate on patients without risk factors. Common bile duct stones, chronic hemolytic diseases, transplant recipients, and diabetes mellitus were the risk factors. Majority of the participants agreed on not performing a cholecystectomy in patients with asymptomatic gallstones. CONCLUSION There exists a lack of consensus among Indian surgeons on asymptomatic gallstone management in India. Where the majority of cases are asymptomatic and do not require surgery, certain comorbidities can influence the line of treatment in individual patients. Currently, the treatment guidelines for asymptomatic patients need to be established as cholecystectomies may be overperformed due to the fear of development of complications.
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Affiliation(s)
- Sargun Virk
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Anesthesiology, Weill Cornell School of Medicine, New York, New York, USA
| | - Harshit Arora
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Priti Patil
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of General Surgery, Bhabha Atomic Research Centre (BARC) and Hospital, Mumbai, India
| | - Bhakti Sarang
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Terna Medical College, Navi Mumbai, India
| | - Monty Khajanchi
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India
| | - Lovenish Bains
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Deepa Veetil Kizhakke
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Manipal Hospital, New Delhi, India
| | - Samarvir Jain
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, India
| | - Priyansh Nathani
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
| | - Ya Dev
- Department of Surgery, Government Medical College, Trivandrum, India
| | - Anita Gadgil
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of General Surgery, Bhabha Atomic Research Centre (BARC) and Hospital, Mumbai, India
| | - Nobhojit Roy
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Jain S, Mahajan A, Patil PM, Bhandarkar P, Khajanchi M. Trends of surgical-care delivery during the COVID-19 pandemic: A multi-centre study in India (IndSurg Collaboration). J Postgrad Med 2023; 69:198-204. [PMID: 37449588 PMCID: PMC10846812 DOI: 10.4103/jpgm.jpgm_485_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/18/2022] [Accepted: 11/24/2022] [Indexed: 07/18/2023] Open
Abstract
Context The COVID-19 pandemic and subsequent lockdowns adversely affected global healthcare services to varying extents. To accommodate its added burden, emergency services were affected along-with elective surgeries. Aims To quantify and analyze the trends of essential surgeries and bellwether procedures during the waxing and waning of the pandemic, across various hospitals in India. Settings and Design Multi-centric retrospective study. Methods and Material A research consortium led by World Health Organization (WHO) Collaboration Center (WHOCC) for Research in Surgical Care Delivery in Low-and Middle-Income countries, India, conducted this study with 5 centers. All surgeries performed during April 2020 (Wave I), November 2020 (Recovery I), and April 2021 (Wave II) were compared with those performed in April 2019 (pre-pandemic period). Statistical Analysis Used Microsoft Excel 2019 and SPSS Version 20. Results The total number of surgeries reduced by 77% during Wave I, which improved to a 52% reduction in Recovery I compared to the pre-pandemic period. However, surgeries were reduced again during Wave II to 68%, but the reduction was less compared to Wave I. Emergency and essential surgeries were affected along with the elective ones but to a lesser extent. Conclusions The present study has quantified the effects of the pandemic on surgical-care delivery across a timeline and documented a reduction in overall surgical volumes during the peaks of the pandemic (Wave I and II) with minimal improvement as the surge of COVID-19 cases declined (Recovery II). The surgical volumes improved during the second wave compared to the first one which may be attributable to better preparedness. Cesarean sections were affected the least.
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Affiliation(s)
- S Jain
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - A Mahajan
- Government Medical College, Amritsar, Punjab, India
| | - PM Patil
- Department of Biostatistics, BARC Hospital, Mumbai, Maharashtra, India
| | - P Bhandarkar
- Department of Biostatistics, BARC Hospital, Mumbai, Maharashtra, India
| | - M Khajanchi
- Department of Surgery, Seth G.S. Medical College and K.E.M Hospital, Mumbai, Maharashtra, India
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Nayan A, Sarang B, Khajanchi M, Roy N, Jesudian G, Menon N, Patil M, Kataria R, Manoharan R, Tongaonkar R, Dev Y, Gadgil A. Exploring the perioperative infection control practices & incidence of surgical site infections in rural India. Antimicrob Resist Infect Control 2023; 12:65. [PMID: 37422654 PMCID: PMC10329309 DOI: 10.1186/s13756-023-01258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/29/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) affect around a third of patients undergoing surgeries worldwide, annually. It is heterogeneously distributed with a higher burden in low and middle-income countries. Although rural and semi-urban hospitals cater to 60-70% of the Indian population, scarce data regarding SSI rates are available from such hospitals. The study aimed to determine the prevalent SSI prevention practices and existing SSI rates in the smaller rural and semi-urban hospitals in India. METHODS This is a prospective study performed in two phases involving surgeons and their hospitals from Indian rural and semi-urban regions. In the first phase, a questionnaire was administered to surgeons enquiring into the perioperative SSI prevention practices and five interested hospitals were recruited for phase two which documented the rate of SSIs and factors affecting them. RESULTS There was full compliance towards appropriate perioperative sterilisation practices and postoperative mop count practice at the represented hospitals. But prophylactic antimicrobials were continued in the postoperative period in more than 80% of the hospitals. The second phase of our study documented an overall SSI rate of 7.0%. The SSI rates were influenced by the surgical wound class with dirty wounds recording six times higher rate of infection than clean cases. CONCLUSIONS SSI prevention practices and protocols were in place in all the less-resourced hospitals surveyed. The SSI rates are comparable or lower than other LMIC settings. However, this is accompanied by poor implementation of the antimicrobial stewardship guidelines.
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Affiliation(s)
- Anveshi Nayan
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Bhakti Sarang
- Department of Surgery, Terna Medical College & Hospital, New Mumbai, India
- WHO Collaboration Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Monty Khajanchi
- WHO Collaboration Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
- Department of Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Nobhojit Roy
- WHO Collaboration Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India.
- Dept of Global Public Health, Karolinska Institute, Stockholm, Sweden.
| | - Gnanaraj Jesudian
- Association of Rural Surgeons of India, Chennai, India
- International Federation of Rural Surgeons, Tiruchirappalli, India
| | - Nandakumar Menon
- Department of Surgery, ASHWINI Gudalur Adivasi Hospital, Gudalur, Nilgiris, Tamil Nadu, India
| | - Mulki Patil
- Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, India
| | - Raman Kataria
- Department of Surgery, Jan Swasthya Sahyog, Bilaspur, Chattisgarh, India
| | - Ravikumar Manoharan
- Department of Surgery, Tribal Health Initiative, Sittilingi, Tamilnadu, India
| | - Rajesh Tongaonkar
- Department of Surgery, Dr Tongaonkar Hospital, Dondaicha, Dhule, India
| | - Ya Dev
- Department of Surgery, Government Medical College, Kollam, Kerala, India
| | - Anita Gadgil
- WHO Collaboration Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
- Department of Surgery, BARC Hospital, Mumbai, India
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4
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Anthony AA, Dutta R, Sarang B, David S, O'Reilly G, Raykar NP, Khajanchi M, Attergrim J, Soni KD, Sharma N, Mohan M, Gadgil A, Roy N, Gerdin Wärnberg M. Profile and triage validity of trauma patients triaged green: a prospective cohort study from a secondary care hospital in India. BMJ Open 2023; 13:e065036. [PMID: 37156594 PMCID: PMC10173999 DOI: 10.1136/bmjopen-2022-065036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To evaluate the profile of non-urgent patients triaged 'green', as part of a triage trial in the emergency department (ED) of a secondary care hospital in India. The secondary aim was to validate the triage trial with the South African Triage Score (SATS). DESIGN Prospective cohort study. SETTING A secondary care hospital in Mumbai, India. PARTICIPANTS Patients aged 18 years and above with a history of trauma defined as having any of the external causes of morbidity and mortality listed in block V01-Y36, chapter XX of the International Classification of Disease version 10 codebook, triaged green between July 2016 and November 2019. PRIMARY AND SECONDARY OUTCOME MEASURES Outcome measures were mortality within 24 hours, 30 days and mistriage. RESULTS We included 4135 trauma patients triaged green. The mean age of patients was 32.8 (±13.1) years, and 77% were males. The median (IQR) length of stay of admitted patients was 3 (13) days. Half the patients had a mild Injury Severity Score (3-8), with the majority of injuries being blunt (98%). Of the patients triaged green by clinicians, three-quarters (74%) were undertriaged on validating with SATS. On telephonic follow-up, two patients were reported dead whereas one died while admitted in hospital. CONCLUSIONS Our study highlights the need for implementation and evaluation of training in trauma triage systems that use physiological parameters, including pulse, systolic blood pressure and Glasgow Coma Scale, for the in-hospital first responders in the EDs.
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Affiliation(s)
| | - Rohini Dutta
- World Health Organization Collaborating Center for Research in Surgical Care Delivery in Low-and-Middle Income Countries, Mumbai, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Bhakti Sarang
- World Health Organization Collaborating Center for Research in Surgical Care Delivery in Low-and-Middle Income Countries, Mumbai, India
- Department of Surgery, Terna Medical College & Hospital, New Mumbai, India
| | - Siddarth David
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Gerard O'Reilly
- Department of Emergency Medicine, Monash University, Clayton, Victoria, Australia
| | - Nakul P Raykar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Monty Khajanchi
- Department of Surgery, Seth Gowardhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Jonatan Attergrim
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Kapil Dev Soni
- Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Naveen Sharma
- Department of Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Monali Mohan
- World Health Organization Collaborating Center for Research in Surgical Care Delivery in Low-and-Middle Income Countries, Mumbai, India
| | - Anita Gadgil
- World Health Organization Collaborating Center for Research in Surgical Care Delivery in Low-and-Middle Income Countries, Mumbai, India
| | - Nobhojit Roy
- World Health Organization Collaborating Center for Research in Surgical Care Delivery in Low-and-Middle Income Countries, Mumbai, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
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5
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Dutta R, Mahajan A, Patil P, Bhandoria G, Sarang B, Virk S, Khajanchi M, Jain S, Bains L, Bhandarkar P, Chatterjee S, Roy N, Gadgil A. Breast Conservative Surgery for Breast Cancer: Indian Surgeon's Preferences and Factors Influencing Them. Indian J Surg Oncol 2023; 14:11-17. [PMID: 36891421 PMCID: PMC9986359 DOI: 10.1007/s13193-022-01601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background It is well established that disease-free survival and overall survival after breast conservation surgery (BCS) followed by radiotherapy are equivalent to that after mastectomy. However, in Asian countries, the rate of BCS continues to remain low. The cause may be multifactorial including the patient's choice, availability and accessibility of infrastructure, and surgeon's choice. We aimed to elucidate the Indian surgeons' perspective while choosing between BCS and mastectomy, in women oncologically eligible for BCS. Methods We conducted a survey-based cross-sectional study in January-February 2021. Indian surgeons with general surgical or specialised oncosurgical training, who consented to participate were included in the study. Multinomial logistic regression was performed to assess the effect of study variables on offering mastectomy or BCS. Results A total of 347 responses were included. The mean age of the participants was 43 ± 11 years. Sixty-three of the surgeons were in the 25-44 years age group with the majority (80%) being males. 66.4% of surgeons 'almost always' offered BCS to oncologically eligible patients. Surgeons who had undergone specialised training in oncosurgery or breast conservation surgery were 35 times more likely to offer BCS (p < 0.01). Surgeons working in hospitals with in-house radiation oncology facilities were 9 times more likely to offer BCS (p < 0.05). Surgeons' years of practice, age, sex and hospital setting did not influence the surgery offered. Conclusion Two-thirds of Indian surgeons preferred BCS over mastectomy. Lack of radiotherapy facilities and specialised surgical training were deterrents to offering BCS to eligible women. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-022-01601-y.
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Affiliation(s)
- Rohini Dutta
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,Christian Medical College and Hospital, Ludhiana, Punjab India
| | - Anshul Mahajan
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,Government Medical College Amritsar, Punjab, India
| | - Priti Patil
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - Geetu Bhandoria
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - Bhakti Sarang
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - Sargun Virk
- Sri Guru Ram Das Institute of Health and Science, Amritsar, Punjab India
| | - Monty Khajanchi
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - Samarvir Jain
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Lovenish Bains
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,Maulana Azad Medical College, New Delhi, India
| | - Prashant Bhandarkar
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - Shamita Chatterjee
- Institute of Post-Graduate Medical Education & Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
| | - Nobhojit Roy
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,Department of Public Health Systems, Karolinska Institute, 171 77 Stockholm, Sweden.,The George Institute for Global Health, New Delhi, India
| | - Anita Gadgil
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,The George Institute for Global Health, New Delhi, India
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6
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Berg J, Alvesson HM, Roy N, Ekelund U, Bains L, Chatterjee S, Bhattacharjee PK, David S, Gupta S, Kamble J, Khajanchi M, Lal P, Malhotra V, Meher R, Mishra A, Mohan LN, Petzold M, Saxena R, Shrivastava P, Singh R, Soni KD, Sural S, Gerdin Wärnberg M. Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries. BMJ Open 2022; 12:e059948. [PMID: 35680271 PMCID: PMC9185581 DOI: 10.1136/bmjopen-2021-059948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare experts' perceived usefulness of audit filters from Ghana, Cameroon, WHO and those locally developed; generate context-appropriate audit filters for trauma care in selected hospitals in urban India; and explore characteristics of audit filters that correlate to perceived usefulness. DESIGN A mixed-methods approach using a multicentre online Delphi technique. SETTING Two large tertiary hospitals in urban India. METHODS Filters were rated on a scale from 1 to 10 in terms of perceived usefulness, with the option to add new filters and comments. The filters were categorised into three groups depending on their origin: low and middle-income countries (LMIC), WHO and New (locally developed), and their scores compared. Significance was determined using Kruskal-Wallis test followed by Wilcoxon rank-sum test. We performed a content analysis of the comments. RESULTS 26 predefined and 15 new filter suggestions were evaluated. The filters had high usefulness scores (mean overall score 9.01 of 10), with the LMIC filters having significantly higher scores compared with those from WHO and those newly added. Three themes were identified in the content analysis relating to medical relevance, feasibility and specificity. CONCLUSIONS Audit filters from other LMICs were deemed highly useful in the urban India context. This may indicate that the transferability of defined trauma audit filters between similar contexts is high and that these can provide a starting point when implemented as part of trauma quality improvement programmes in low-resource settings.
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Affiliation(s)
- Johanna Berg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Emergency and Internal Medicine, Skane University Hospital, Malmo, Sweden
| | | | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The George Institute for Global Health India, New Delhi, Delhi, India
| | - Ulf Ekelund
- Emergency Medicine, Department of Clinical Sciences, Lund University Faculty of Medicine, Lund, Sweden
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
- WHO Collaboration Centre for Research in Surgical Care Delivery In Low and Middle-Income Countries, Mumbai, Maharashtra, India
| | - Shamita Chatterjee
- Department of Surgery, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | | | - Siddarth David
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Doctors For You, Mumbai, Maharashtra, India
| | - Swati Gupta
- Department of Radiodiagnosis and Imaging, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Jyoti Kamble
- Doctors For You, Mumbai, Maharashtra, India
- School of Public health, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Monty Khajanchi
- WHO Collaboration Centre for Research in Surgical Care Delivery In Low and Middle-Income Countries, Mumbai, Maharashtra, India
- Department of Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Pawanindra Lal
- Department of Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Vikas Malhotra
- Department of ENT and Head & Neck Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Ravi Meher
- Department of ENT and Head & Neck Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Anurag Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | | | - Max Petzold
- School Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Ritu Saxena
- Department of Accident and Emergency, Lok Nayak Hospital, New Delhi, India
| | - Prabhat Shrivastava
- Department of Burns and Plastic Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Rajdeep Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Kapil Dev Soni
- Department of Critical and Intensive Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sumit Sural
- Department of Orthopaedic Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Banerjee N, Sharma N, Soni KD, Bansal V, Mahajan A, Khajanchi M, Gerdin Wärnberg M, Roy N. Are home environment injuries more fatal in children and the elderly? Injury 2022; 53:1987-1993. [PMID: 35367079 DOI: 10.1016/j.injury.2022.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION 'In-home injuries' are those that occur within the house or its immediate surroundings. The literature on the prevalence and magnitude of home injuries is sparse. This study was designed to characterize the mechanisms of 'in-home' injuries and compare their outcomes with 'outside home injuries'. MATERIALS AND METHODS The Australia-India Trauma Systems Collaboration (AITSC) Project created a multicentric registry consisting of trauma patients admitted at four urban tertiary care hospitals in India from April 2016 to March 2018. This registry data was analysed for this study. All admitted patients except for dead on arrival were included. Patients were categorised into 'in-home' and 'outside home' cohorts based on the place where the trauma occurred. The outcome measures were 30 day in-hospital mortality and the length of hospital stay. Two subgroup analyses were performed, the first comprised pediatric patients (<15 years) and the second elderly patients >64 years). RESULTS Among 9354 patients in the AITSC data registry, 8398 patients were included in the study. Out of these, 29 percent were in-home injuries, whereas the rest occurred outside home. The 30 day in-hospital mortality was 10.6 percent in the 'in-home' cohort, as compared to 13.7 percent in the 'outside home' cohort. This difference although significant on univariable analysis (p <0.01), there was no significant difference on multivariable regression analysis, after adjusting for age and injury severity score (OR = 0.88, 95% CI = 0.73-1.04; p = 0.15). The length of hospital stay was shorter in the home injuries group (median = 5 days; IQR = 3-12 days) compared to the outside-home group (median = 7 days; IQR = 4-14 days) (p < 0.01). In the pediatric and the elderly, on multivariable regression analysis, in-home injuries were associated with higher mortality than outside home injuries. CONCLUSION There was no significant difference in the 30 day in-hospital mortality amongst admitted trauma patients sustaining injuries at home or outside the home. However, in pediatric and elderly patients the chances of mortality was significantly higher when injured at home.
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Affiliation(s)
- Niladri Banerjee
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Naveen Sharma
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Kapil Dev Soni
- Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Bansal
- Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | | | - Monty Khajanchi
- Department of Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Surgical Unit, WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, BARC Hospital (Government of India), Mumbai, India.
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Clark D, Joannides A, Adeleye AO, Bajamal AH, Bashford T, Biluts H, Budohoski K, Ercole A, Fernández-Méndez R, Figaji A, Gupta DK, Härtl R, Iaccarino C, Khan T, Laeke T, Rubiano A, Shabani HK, Sichizya K, Tewari M, Tirsit A, Thu M, Tripathi M, Trivedi R, Devi BI, Servadei F, Menon D, Kolias A, Hutchinson P, Abdallah OI, Abdel-Lateef A, Abdifatah K, Abdullateef A, Abeygunaratne R, Aboellil M, Adam A, Adams R, Adeleye A, Adeolu A, Adji NK, Afianti N, Agarwal S, Aghadi IK, Aguilar PMM, Ahmad SR, Ahmed D, Ahmed N, Aizaz H, Aji YK, Alamri A, Alberto AJM, Alcocer LA, Alfaro LG, Al-Habib A, Alhourani A, Ali SMR, Alkherayf F, AlMenabbawy A, Alshareef A, Aminullah MAS, Amjad M, Amorim RLOD, Anbazhagan S, Andrade A, Antar W, Anyomih TT, Aoun S, Apriawan T, Armocida D, Arnold P, Arraez M, Assefa T, Asser A, Athiththan S, Attanayake D, Aung MM, Avi A, Ayala VEA, Azab M, Azam G, Azharuddin M, Badejo O, Badran M, Baig AA, Baig RA, Bajaj A, Baker P, Bala R, Balasa A, Balchin R, Balogun J, Ban VS, Bandi BKR, Bandyopadhyay S, Bank M, Barthelemy E, Bashir MT, Basso LS, Basu S, Batista A, Bauer M, Bavishi D, Beane A, Bejell S, Belachew A, Belli A, Belouaer A, Bendahane NEA, Benjamin O, Benslimane Y, Benyaiche C, Bernucci C, Berra LV, Bhebe A, Bimpis A, Blanaru D, Bonfim JC, Borba LAB, Borcek AO, Borotto E, Bouhuwaish AEM, Bourilhon F, Brachini G, Breedon J, Broger M, Brunetto GMF, Bruzzaniti P, Budohoska N, Burhan H, Calatroni ML, Camargo C, Cappai PF, Cardali SM, Castaño-Leon AM, Cederberg D, Celaya M, Cenzato M, Challa LM, Charest D, Chaurasia B, Chenna R, Cherian I, Ching'o JH, Chotai T, Choudhary A, Choudhary N, Choumin F, Cigic T, Ciro J, Conti C, Corrêa ACDS, Cossu G, Couto MP, Cruz A, D'Silva D, D'Aliberti GA, Dampha L, Daniel RT, Dapaah A, Darbar A, Dascalu G, Dauda HA, Davies O, Delgado-Babiano A, Dengl M, Despotovic M, Devi I, Dias C, Dirar M, Dissanayake M, Djimbaye H, Dockrell S, Dolachee A, Dolgopolova J, Dolgun M, Dow A, Drusiani D, Dugan A, Duong DT, Duong TK, Dziedzic T, Ebrahim A, El Fatemi N, El Helou AE, El Maaqili RE, El Mostarchid BE, El Ouahabi AE, Elbaroody M, El-Fiki A, El-Garci A, El-Ghandour NM, Elhadi M, Elleder V, Elrais S, El-shazly M, Elshenawy M, Elshitany H, El-Sobky O, Emhamed M, Enicker B, Erdogan O, Ertl S, Esene I, Espinosa OO, Fadalla T, Fadelalla M, Faleiro RM, Fatima N, Fawaz C, Fentaw A, Fernandez CE, Ferreira A, Ferri F, Figaji T, Filho ELB, Fin L, Fisher B, Fitra F, Flores AP, Florian IS, Fontana V, Ford L, Fountain D, Frade JMR, Fratto A, Freyschlag C, Gabin AS, Gallagher C, Ganau M, Gandia-Gonzalez ML, Garcia A, Garcia BH, Garusinghe S, Gebreegziabher B, Gelb A, George JS, Germanò AF, Ghetti I, Ghimire P, Giammarusti A, Gil JL, Gkolia P, Godebo Y, Gollapudi PR, Golubovic J, Gomes JF, Gonzales J, Gormley W, Gots A, Gribaudi GL, Griswold D, Gritti P, Grobler R, Gunawan R, Hailemichael B, Hakkou E, Haley M, Hamdan A, Hammed A, Hamouda W, Hamzah NA, Han NL, Hanalioglu S, Haniffa R, Hanko M, Hanrahan J, Hardcastle T, Hassani FD, Heidecke V, Helseth E, Hernández-Hernández MÁ, Hickman Z, Hoang LMC, Hollinger A, Horakova L, Hossain-Ibrahim K, Hou B, Hoz S, Hsu J, Hunn M, Hussain M, Iacopino G, Ideta MML, Iglesias I, Ilunga A, Imtiaz N, Islam R, Ivashchenko S, Izirouel K, Jabal MS, Jabal S, Jabang JN, Jamjoom A, Jan I, Jarju LBM, Javed S, Jelaca B, Jhawar SS, Jiang TT, Jimenez F, Jiris J, Jithoo R, Johnson W, Joseph M, Joshi R, Junttila E, Jusabani M, Kache SA, Kadali SP, Kalkmann GF, Kamboh U, Kandel H, Karakus AK, Kassa M, Katila A, Kato Y, Keba M, Kehoe K, Kertmen HH, Khafaji S, Khajanchi M, Khan M, Khan MM, Khan SD, Khizar A, Khriesh A, Kierońska S, Kisanga P, Kivevele B, Koczyk K, Koerling AL, Koffenberger D, Kõiv K, Kõiv L, Kolarovszki B, König M, Könü-Leblebicioglu D, Koppala SD, Korhonen T, Kostkiewicz B, Kostyra K, Kotakadira S, Kotha AR, Kottakki MNR, Krajcinovic N, Krakowiak M, Kramer A, Krishnamoorthy S, Kumar A, Kumar P, Kumar P, Kumarasinghe N, Kuncha G, Kutty RK, Laeke T, Lafta G, Lammy S, Lapolla P, Lardani J, Lasica N, Lastrucci G, Launey Y, Lavalle L, Lawrence T, Lazaro A, Lebed V, Leinonen V, Lemeri L, Levi L, Lim JY, Lim XY, Linares-Torres J, Lippa L, Lisboa L, Liu J, Liu Z, Lo WB, Lodin J, Loi F, Londono D, Lopez PAG, López CB, Lotbiniere-Bassett MD, Lulens R, Luna FH, Luoto T, M.V. VS, Mabovula N, MacAllister M, Macie AA, Maduri R, Mahfoud M, Mahmood A, Mahmoud F, Mahoney D, Makhlouf W, Malcolm G, Malomo A, Malomo T, Mani MK, Marçal TG, Marchello J, Marchesini N, Marhold F, Marklund N, Martín-Láez R, Mathaneswaran V, Mato-Mañas DJ, Maye H, McLean AL, McMahon C, Mediratta S, Mehboob M, Meneses A, Mentri N, Mersha H, Mesa AM, Meyer C, Millward C, Mimbir SA, Mingoli A, Mishra P, Mishra T, Misra B, Mittal S, Mohammed I, Moldovan I, Molefe M, Moles A, Moodley P, Morales MAN, Morgan L, Morillo GDC, Moustafa W, Moustakis N, Mrichi S, Munjal SS, Muntaka AJM, Naicker D, Nakashima PEH, Nandigama PK, Nash S, Negoi I, Negoita V, Neupane S, Nguyen MH, Niantiarno FH, Noble A, Nor MAM, Nowak B, Oancea A, O'Brien F, Okere O, Olaya S, Oliveira L, Oliveira LM, Omar F, Ononeme O, Opšenák R, Orlandini S, Osama A, Osei-Poku D, Osman H, Otero A, Ottenhausen M, Otzri S, Outani O, Owusu EA, Owusu-Agyemang K, Ozair A, Ozoner B, Paal E, Paiva MS, Paiva W, Pandey S, Pansini G, Pansini L, Pantel T, Pantelas N, Papadopoulos K, Papic V, Park K, Park N, Paschoal EHA, Paschoalino MCDO, Pathi R, Peethambaran A, Pereira TA, Perez IP, Pérez CJP, Periyasamy T, Peron S, Phillips M, Picazo SS, Pinar E, Pinggera D, Piper R, Pirakash P, Popadic B, Posti JP, Prabhakar RB, Pradeepan S, Prasad M, Prieto PC, Prince R, Prontera A, Provaznikova E, Quadros D, Quintero NJR, Qureshi M, Rabiel H, Rada G, Ragavan S, Rahman J, Ramadhan O, Ramaswamy P, Rashid S, Rathugamage J, Rätsep T, Rauhala M, Raza A, Reddycherla NR, Reen L, Refaat M, Regli L, Ren H, Ria A, Ribeiro TF, Ricci A, Richterová R, Ringel F, Robertson F, Rocha CMSC, Rogério JDS, Romano AA, Rothemeyer S, Rousseau GRG, Roza R, Rueda KDF, Ruiz R, Rundgren M, Rzeplinski R, S.Chandran R, Sadayandi RA, Sage W, Sagerer ANJ, Sakar M, Salami M, Sale D, Saleh Y, Sánchez-Viguera C, Sandila S, Sanli AM, Santi L, Santoro A, Santos AKDD, Santos SCD, Sanz B, Sapkota S, Sasidharan G, Sasillo I, Satoskar R, Sayar AC, Sayee V, Scheichel F, Schiavo FL, Schupper A, Schwarz A, Scott T, Seeberger E, Segundo CNC, Seidu AS, Selfa A, Selmi NH, Selvarajah C, Şengel N, Seule M, Severo L, Shah P, Shahzad M, Shangase T, Sharma M, Shiban E, Shimber E, Shokunbi T, Siddiqui K, Sieg E, Siegemund M, Sikder SR, Silva ACV, Silva A, Silva PA, Singh D, Skadden C, Skola J, Skouteli E, Słoniewski P, Smith B, Solanki G, Solla DF, Solla D, Sonmez O, Sönmez M, Soon WC, Stefini R, Stienen MN, Stoica B, Stovell M, Suarez MN, Sulaiman A, Suliman M, Sulistyanto A, Sulubulut Ş, Sungailaite S, Surbeck M, Szmuda T, Taddei G, Tadele A, Taher ASA, Takala R, Talari KM, Tan BH, Tariciotti L, Tarmohamed M, Taroua O, Tatti E, Tenovuo O, Tetri S, Thakkar P, Thango N, Thatikonda SK, Thesleff T, Thomé C, Thornton O, Timmons S, Timoteo EE, Tingate C, Tliba S, Tolias C, Toman E, Torres I, Torres L, Touissi Y, Touray M, Tropeano MP, Tsermoulas G, Tsitsipanis C, Turkoglu ME, Uçkun ÖM, Ullman J, Ungureanu G, Urasa S, Ur-Rehman O, Uysal M, Vakis A, Valeinis E, Valluru V, Vannoy D, Vargas P, Varotsis P, Varshney R, Vats A, Veljanoski D, Venturini S, Verma A, Villa C, Villa G, Villar S, Villard E, Viruez A, Voglis S, Vulekovic P, Wadanamby S, Wagner K, Walshe R, Walter J, Waseem M, Whitworth T, Wijeyekoon R, Williams A, Wilson M, Win S, Winarso AWW, Ximenes AWP, Yadav A, Yadav D, Yakoub KM, Yalcinkaya A, Yan G, Yaqoob E, Yepes C, Yılmaz AN, Yishak B, Yousuf FB, Zahari MZ, Zakaria H, Zambonin D, Zavatto L, Zebian B, Zeitlberger AM, Zhang F, Zheng F, Ziga M. Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study. Lancet Neurol 2022; 21:438-449. [PMID: 35305318 DOI: 10.1016/s1474-4422(22)00037-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/19/2021] [Accepted: 01/17/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. METHODS We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. FINDINGS Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49). INTERPRETATION Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. FUNDING National Institute for Health Research Global Health Research Group.
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Affiliation(s)
- David Clark
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; Neurosurgery Division, University Teaching Hospital, Lusaka, Zambia.
| | - Alexis Joannides
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Amos Olufemi Adeleye
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Dr Soetomo Hospital, Surabaya, Jawa Timur, Indonesia
| | - Tom Bashford
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Hagos Biluts
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Karol Budohoski
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Ari Ercole
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Rocío Fernández-Méndez
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Anthony Figaji
- Division of Neurosurgery and Neurosciences Institute, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Deepak Kumar Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Corrado Iaccarino
- Neurosurgery Division, University Hospital of Parma, Parma, Emilia-Romagna, Italy
| | - Tariq Khan
- Department of Neurosurgery, North West General Hospital & Research Center, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tsegazeab Laeke
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Andrés Rubiano
- Department of Neurosurgery, Universidad El Bosque, Bogota, Colombia
| | - Hamisi K Shabani
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute and Muhimbili University College of Allied Health Sciences, Dar es Salaam, Tanzania
| | | | - Manoj Tewari
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Abenezer Tirsit
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Myat Thu
- Department of Neurosurgery, Yangon General Hospital, Yangon, Yangon Region, Myanmar
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Rikin Trivedi
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Franco Servadei
- Humanitas Clinical and Research Center-IRCCS and Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - David Menon
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Angelos Kolias
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Peter Hutchinson
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
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Gerdin Wärnberg M, Berg J, Bhandarkar P, Chatterjee A, Chatterjee S, Chintamani C, Felländer-Tsai L, Gadgil A, Ghag G, Hasselberg M, Juillard C, Khajanchi M, Kizhakke Veetil D, Kumar V, Kundu D, Mishra A, Patil P, Roy N, Roy A, David S, Singh R, Solomon H, Soni KD, Strömmer L, Tandon M. A pilot multicentre cluster randomised trial to compare the effect of trauma life support training programmes on patient and provider outcomes. BMJ Open 2022; 12:e057504. [PMID: 35437251 PMCID: PMC9016405 DOI: 10.1136/bmjopen-2021-057504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Trauma accounts for nearly 10% of the global burden of disease. Several trauma life support programmes aim to improve trauma outcomes. There is no evidence from controlled trials to show the effect of these programmes on patient outcomes. We describe the protocol of a pilot study that aims to assess the feasibility of conducting a cluster randomised controlled trial comparing advanced trauma life support (ATLS) and primary trauma care (PTC) with standard care. METHODS AND ANALYSIS We will pilot a pragmatic three-armed parallel, cluster randomised controlled trial in India, where neither of these programmes are routinely taught. We will recruit tertiary hospitals and include trauma patients and residents managing these patients. Two hospitals will be randomised to ATLS, two to PTC and two to standard care. The primary outcome will be all-cause mortality at 30 days from the time of arrival to the emergency department. Our secondary outcomes will include patient, provider and process measures. All outcomes except time-to-event outcomes will be measured both as final values as well as change from baseline. We will compare outcomes in three combinations of trial arms: ATLS versus PTC, ATLS versus standard care and PTC versus standard care using absolute and relative differences along with associated CIs. We will conduct subgroup analyses across the clinical subgroups men, women, blunt multisystem trauma, penetrating trauma, shock, severe traumatic brain injury and elderly. In parallel to the pilot study, we will conduct community consultations to inform the planning of the full-scale trial. ETHICS AND DISSEMINATION We will apply for ethics approvals to the local institutional review board in each hospital. The protocol will be published to Clinical Trials Registry-India and ClinicalTrials.gov. The results will be published and the anonymised data and code for analysis will be released publicly.
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Affiliation(s)
- Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Johanna Berg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Emergency Medicine, Department of Internal and Emergency Medicine, Skåne University Hospital, Malmö, Sweden
| | - Prashant Bhandarkar
- Tata Institute of Social Sciences School of Health Systems Studies, Deonar, Maharashtra, India
- World Health Organization Collaborating Center for Research in Surgical Care Delivery in Low-and-Middle Income Countries, Mumbai, India
| | - Anirban Chatterjee
- Department of Orthopaedic Sciences, Medica Superspecialty Hospital, Kolkata, India
| | - Shamita Chatterjee
- Department of Surgery, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Chintamani Chintamani
- Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Li Felländer-Tsai
- Division of Orthopaedics and Biotechnology, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Anita Gadgil
- World Health Organization Collaborating Center for Research in Surgical Care Delivery in Low-and-Middle Income Countries, Mumbai, India
| | - Geeta Ghag
- Department of Surgery, HBT Medical College and Dr R N Cooper Municipal General Hospital, Mumbai, India
| | - Marie Hasselberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Catherine Juillard
- Division of General Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, UK
| | - Monty Khajanchi
- Department of Surgery, Seth Gowardhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | | | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Debabrata Kundu
- Department of Surgery, Medical College Kolkata, Kolkata, India
| | - Anurag Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Priti Patil
- World Health Organization Collaborating Center for Research in Surgical Care Delivery in Low-and-Middle Income Countries, Mumbai, India
- Department of Statistics, Bhabha Atomic Research Centre Medical Division, Mumbai, Maharashtra, India
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- World Health Organization Collaborating Center for Research in Surgical Care Delivery in Low-and-Middle Income Countries, Mumbai, India
| | - Amit Roy
- Department of Surgery, Sir Nil Ratan Sircar Medical College & Hospital, Kolkata, India
| | - Siddarth David
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Doctors For You, Mumbai, India
| | - Rajdeep Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Harris Solomon
- Department of Cultural Anthropology and the Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kapil Dev Soni
- Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Lovisa Strömmer
- Department of Surgery, Capio S:t Görans Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Megha Tandon
- Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
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12
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Moghe D, Prajapati R, Banker A, Khajanchi M. A Comparative Study of Desarda's Versus Lichtenstein's Technique for Uncomplicated Inguinal Hernia Repair. Cureus 2022; 14:e23998. [PMID: 35547436 PMCID: PMC9086529 DOI: 10.7759/cureus.23998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Since mesh-related long-term morbidity like chronic groin pain and vas entrapment in patients with an inguinal hernia is a concern, tissue-based repairs should be revaluated. There have been few prospective studies comparing the outcomes of Lichtenstein's technique and Desarda's technique for the repair of uncomplicated inguinal hernias. So, we conducted this prospective study comparing the two techniques. Methods This is a single-center prospective observational study conducted for a period of one year (2019). The patients who underwent surgery for uncomplicated inguinal hernia either by Lichtenstein's technique or Desarda's technique were included in the study. The two techniques were compared with respect to recurrence rates, immediate postoperative pain, chronic groin pain, wound infection, and the time taken to return to activities of daily living (ADL). Results There was no significant difference in the recurrence rates, chronic groin pain, wound infection, or return to ADL between Lichtenstein's technique and Desarda's technique of inguinal hernia repair. The mean duration to return to ADL was lesser when patients underwent Desarda's repair though this difference was not significant. Conclusion Desarda's tissue repair was found comparable to Lichtenstein's mesh repair in terms of recurrence and postoperative morbidity, immediate postoperative pain, chronic groin pain, wound infection, and the time taken to return to ADL. Desarda's technique may be considered as an alternative to mesh-based repairs to avoid long-term mesh-related morbidity for uncomplicated indirect hernias in the younger population.
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Affiliation(s)
- Dhanashree Moghe
- General Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial (KEM) Hospital, Mumbai, IND
| | - Ramlal Prajapati
- General Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial (KEM) Hospital, Mumbai, IND
| | - Amay Banker
- General Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial (KEM) Hospital, Mumbai, IND
| | - Monty Khajanchi
- General Surgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial (KEM) Hospital, Mumbai, IND
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13
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Khajanchi M. Surgical trials in India, where do we stand? J Postgrad Med 2022; 68:197-198. [PMID: 36255017 PMCID: PMC9841548 DOI: 10.4103/jpgm.jpgm_367_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- M Khajanchi
- Consultant WHO Collaborating Centre India, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India,Address for correspondence: Dr. Khajanchi M, E-mail:
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14
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Moghe D, Khajanchi M, Gadgil A, Gerdin Wärnberg M, Dev Soni K, Mohan M, Nobhojit R. Is sex an independent risk factor of in-hospital mortality in patients with burns? A multicentre cohort study from urban India. Burns Open 2022. [DOI: 10.1016/j.burnso.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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15
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Sarang B, Raykar N, Gadgil A, Mishra G, Wärnberg MG, Rattan A, Khajanchi M, Soni KD, Mohan M, Sharma N, Kumar V, Kv D, Roy N. Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study. World J Surg 2021; 45:3567-3574. [PMID: 34420094 PMCID: PMC8572839 DOI: 10.1007/s00268-021-06293-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal trauma is present in 0.5-5% of patients admitted for trauma. Advancements in radiologic imaging and minimal-invasive techniques have led to decreased need for surgical intervention. We used a large trauma cohort to characterise renal trauma patients, their management and outcomes. METHODS We analysed "Towards Improved Trauma Care Outcomes in India" cohort from four urban tertiary public hospitals in India between 1st September 2013 and 31st December 2015. The data of patients with renal trauma were extracted using International Classification of Diseases 10 codes and analysed for demographic and clinical details. RESULTS A total of 16,047 trauma patients were included in this cohort. Abdominal trauma comprised 1119 (7%) cases, of which 144 (13%) had renal trauma. Renal trauma was present in 1% of all the patients admitted for trauma. The mean age was 28 years (SD-14.7). A total of 119 (83%) patients were male. Majority (93%) were due to blunt injuries. Road traffic injuries were the most common mechanism (53%) followed by falls (29%). Most renal injuries (89%) were associated with other organ injuries. Seven of the 144 (5%) patients required nephrectomy. Three patients had grade V trauma; all underwent nephrectomy. The 30-day in-hospital mortality, in patients with renal trauma, was 17% (24/144). CONCLUSION Most renal trauma patients were managed nonoperatively. 89% of patients with renal trauma had concomitant injuries. The renal trauma profile from this large cohort may be generalisable to urban contexts in India and other low- and middle-income countries.
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Affiliation(s)
- Bhakti Sarang
- Department of Surgery, Terna Medical College and Hospital, New Mumbai, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, India
| | - Nakul Raykar
- Trauma and Emergency Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Anita Gadgil
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, India
- Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India
| | - Gunjan Mishra
- Department of Surgery, Mahatma Gandhi Mission Medical College and Hospital, New Mumbai, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Amulya Rattan
- Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Rishikesh, India
| | - Monty Khajanchi
- Department of Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Hospital, AIIMS, New Delhi, India
| | - Monali Mohan
- Health Systems Strengthening, Muzaffarpur Field Health Laboratory, CARE-India, Patna, Bihar, India
| | - Naveen Sharma
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, India
| | - Deepa Kv
- Department of Surgery, Manipal Hospital, Dwarka, Delhi, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, India.
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
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Raykar NP, Makin J, Khajanchi M, Olayo B, Munoz Valencia A, Roy N, Ottolino P, Zinco A, MacLeod J, Yazer M, Rajgopal J, Zeng B, Lee HK, Bidanda B, Kumar P, Puyana JC, Rudd K. Assessing the global burden of hemorrhage: The global blood supply, deficits, and potential solutions. SAGE Open Med 2021; 9:20503121211054995. [PMID: 34790356 PMCID: PMC8591638 DOI: 10.1177/20503121211054995] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 10/04/2021] [Indexed: 01/28/2023] Open
Abstract
There is a critical shortage of blood available for transfusion in many low- and middle-income countries. The consequences of this scarcity are dire, resulting in uncounted morbidity and mortality from trauma, obstetric hemorrhage, and pediatric anemias, among numerous other conditions. The process of collecting blood from a donor to administering it to a patient involves many facets from donor availability to blood processing to blood delivery. Each step faces particular challenges in low- and middle-income countries. Optimizing existing strategies and introducing new approaches will be imperative to ensure a safe and sufficient blood supply worldwide.
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Affiliation(s)
- Nakul P Raykar
- Trauma & Emergency General Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Departments of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jennifer Makin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Bernard Olayo
- Center for Public Health and Development, Nairobi, Kenya
| | | | - Nobhojit Roy
- Health Systems Strengthening Unit, CARE-India, Bihar, India.,Department of Surgery, KEM Hospital, Mumbai, India
| | - Pablo Ottolino
- Department of Surgery, Hospital Sotero Del Rio, Universidad Católica, Santiago, Chile
| | - Analia Zinco
- Department of Surgery, Hospital Sotero Del Rio, Universidad Católica, Santiago, Chile
| | - Jana MacLeod
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Business School, Strathmore University, Nairobi, Kenya
| | - Mark Yazer
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jayant Rajgopal
- Department of Industrial Engineering, School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bo Zeng
- Department of Industrial Engineering, School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hyo Kyung Lee
- Department of Industrial Engineering, School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bopaya Bidanda
- Department of Industrial Engineering, School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pratap Kumar
- Business School, Strathmore University, Nairobi, Kenya
| | - Juan Carlos Puyana
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kristina Rudd
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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17
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Khajanchi M, Moghe D, Bavishi D. Sex-based Differences in the Outcomes of Admitted Burns Patients in Urban India: A Multi-centre Cohort Study. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Deepa KV, Venghateri JB, Khajanchi M, Gadgil A, Roy N. Cancer epidemiology literature from India: Does it reflect the reality? J Public Health (Oxf) 2021; 42:e421-e427. [PMID: 31883021 PMCID: PMC7685847 DOI: 10.1093/pubmed/fdz160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/29/2019] [Accepted: 10/29/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The alarming escalation of cancers over infectious diseases in the lower and middle-income countries warrants a better understanding of this epidemiological transition. The epidemiology of cancers in India is sparsely addressed in the literature. Hence, in this manuscript, we present the review done, on research manuscripts, addressing cancer incidence, trends and risk factors from India over the last 12 years. Studies addressing screening, treatment and clinical trials were excluded. METHODS We evaluated the studies for the theme addressed, study design, sample size, the region of origin and whether it was population or hospital-based study. RESULTS The studies highlighted a significant shortage of multicenter population-based data in the incidence and risk factors associated with various malignancies in India. Further, we also observed that there was a relative lack of information from the northern and northeastern parts of India. The reviewed articles also indicated the need for a robust design for the studies, large sample size and uniformity in reporting incidence for appropriately drawing conclusions from a study. Reporting of country-specific risk factors with their geographical variations was also sparse. CONCLUSION Overall, the cancer epidemiology literature from India is sparse. More studies with robust designs representing all parts of the country are currently needed.
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Affiliation(s)
| | - Jubina Balan Venghateri
- Department of Surgery, WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, BARC Hospital, Mumbai, India
| | | | - Anita Gadgil
- Department of Surgery, WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, BARC Hospital, Mumbai, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, India.,Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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Bhandoria G, Gadgil A, Khajanchi M, Sarang B, Kizhakke Veetil D, Wadhawan R, Bhandarkar P, Mohan M, Shah P, Bains L, Mishra A, Arora S, Rattan A, Kant R, Sharma N, Bhavishi D, Satoskar RR, Prajapati R, Srivastava KS, Kamble P, Mayadeo NM, Gokhale A, Jaydeep H, Belekar D, Roy N. Effects of the COVID-19 pandemic on delivery of emergency surgical care in India. Br J Surg 2021; 108:e154-e155. [PMID: 33793717 PMCID: PMC7929169 DOI: 10.1093/bjs/znab004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022]
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20
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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: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Shah P, Sarang B, Gadgil A, Bhandoria G, Khajanchi M, Veetil DK, Bhandarkar P, Gupta MM, Goh D, Roy N. P43 Did COVID-19 Pandemic change Anaesthesia Practices in India: A Multi-centre Cross-sectional Study. BJS Open 2021. [PMCID: PMC8030155 DOI: 10.1093/bjsopen/zrab032.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The anaesthetic management for surgeries during the COVID-19 pandemic has posed unique challenges. Safety of all healthcare workers is an additional concern along with heightened risk to patients during General Anesthesia (GA). COVID-19 pneumonia and aerosol generation may be exacerbated during airway intervention and GA. We aimed to assess the change in the mode of anaesthesia due to the pandemic. Methods A research consortium led by WHO Collaboration Centre for Research in Surgical Care Delivery in Low and Middle Income countries, India, conducted this retrospective cross-sectional study in 12 hospitals across the country. We compared the anaesthesia preferences during pandemic (April 2020) to a corresponding pre pandemic period (April 2019) Results A total of 636 out of 2,162 (29.4%) and 156 out of 927 (16.8%) surgeries were performed under GA in April 2019 and April 2020 respectively, leading to a fall of 13% in usage of GA. A 5% reduction in GA and a 12% increase in the usage of regional anaesthesia was observed for cesarean sections. There was no significant change in anesthesia for laparotomies and fracture surgeries. However, 14% increase in GA usage was observed in surgeries for local soft tissue infections and necrotic tissues. Conclusion Though overall usage of GA reduced marginally, the change was mainly contributed by anesthesia for caesarean births. The insignificant change in anaesthesia for other surgeries may be attributed to the lack of facilities for spinal anaesthesia and may reflect the risk taking behaviour of healthcare professionals in COVID-19 pandemic.
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Affiliation(s)
- Priyansh Shah
- Global Surgery Research Fellow, WHOCC for Research in Surgical Care Delivery in LMICs, Mumbai
| | - Bhakti Sarang
- Global Surgery Research Fellow, WHOCC for Research in Surgical Care Delivery in LMICs, Mumbai
| | - Anita Gadgil
- Global Surgery Research Fellow, WHOCC for Research in Surgical Care Delivery in LMICs, Mumbai
| | - Geetu Bhandoria
- Global Surgery Research Fellow, WHOCC for Research in Surgical Care Delivery in LMICs, Mumbai
| | - Monty Khajanchi
- Global Surgery Research Fellow, WHOCC for Research in Surgical Care Delivery in LMICs, Mumbai
| | - Deepa Kizhakke Veetil
- Global Surgery Research Fellow, WHOCC for Research in Surgical Care Delivery in LMICs, Mumbai
| | - Prashant Bhandarkar
- Global Surgery Research Fellow, WHOCC for Research in Surgical Care Delivery in LMICs, Mumbai
| | - Monali Mohan Gupta
- Global Surgery Research Fellow, WHOCC for Research in Surgical Care Delivery in LMICs, Mumbai
| | - Dylan Goh
- Global Surgery Research Fellow, WHOCC for Research in Surgical Care Delivery in LMICs, Mumbai
| | - Nobhojit Roy
- Global Surgery Research Fellow, WHOCC for Research in Surgical Care Delivery in LMICs, Mumbai
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Gupta S, Khajanchi M, Solomon H, Raykar NP, Alkire BC, Roy N, Park KB, Kumar V. Traumatic Brain Injury in Mumbai: A Survey of Providers along the Care Continuum. Asian J Neurosurg 2020; 15:627-633. [PMID: 33145217 PMCID: PMC7591204 DOI: 10.4103/ajns.ajns_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/08/2020] [Accepted: 03/31/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction: Traumatic brain injury (TBI) represents a significant burden of a global disease, especially in low- and middle-income countries (LMICs) such as India. Efforts to curb the impact of TBI require an appreciation of local factors related to this disease and its treatment. Methods: Semi-structured qualitative interviews were administered to paramedics, anesthesiologists, general surgeons, and neurosurgeons in locations throughout Mumbai from April to May 2018. A thematic analysis with an iterative coding was used to analyze the data. The primary objective was to identify provider-perceived themes related to TBI care in Mumbai. Results: A total of 50 participants were interviewed, including 17 paramedics, 15 anesthesiologists, 9 general surgeons, and 9 neurosurgeons who were involved in caring for TBI patients. The majority of physicians interviewed discussed their experiences in public sector hospitals (82%), while 12% discussed private sector hospitals and 6% discussed both. Four major themes emerged: Workforce, equipment, financing care, and the family and public role. These themes were often discussed in the context of their effects on increasing or decreasing complications and delays. Participants developed adaptations when managing shortcomings in these thematic areas. These adaptations included teamwork during workforce shortages and resource allocation when equipment was limited among others. Conclusions: Workforce, equipment, financing care, and the family and public role were identified as major themes in the care for TBI in Mumbai. These thematic elements provide a framework to evaluate and improve care along the care spectrum for TBI. Similar frameworks should be adapted to local contexts in urbanizing cities in LMICs.
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Affiliation(s)
- Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Monty Khajanchi
- Department of Surgery, King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Harris Solomon
- Department of Cultural Anthropology, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nakul P Raykar
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Blake C Alkire
- Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Institute, Harvard Medical School, Boston, MA, USA
| | - Nobhojit Roy
- National Health System Resource Center, New Delhi, India
| | - Kee B Park
- Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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24
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Wärnberg Gerdin L, Khajanchi M, Kumar V, Roy N, Saha ML, Soni KD, Mishra A, Kamble J, Borle N, Verma CP, Gerdin Wärnberg M. Comparison of emergency department trauma triage performance of clinicians and clinical prediction models: a cohort study in India. BMJ Open 2020; 10:e032900. [PMID: 32075827 PMCID: PMC7044989 DOI: 10.1136/bmjopen-2019-032900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate and compare the abilities of clinicians and clinical prediction models to accurately triage emergency department (ED) trauma patients. We compared the decisions made by clinicians with the Revised Trauma Score (RTS), the Glasgow Coma Scale, Age and Systolic Blood Pressure (GAP) score, the Kampala Trauma Score (KTS) and the Gerdin et al model. DESIGN Prospective cohort study. SETTING Three hospitals in urban India. PARTICIPANTS In total, 7697 adult patients who presented to participating hospitals with a history of trauma were approached for enrolment. The final study sample included 5155 patients. The majority (4023, 78.0%) were male. MAIN OUTCOME MEASURE The patient outcome was mortality within 30 days of arrival at the participating hospital. A grid search was used to identify model cut-off values. Clinicians and categorised models were evaluated and compared using the area under the receiver operating characteristics curve (AUROCC) and net reclassification improvement in non-survivors (NRI+) and survivors (NRI-) separately. RESULTS The differences in AUROCC between each categorised model and the clinicians were 0.016 (95% CI -0.014 to 0.045) for RTS, 0.019 (95% CI -0.007 to 0.058) for GAP, 0.054 (95% CI 0.033 to 0.077) for KTS and -0.007 (95% CI -0.035 to 0.03) for Gerdin et al. The NRI+ for each model were -0.235 (-0.37 to -0.116), 0.17 (-0.042 to 0.405), 0.55 (0.47 to 0.65) and 0.22 (0.11 to 0.717), respectively. The NRI- were 0.385 (0.348 to 0.4), -0.059 (-0.476 to -0.005), -0.162 (-0.18 to -0.146) and 0.039 (-0.229 to 0.06), respectively. CONCLUSION The findings of this study suggest that there are no substantial differences in discrimination and net reclassification improvement between clinicians and all four clinical prediction models when using 30-day mortality as the outcome of ED trauma triage in adult patients. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02838459).
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Affiliation(s)
- Ludvig Wärnberg Gerdin
- Department of Industrial Economics and Management, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Monty Khajanchi
- Department of Surgery, Seth Gowardhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal General Hospital, Mumbai, India
| | - Nobhojit Roy
- Surgical Unit, WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, BARC Hospital (Government of India), Mumbai, India
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Makhan Lal Saha
- Department of Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
| | - Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anurag Mishra
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | | | - Nitin Borle
- Department of General Surgery, KB Bhabha Municipal General Hospital Mumbai, Mumbai, India
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25
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Bhoyar R, Borle N, Khajanchi M, Nagral S. Study of pre-hospital care, patterns of injury and outcomes of suburban railway accident victims in Mumbai, India. Natl Med J India 2020; 33:201-204. [PMID: 34045372 DOI: 10.4103/0970-258x.316263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background . India has one of the largest railway networks, with a high incidence of railway-related accidents and fatality rate of 150/million passengers per year. We evaluated the pre-hospitalization period, pattern of injury and outcome of train accident victims in a metropolitan city. Methods . For this prospective observational study, we included victims of railway accidents presenting to a public hospital of Mumbai (a metropolitan city) from November 2014 to September 2016. We documented a detailed history of the victims and patterns of injury. Injuries were assessed using the revised trauma score, injury severity score (ISS) and trauma score-ISS. The outcome of surviving persons was assessed using the European quality of life questionnaire (EQ-5D-5L) and visual analogue scale (EQ-VAS). Results . Eighty-one accident victims were admitted during the study period, of which 37 (46%) were seriously injured. The victims were predominantly male (85%), in the age group of 14-45 years (91%), 23 (28%) were in an intoxicated state. Most accidents happened during morning and evening peak hours (60%). The average time for victims to reach hospital was 38.1 minutes and 77 (95%) were transported by an ambulance accompanied by a doctor, while 8 (10%) received first aid at the railway station or in the ambulance. Ten (12%) accident victims died while 71 (88%) were discharged. Conclusions . We found a high incidence of people in their productive age group losing their lives to railway accidents, which can be prevented with the help of a robust transport system and training the first responder emergency medical care providers.
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Affiliation(s)
- Ruchita Bhoyar
- Department of Surgery, K.B. Bhabha Municipal General Hospital, Bandra (West), Mumbai 400050, Maharashtra, India
| | - Nitin Borle
- Department of Surgery, K.B. Bhabha Municipal General Hospital, Bandra (West), Mumbai 400050, Maharashtra, India
| | - Monty Khajanchi
- Department of Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sanjay Nagral
- Department of Surgery, K.B. Bhabha Municipal General Hospital, Bandra (West), Mumbai 400050, Maharashtra, India
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26
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Sterner M, Attergrim J, Claeson A, Kumar V, Khajanchi M, Dharap S, Gerdin M. Both the multiplicative and single-worst-injury International Classification of Diseases Injury Severity Score underperform in urban Indian hospitals. Trauma 2019. [DOI: 10.1177/1460408618789970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Trauma accounts for 9% of all deaths worldwide, killing almost five million people annually. As India accounts for more than one million of these deaths, research on local trauma care is of great importance. A key aspect of such research is outcome comparisons between contexts. One tool to adjust these comparisons for trauma severity is the International Classification of Diseases Injury Severity Score. The aim was to assess two versions of this score in India. Methods The data used were from the project Towards Improved Trauma Care Outcomes in India. Published survival risk ratios were used to calculate multiplicative-International Classification of Diseases Injury Severity Score and single-worst-injury-International Classification of Diseases Injury Severity Score for the 200 most recent non-surviving patients and the surviving patients during the same period. Score performance was measured in discrimination and calibration. Results The 30-day prediction single-worst-injury-International Classification of Diseases Injury Severity Score discriminated best with an area under the receiver operating characteristics curve of 0.668 (95% CI 0.645–0.690) and a calibration slope of 0.830 (95% CI 0.708–0.940). Conclusions The single-worst-injury-International Classification of Diseases Injury Severity Score applied on 30-day mortality was the only score to calibrate on a satisfactory level. None of the scores had an acceptable discrimination. In interpreting these findings, we see that none of the tested scores can currently be implemented in the studied hospitals.
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Affiliation(s)
- Mattias Sterner
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Jonatan Attergrim
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Alice Claeson
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Monty Khajanchi
- Department of General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Satish Dharap
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Martin Gerdin
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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27
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Gupta S, Khajanchi M, Kumar V, Raykar NP, Alkire BC, Roy N, Park KB. Third delay in traumatic brain injury: time to management as a predictor of mortality. J Neurosurg 2019; 132:1-7. [PMID: 30660121 DOI: 10.3171/2018.8.jns182182] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 08/28/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a global epidemic with an increasing incidence in low- and middle-income countries (LMICs). The time from arrival at the hospital to receiving appropriate treatment ("third delay") can vary widely in LMICs, although its association with mortality in TBI remains unknown. METHODS A retrospective cohort analysis with multivariable logistic regression was conducted using the Toward Improved Trauma Care Outcomes in India database, which contains data from 4 urban trauma centers in India from 2013-2015. RESULTS There were 6278 TBIs included in the cohort. The patients' median age was 39 years (interquartile range 27-52 years) and 80% of patients were male. The most frequent mechanisms of injury were road traffic accidents (52%) and falls (34%). A majority of cases were transfers from other facilities (79%). In-hospital 30-day mortality was 27%; of patients who died, 21% died within 24 hours of arrival. The median third delay was 10 minutes (interquartile range 0-60 minutes); 34% of cases had moderate third delay (10-60 minutes) and 22% had extended third delay (≥ 61 minutes). Overall 30-day mortality was associated with moderate third delay (OR 1.3, p = 0.001) and extended third delay (OR 1.3, p = 0.001) after adjustment by pertinent covariates. This effect was pronounced for 24-hour mortality: moderate and extended third delays were independently associated with ORs of 3.4 and 3.8, respectively, for 24-hour mortality (both p < 0.001). CONCLUSIONS Third delay is associated with early mortality in patients with TBI, and represents a target for process improvement in urban trauma centers.
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Affiliation(s)
| | - Monty Khajanchi
- 2Department of Surgery, Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai
| | - Vineet Kumar
- 3Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - Nakul P Raykar
- 4Department of Surgery, Beth Israel Deaconess Medical Center, Boston
- 5Program for Global Surgery and Social Change, Harvard Medical School, Boston
| | - Blake C Alkire
- 6Department of Otolaryngology, Massachusetts Eye and Ear Institute, Boston, Massachusetts
| | - Nobhojit Roy
- 7National Health Systems Resource Centre (NHSRC), Ministry of Health & Family Welfare, Government of India, New Delhi; and
- 8WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, BARC Hospital, Mumbai, India
| | - Kee B Park
- 5Program for Global Surgery and Social Change, Harvard Medical School, Boston
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28
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Moore L, Champion H, Tardif PA, Kuimi BL, O'Reilly G, Leppaniemi A, Cameron P, Palmer CS, Abu-Zidan FM, Gabbe B, Gaarder C, Yanchar N, Stelfox HT, Coimbra R, Kortbeek J, Noonan VK, Gunning A, Gordon M, Khajanchi M, Porgo TV, Turgeon AF, Leenen L. Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis. World J Surg 2018; 42:1327-1339. [PMID: 29071424 DOI: 10.1007/s00268-017-4292-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. METHODS We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. RESULTS We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [-0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. CONCLUSIONS This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.
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Affiliation(s)
- Lynne Moore
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada. .,Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center (Enfant-Jésus Hospital), Québec, QC, Canada.
| | - Howard Champion
- Department of Surgery, University of the Health Sciences, Annapolis, MD, USA
| | - Pier-Alexandre Tardif
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center (Enfant-Jésus Hospital), Québec, QC, Canada
| | - Brice-Lionel Kuimi
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center (Enfant-Jésus Hospital), Québec, QC, Canada
| | - Gerard O'Reilly
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University hospital, Helsinki, Finland
| | - Peter Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
| | - Natalie Yanchar
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Henry Thomas Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Raul Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California, San Diego Health System, San Diego, CA, USA
| | - John Kortbeek
- Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, AB, Canada
| | | | - Amy Gunning
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Malcolm Gordon
- Department of Emergency Medicine, University of Glasgow, Glasgow, UK
| | | | - Teegwendé V Porgo
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center (Enfant-Jésus Hospital), Québec, QC, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center (Enfant-Jésus Hospital), Québec, QC, Canada
| | - Luke Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Gupta S, Khajanchi M, Kumar V, Raykar N, Alkire B, Roy N, Park KB. 188 Third Delay in Traumatic Brain Injury. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Attergrim J, Sterner M, Claeson A, Dharap S, Gupta A, Khajanchi M, Kumar V, Gerdin Wärnberg M. Predicting mortality with the international classification of disease injury severity score using survival risk ratios derived from an Indian trauma population: A cohort study. PLoS One 2018; 13:e0199754. [PMID: 29949624 PMCID: PMC6021077 DOI: 10.1371/journal.pone.0199754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 06/13/2018] [Indexed: 11/25/2022] Open
Abstract
Background Trauma is predicted to become the third leading cause of death in India by 2020, which indicate the need for urgent action. Trauma scores such as the international classification of diseases injury severity score (ICISS) have been used with great success in trauma research and in quality programmes to improve trauma care. To this date no valid trauma score has been developed for the Indian population. Study design This retrospective cohort study used a dataset of 16047 trauma-patients from four public university hospitals in urban India, which was divided into derivation and validation subsets. All injuries in the dataset were assigned an international classification of disease (ICD) code. Survival Risk Ratios (SRRs), for mortality within 24 hours and 30 days were then calculated for each ICD-code and used to calculate the corresponding ICISS. Score performance was measured using discrimination by calculating the area under the receiver operating characteristics curve (AUROCC) and calibration by calculating the calibration slope and intercept to plot a calibration curve. Results Predictions of 30-day mortality showed an AUROCC of 0.618, calibration slope of 0.269 and calibration intercept of 0.071. Estimates of 24-hour mortality consistently showed low AUROCCs and negative calibration slopes. Conclusions We attempted to derive and validate a version of the ICISS using SRRs calculated from an Indian population. However, the developed ICISS-scores overestimate mortality and implementing these scores in clinical or policy contexts is not recommended. This study, as well as previous reports, suggest that other scoring systems might be better suited for India and other Low- and middle-income countries until more data are available.
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Affiliation(s)
- Jonatan Attergrim
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Mattias Sterner
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Alice Claeson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Satish Dharap
- Department of General Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Amit Gupta
- Division of Trauma Surgery & Critical Care, J.P.N. Apex Trauma Center, New Delhi, India
| | - Monty Khajanchi
- Department of General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Vineet Kumar
- Department of General Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
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Claeson A, Sterner M, Attergrim J, Khajanchi M, Kumar V, Saha ML, Gerdin Wärnberg M. Assessment of the predictive value of the International Classification of Diseases Injury Severity Score for trauma mortality in urban India. J Surg Res 2018; 229:357-364. [PMID: 29937014 DOI: 10.1016/j.jss.2018.03.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/10/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Trauma is the cause of 1.2 million deaths in India annually. Injury severity scores play an important role in trauma research and care because these scores enable the adjustment of trauma severity when comparing mortality outcomes. The generalizability of the International Classification of Diseases Injury Severity Score (ICISS) between different populations is not fully known, and the validity of the ICISS has not been assessed in the Indian context. The aim of this study was to assess the predictive performances of three international versions of the ICISS, derived from data from Australia, New Zealand and pooled data from seven different high-income countries, in trauma patients admitted to four public hospitals in urban India. MATERIAL AND METHODS We used patient data from an Indian cohort of 16,047 trauma patients. The patients were assigned an ICISS based on International Classification of Diseases codes using survival risk ratios from publicly available data sets from Australia and New Zealand and with pooled data from seven different high-income countries. Predicted mortality based on the ICISS was compared with observed patient mortality, and the predictive performance was assessed in terms of discrimination and calibration. RESULTS Discrimination and calibration did not reach the threshold for predictive performance in any of the ICISS versions used. The threshold value used was 0.8 for discrimination, which was not significantly different from one for the calibration slope and not significantly different from zero for the calibration intercept. CONCLUSIONS None of the international versions of the ICISS adequately predicted mortality within the study population, indicating the need for an ICISS version specifically adapted to the Indian context.
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Affiliation(s)
- Alice Claeson
- System and Policy Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Mattias Sterner
- System and Policy Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jonathan Attergrim
- System and Policy Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Monty Khajanchi
- Department of General Surgery, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India
| | - Vineet Kumar
- Department of Surgery, College Building First Floor, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - Makhan Lal Saha
- Department of General Surgery, Institute of Post-Graduate Medical Education and Research, Kolkata, India
| | - Martin Gerdin Wärnberg
- System and Policy Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Mansourati M, Kumar V, Khajanchi M, Saha ML, Dharap S, Seger R, Gerdin Wärnberg M. Mortality following surgery for trauma in an Indian trauma cohort. Br J Surg 2018; 105:1274-1282. [DOI: 10.1002/bjs.10862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/08/2018] [Accepted: 02/15/2018] [Indexed: 11/07/2022]
Abstract
Abstract
Background
India accounts for 20 per cent of worldwide trauma mortality. Little is known about the quality of trauma surgery in an Indian setting. The aim of this study was to estimate the overall perioperative mortality rate, and to assess the association between type of acute surgical intervention and perioperative mortality among adult patients treated for trauma in an urban Indian setting.
Methods
Data were obtained from injured adult patients enrolled in four urban Indian hospitals during 2013–2015. Those who had surgery within 24 h of arrival at hospital were included in the analysis. Patients with missing data were excluded. The perioperative mortality rate was measured at 48 h and 30 days after arrival at hospital. Generalized linear mixed models were used for risk adjustment of procedure-specific mortality.
Results
Among 2986 patients who underwent trauma surgery, the overall 48-h mortality rate was 6·0 per cent, and the 30-day mortality rate was 23·1 per cent. The highest adjusted odds ratios (ORs) for 48-h mortality were found for patients who underwent surgery on the peripheral vasculature (OR 4·71, 95 per cent c.i. 1·18 to 16·59; P = 0·030) and the digestive system and spleen (OR 3·77, 1·33 to 9·01; P = 0·010) compared with those who had nervous system surgery.
Conclusion
In this study of surgery in an Indian trauma cohort, there was an excess of late perioperative deaths. Mortality differed significantly according to the type of surgery being undertaken.
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Affiliation(s)
- M Mansourati
- Global Health: Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - V Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - M Khajanchi
- Department of Surgery, Seth G. S. Medical College and King Edward Memorial Hospital, Mumbai, India
| | - M L Saha
- Department of Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
| | - S Dharap
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - R Seger
- Global Health: Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - M Gerdin Wärnberg
- Global Health: Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Moore L, Champion H, O’Reilly G, Leppaniemi A, Cameron P, Palmer C, Abu-Zidan FM, Gabbe B, Gaarder C, Yanchar N, Stelfox HT, Coimbra R, Kortbeek J, Noonan V, Gunning A, Leenan L, Gordon M, Khajanchi M, Shemilt M, Porgo V, Turgeon AF. Impact of trauma system structure on injury outcomes: a systematic review protocol. Syst Rev 2017; 6:12. [PMID: 28109306 PMCID: PMC5251247 DOI: 10.1186/s13643-017-0408-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/06/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Injury represents one of the greatest public health challenges of our time with over 5 million deaths and 100 million people temporarily or permanently disabled every year worldwide. The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, the organisation of trauma care varies significantly across trauma systems and we know little about which components of trauma systems contribute to their effectiveness. The objective of the study described in this protocol is to systematically review evidence of the impact of trauma system components on clinically significant outcomes including mortality, function and disability, quality of life, and resource utilization. METHODS We will perform a systematic review of studies evaluating the association between at least one trauma system component (e.g. accreditation by a central agency, interfacility transfer agreements) and at least one injury outcome (e.g. mortality, disability, resource use). We will search MEDLINE, EMBASE, COCHRANE central, and BIOSIS/Web of Knowledge databases, thesis holdings, key injury organisation websites and conference proceedings for eligible studies. Pairs of independent reviewers will evaluate studies for eligibility and extract data from included articles. Methodological quality will be evaluated using elements of the ROBINS-I tool and the Cochrane risk of bias tool for non-randomized and randomized studies, respectively. Strength of evidence will be evaluated using the GRADE tool. DISCUSSION We expect to advance knowledge on the components of trauma systems that contribute to their effectiveness. This may lead to recommendations on trauma system structure that will help policy-makers make informed decisions as to where resources should be focused. The review may also lead to specific recommendations for future research efforts. SYSTEMATIC REVIEW REGISTRATION This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 28-06-2016. PROSPERO 2016:CRD42016041336 Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016041336 .
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Affiliation(s)
- Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec, QC Canada
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie–Urgence-Soins intensifs (Trauma–Emergency–Critical Care Medicine), CHU de Québec–Université Laval Research Center (Enfant-Jésus Hospital), 1401, 18e rue, local H-012a, Québec, G1J 1Z4 Canada
| | | | - Gerard O’Reilly
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ari Leppaniemi
- Department of Surgery, Helsinki University, Helsinki, Finland
| | - Peter Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Monash University, Melbourne, Australia
| | - Cameron Palmer
- Trauma Service, Royal Children’s Hospital, Melbourne, Australia
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
| | - Natalie Yanchar
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia Canada
| | - Henry Thomas Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Raul Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California, San Diego Health System, San Diego, California USA
| | - John Kortbeek
- Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alberta Canada
| | - Vanessa Noonan
- Rick Hansen Institute, Vancouver, BC Canada
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Amy Gunning
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luke Leenan
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Malcolm Gordon
- Department of Emergency Medicine, University of Glasgow, Glasgow, UK
| | | | - Michèle Shemilt
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie–Urgence-Soins intensifs (Trauma–Emergency–Critical Care Medicine), CHU de Québec–Université Laval Research Center (Enfant-Jésus Hospital), 1401, 18e rue, local H-012a, Québec, G1J 1Z4 Canada
| | - Valérie Porgo
- Department of Social and Preventative Medicine, Université Laval, Québec, QC Canada
| | - Alexis F. Turgeon
- Department of Social and Preventative Medicine, Université Laval, Québec, QC Canada
| | - on behalf of the International Injury Care Improvement Initiative
- Department of Social and Preventative Medicine, Université Laval, Québec, QC Canada
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie–Urgence-Soins intensifs (Trauma–Emergency–Critical Care Medicine), CHU de Québec–Université Laval Research Center (Enfant-Jésus Hospital), 1401, 18e rue, local H-012a, Québec, G1J 1Z4 Canada
- U Health Sciences, Baltimore, Maryland USA
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Surgery, Helsinki University, Helsinki, Finland
- Emergency and Trauma Centre, The Alfred Hospital, Monash University, Melbourne, Australia
- Trauma Service, Royal Children’s Hospital, Melbourne, Australia
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia Canada
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California, San Diego Health System, San Diego, California USA
- Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alberta Canada
- Rick Hansen Institute, Vancouver, BC Canada
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Emergency Medicine, University of Glasgow, Glasgow, UK
- Seth G.S. Medical College and KEM Hospital, Mumbai, India
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Roy N, Gerdin M, Schneider E, Kizhakke Veetil DK, Khajanchi M, Kumar V, Saha ML, Dharap S, Gupta A, Tomson G, von Schreeb J. Validation of international trauma scoring systems in urban trauma centres in India. Injury 2016; 47:2459-2464. [PMID: 27667119 DOI: 10.1016/j.injury.2016.09.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In the Lower-Middle Income Country setting, we validate trauma severity scoring systems, namely Injury Severity Score (ISS), New Injury Severity Scale (NISS) score, the Kampala Trauma Score (KTS), Revised Trauma Score (RTS) score and the TRauma Injury Severity Score (TRISS) using Indian trauma patients. PATIENTS AND METHODS From 1 September 2013 to 28 February 2015, we conducted a prospective multi-centre observational cohort study of trauma patients in four Indian university hospitals, in three megacities, Kolkata, Mumbai and Delhi. All adult patients presenting to the casualty department with a history of injury and who were admitted to inpatient care were included. The primary outcome was in-hospital mortality within 30-days of admission. The sensitivity and specificity of each score to predict inpatient mortality within 30days was assessed by the areas under the receiver operating characteristic curve (AUC). Model fit for the performance of individual scoring systems was accomplished by using the Akaike Information criterion (AIC). RESULTS In a registry of 8791 adult trauma patients, we had a cohort of 7197 patients eligible for the study. 4091 (56.8%)patients had all five scores available and was the sample for a complete case analysis. Over a 30-day period, the scores (AUC) was TRISS (0.82), RTS (0.81), KTS (0.74), NISS (0.65) and ISS (0.62). RTS was the most parsimonious model with the lowest AIC score. Considering overall mortality, both physiologic scores (RTS, KTS) had better discrimination and goodness-of-fit than ISS or NISS. The ability of all Injury scores to predict early mortality (24h) was better than late mortality (30day). CONCLUSION On-admission physiological scores outperformed the more expensive anatomy-based ISS and NISS. The retrospective nature of ISS and TRISS score calculations and incomplete imaging in LMICs precludes its use in the casualty department of LMICs. They will remain useful for outcome comparison across trauma centres. Physiological scores like the RTS and KTS will be the practical score to use in casualty departments in the urban Indian setting, to predict early trauma mortality and improve triage.
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Affiliation(s)
- Nobhojit Roy
- Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden; BARC Hospital (Govt of India), HBNI University, Mumbai, India.
| | - Martin Gerdin
- Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.
| | - Eric Schneider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA 02120, USA.
| | | | - Monty Khajanchi
- BARC Hospital (Govt of India), HBNI University, Mumbai, India.
| | - Vineet Kumar
- Department of General Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.
| | - Makhal Lal Saha
- Department of Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India.
| | - Satish Dharap
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai,India.
| | - Amit Gupta
- Department of Surgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Göran Tomson
- Department of Learning, Informatics, Management & Ethics (LIME) and Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Johan von Schreeb
- Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.
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Roy N, Gerdin M, Ghosh SN, Gupta A, Saha ML, Khajanchi M, Dharap SB, Mohd Ismail D, von Schreeb J. The Chennai consensus on in-hospital trauma care for India. J Emerg Trauma Shock 2016; 9:90-2. [PMID: 27162445 PMCID: PMC4843576 DOI: 10.4103/0974-2700.179460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nobhojit Roy
- Department of General Surgery, BARC Hospital, Mumbai, India; Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, Europe E-mail:
| | - Martin Gerdin
- Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, Europe E-mail:
| | - Samarendra Nath Ghosh
- Department of Neurosurgery, Bangur Institute of Neurosciences and IPGMER, SSKM Hospital, Kolkata, West Bengal, India
| | - Amit Gupta
- All India Institute of Medical Sciences, JPN Apex Trauma Centre, New Delhi, India
| | - Makhan Lal Saha
- Department of General Surgery, Institute of PG Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Monty Khajanchi
- Department of General Surgery, King Edward Memorial Hospital, Mumbai, India
| | - Satish B Dharap
- Department of General Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Deen Mohd Ismail
- Department of Orthopaedics, Rajiv Gandhi General Hospital and Madras Medical College, Chennai, Tamil Nadu, India
| | - Johan von Schreeb
- Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, Europe E-mail:
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Bhat KRS, Khajanchi M, Prajapati R, Satoskar RR. Evaluation of Pain Preoperatively and Postoperatively in Patients with Chronic Pancreatitis Undergoing Longitudinal Pancreaticojejunostomy. Indian J Surg 2016; 77:1098-102. [PMID: 27011518 DOI: 10.1007/s12262-014-1173-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 09/11/2014] [Indexed: 11/30/2022] Open
Abstract
Chronic pancreatitis is a fairly common condition with pain being the major symptom, and longitudinal pancreaticojejunostomy (LPJ) is performed for symptomatic relief. The aim of the study is to assess relief of pain post-LPJ for chronic pancreatitis and to evaluate the factors influencing relief of symptoms. A prospective observational non-interventional study enrolling 28 patients. This study involved a questionnaire studying various risk factors and pain related to chronic pancreatitis, pancreaticojejunostomy, and postoperative assessment of pain relief at 1 and 6 months from surgery. Pain was assessed using Visual analogue scale (VAS). In chronic pancreatitis, there is a significant relief in symptoms of pain post-LPJ; the degree of relief was less in the alcoholics vs non-alcoholics (p = 0.09) and smokers. There was also reduction in analgesic requirement and frequency of acute attacks of pain. Fifty-seven percent of patients had a complete remission of their pain after LPJ for CP. In chronic pancreatitis, there is a significant relief in symptoms of pain post-LPJ, although the degree of relief is less in the alcoholics and smokers.
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Affiliation(s)
- K R Seetharam Bhat
- Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400-012 India
| | - Monty Khajanchi
- Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400-012 India
| | - Ram Prajapati
- Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400-012 India
| | - R R Satoskar
- Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra 400-012 India
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Roy N, Gerdin M, Ghosh S, Gupta A, Kumar V, Khajanchi M, Schneider EB, Gruen R, Tomson G, von Schreeb J. 30-Day In-hospital Trauma Mortality in Four Urban University Hospitals Using an Indian Trauma Registry. World J Surg 2016; 40:1299-307. [DOI: 10.1007/s00268-016-3452-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gerdin M, Roy N, Khajanchi M, Kumar V, Felländer-Tsai L, Petzold M, Tomson G, von Schreeb J. Validation of a novel prediction model for early mortality in adult trauma patients in three public university hospitals in urban India. BMC Emerg Med 2016; 16:15. [PMID: 26905408 PMCID: PMC4763419 DOI: 10.1186/s12873-016-0079-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/16/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Trauma is one of the top threats to population health globally. Several prediction models have been developed to supplement clinical judgment in trauma care. Whereas most models have been developed in high-income countries the majority of trauma deaths occur in low- and middle-income countries. Almost 20 % of all global trauma deaths occur in India alone. The aim of this study was to validate a basic clinical prediction model for use in urban Indian university hospitals, and to compare it with existing models for use in early trauma care. METHODS We conducted a prospective cohort study in three hospitals across urban India. The model we aimed to validate included systolic blood pressure and Glasgow coma scale. We compared this model with three additional models, which all have been designed for use in bedside trauma care, and two single variable models based on systolic blood pressure and Glasgow coma scale respectively. The outcome was early mortality, defined as death within 24 h from the time when vital signs were first measured. We compared the models in terms of discrimination, calibration, and potential clinical consequences using decision curve analysis. Multiple imputation was used to handle missing data. Performance measures are reported using their median and inter-quartile range (IQR) across imputed datasets. RESULTS We analysed 4440 patients, out of which 1629 were used as an updating sample and 2811 as a validation sample. We found no evidence that the basic model that included only systolic blood pressure and Glasgow coma scale had worse discrimination or potential clinical consequences compared to the other models. A model that also included heart had better calibration. For the model with systolic blood pressure and Glasgow coma scale the discrimination in terms of area under the receiver operating characteristics curve was 0.846 (IQR 0.841-0.849). Calibration measured by estimating a calibration slope was 1.183 (IQR 1.168-1.202). Decision curve analysis revealed that using this model could potentially result in 45 fewer unnecessary surveys per 100 patients. CONCLUSIONS A basic clinical prediction model with only two parameters may prove to be a feasible alternative to more complex models in contexts such as the Indian public university hospitals studied here. We present a colour-coded chart to further simplify the decision making in early trauma care.
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Affiliation(s)
- Martin Gerdin
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Solna, 171 65, Stockholm, Sweden.
| | - Nobhojit Roy
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Solna, 171 65, Stockholm, Sweden.
- Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India.
- Tata Institute of Social Sciences, School of Habitat, Mumbai, India.
| | - Monty Khajanchi
- General Surgery, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, India.
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.
| | - Li Felländer-Tsai
- Department of Clinical Science Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden.
| | - Max Petzold
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Göran Tomson
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Solna, 171 65, Stockholm, Sweden.
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Johan von Schreeb
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Solna, 171 65, Stockholm, Sweden.
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Gerdin M, Roy N, Felländer-Tsai L, Tomson G, von Schreeb J, Petzold M, Gupta A, Jhakal A, Basak D, Mohamed Ismail D, Yabo D, Jegadeesan K, Kamble J, Saha ML, Nitnaware M, Khajanchi M, Jothi R, Ghosh SN, Bhoi S, Mahindrakar S, Dharap S, Rao S, Kamal V, Kumar V, Tirlotkar S. Traumatic transfers: calibration is adversely affected when prediction models are transferred between trauma care contexts in India and the United States. J Clin Epidemiol 2016; 74:177-86. [PMID: 26775627 DOI: 10.1016/j.jclinepi.2016.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/13/2015] [Accepted: 01/04/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We evaluated the transferability of prediction models between trauma care contexts in India and the United States and explored updating methods to adjust such models for new contexts. STUDY DESIGN AND SETTINGS Using a combination of prospective cohort and registry data from 3,728 patients of Towards Improved Trauma Care Outcomes in India (TITCO) and from 18,756 patients of the US National Trauma Data Bank (NTDB), we derived models in one context and validated them in the other, assessing them for discrimination and calibration using systolic blood pressure, heart rate, and Glasgow coma scale as candidate predictors. RESULTS Early mortality was 8% in the TITCO and 1-2% in the NTDB samples. Both models discriminated well, but the TITCO model overestimated the risk of mortality in NTDB patients, and the NTDB model underestimated the risk in TITCO patients. CONCLUSION Transferability was good in terms of discrimination but poor in terms of calibration. It was possible to improve this miscalibration by updating the models' intercept. This updating method could be used in samples with as few as 25 events.
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Affiliation(s)
- Martin Gerdin
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Nobhojit Roy
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, Maharashtra 400085, India; School of Habitat, Tata Institute of Social Sciences, Chembur, Mumbai, Maharashtra 400088, India
| | - Li Felländer-Tsai
- Division of Orthopedics and Biotechnology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Alfred Nobels allé 8, SE-141 52 Huddinge, Sweden
| | - Göran Tomson
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Johan von Schreeb
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Max Petzold
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, SE-405 30 Gothenburg, Sweden; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Johannesburg 2193, South Africa
| | | | - Amit Gupta
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - Ashish Jhakal
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - Debojit Basak
- Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Harish Mukherjee Rd, Bhowanipore, Kolkata, India
| | - Deen Mohamed Ismail
- Department of Orthopedics, Madras Medical College, Chennai, Tamil Nadu 600003, India
| | - Dusu Yabo
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - K Jegadeesan
- Madras Medical College, Chennai, Tamil Nadu 600003, India
| | - Jyoti Kamble
- King Edward Memorial Hospital, Mumbai, Maharashtra 400012, India
| | - Makhan Lal Saha
- Department of Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Harish Mukherjee Rd, Bhowanipore, Kolkata, India
| | - Mangesh Nitnaware
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra 400022, India
| | - Monty Khajanchi
- General Surgery, Seth GS Medical College & King Edward Memorial Hospital, Mumbai, Maharashtra 400012, India
| | - Ranganathan Jothi
- Department of Neurosurgery, Madras Medical College, Chennai, Tamil Nadu 600003, India
| | - Samarendra Nath Ghosh
- Department of Neurosurgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Harish Mukherjee Rd, Bhowanipore, Kolkata, India
| | - Sanjeev Bhoi
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - Santosh Mahindrakar
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - Satish Dharap
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra 400022, India
| | - Shilpa Rao
- Department of Surgery, King Edward Memorial Hospital, Mumbai, Maharashtra 400012, India
| | - Veera Kamal
- Madras Medical College, Chennai, Tamil Nadu 600003, India
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra 400022, India
| | - Santosh Tirlotkar
- School of Habitat, Tata Institute of Social Sciences, Chembur, Mumbai, Maharashtra 400088, India
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Gerdin M, Roy N, Khajanchi M, Kumar V, Dharap S, Felländer-Tsai L, Petzold M, Bhoi S, Saha ML, von Schreeb J. Correction: Predicting Early Mortality in Adult Trauma Patients Admitted to Three Public University Hospitals in Urban India: A Prospective Multicentre Cohort Study. PLoS One 2015; 10:e0144886. [PMID: 26673911 PMCID: PMC4684508 DOI: 10.1371/journal.pone.0144886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kumar V, Khajanchi M, Raykar NP, Gerdin M, Roy N. Waiting at the hospital door: a prospective, multicentre assessment of third delay in four tertiary hospitals in India. Lancet 2015; 385 Suppl 2:S24. [PMID: 26313071 DOI: 10.1016/s0140-6736(15)60819-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A common framework to assess delays in health-care in countries with low-income and middle-income (LMICs) defines three time periods that add to the interval between onset of symptoms and treatment; the time it takes to receive care after hospital arrival is known as the third delay. Tertiary centres in LMICs are known to be overcrowded and under-capacity, but few studies have formally assessed the third delay. This study aims to quantify the third delay in LMIC tertiary centres and identify contributing factors at the facility level. METHODS A prospective multicentre study was conducted from July, 2013, to July, 2014, in four tertiary care hospitals in the three largest cities in India: Mumbai, Delhi, and Kolkata. The time from patient arrival to the time when vital signs were first recorded was used as a proxy for the third delay. This delay was recorded by the research officers for those patients who were directly observed. For the rest of the patients the data were collected from patient records. Qualitative interviews were conducted with a subset of patients exploring reasons for the delay. FINDINGS Data were collected for 5087 patients (1664 from Delhi, 469 from Mumbai centre-1, 711 from Mumbai centre-2, and 2243 from Kolkatta); median age was 30 years (IQR 20-45), 3944 (78%) were men, 3372 (66%) were transfers from other facilities, and 3424 (67·3%) arrived in an ambulance. Researchers directly observed 1392 (27·4%) patients from arrival to time of vital signs. There were wide variations in delays between groups, transferred versus direct presentation (0 min vs 20 min) and in between hospitals (median time 0·0 min in Mumbai to 1·5 h in Kolkatta) and in groups within each hospital. The reasons for delay were multifactorial: administrative (police case recordings, admission paper registration), logistical (no vacant beds, no physician available), and process-based (investigations before vitals, multiple patients at one time, junior physicians in-charge); process based reasons were the most common (80%). INTERPRETATION Delays in care persist in tertiary centres in LMICs for a variety of reasons. Low-cost but context-specific changes that optimise care processes like prioritisation and transfer protocols could yield major reductions in third delay. Adoption of best practices of the better performing hospitals in the Indian setting will help to improve the trauma quality practices in India. FUNDING The Laerdal Foundation for Acute Medicine and the Swedish National Board of Health and Welfare.
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Affiliation(s)
- Vineet Kumar
- Lokmanya Tilak Municipal Medical College and General Hospital, General Surgery, Mumbai, Maharashtra, India.
| | | | - Nakul P Raykar
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Nobhojit Roy
- Bhabha Atomic Research Centre Hospital, Mumbai, India
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Gerdin M, Roy N, Dharap S, Kumar V, Khajanchi M, Tomson G, Tsai LF, Petzold M, von Schreeb J. Early hospital mortality among adult trauma patients significantly declined between 1998-2011: three single-centre cohorts from Mumbai, India. PLoS One 2014; 9:e90064. [PMID: 24594775 PMCID: PMC3940776 DOI: 10.1371/journal.pone.0090064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 01/29/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Traumatic injury causes more than five million deaths each year of which about 90% occur in low- and middle-income countries (LMIC). Hospital trauma mortality has been significantly reduced in high-income countries, but to what extent similar results have been achieved in LMIC has not been studied in detail. Here, we assessed if early hospital mortality in patients with trauma has changed over time in an urban lower middle-income setting. METHODS We conducted a retrospective study of patients admitted due to trauma in 1998, 2002, and 2011 to a large public hospital in Mumbai, India. Our outcome measure was early hospital mortality, defined as death between admission and 24-hours. We used multivariate logistic regression to assess the association between time and early hospital mortality, adjusting for patient case-mix. Injury severity was quantified using International Classification of Diseases-derived Injury Severity Score (ICISS). Major trauma was defined as ICISS<0.90. RESULTS We analysed data on 4189 patients out of which 86.5% were males. A majority of patients were between 15 and 55 years old and 36.5% had major trauma. Overall early hospital mortality was 8.9% in 1998, 6.0% in 2002, and 8.1% in 2011. Among major trauma patients, early hospital mortality was 13.4%, in 1998, 11.3% in 2002, and 10.9% in 2011. Compared to trauma patients admitted in 1998, those admitted in 2011 had lower odds for early hospital mortality (OR = 0.56, 95% CI = 0.41-0.76) including those with major trauma (OR = 0.57, 95% CI = 0.41-0.78). CONCLUSIONS We observed a significant reduction in early hospital mortality among patients with major trauma between 1998 and 2011. Improved survival was evident only after we adjusted for patient case-mix. This finding highlights the importance of risk-adjustment when studying longitudinal mortality trends.
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Affiliation(s)
- Martin Gerdin
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Nobhojit Roy
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India
- School of Habitat, Tata Institute of Social Sciences, Mumbai, India
| | - Satish Dharap
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Monty Khajanchi
- Department of Surgery, Seth G. S. Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Göran Tomson
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Li Felländer Tsai
- Division of Orthopedics and Biotechnology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Max Petzold
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan von Schreeb
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Manay P, Khajanchi M, Prajapati R, Satoskar R. Pedicled omental and split skin graft in the reconstruction of the anterior abdominal wall. Int J Surg Case Rep 2014; 5:161-3. [PMID: 24566428 DOI: 10.1016/j.ijscr.2013.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 12/11/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The POSSG is a pedicled graft based on either the right or left gastro-epiploic arteries. It is used with a dual mesh in reconstruction of full thickness defects of anterior abdominal wall and covered by skin grafts. PRESENTATION OF CASE A recurrent malignant peripheral nerve sheath tumor (MPNST) of the anterior abdominal wall was excised leaving a large defect. The POSSG was used for reconstruction. A large dual mesh was placed to close the defect in the abdominal wall by suturing it to the remnant rim of abdominal muscles. The omental pedicle was brought through a keyhole in the mesh, spread out over the mesh, sutured and covered by split skin grafts. The final graft take was 90 percent. DISCUSSION The POSSG can be used to reconstruct any size of anterior abdominal wall defects due to the malleable nature of omentum. Its prerequisite however is a dual mesh like PROCEED. The POSSG helps keep the more complex musculofasciocutaneous flaps as lifeboats. It can be used singly where multiple musculofasciocutaneous flaps would otherwise have been required. It can be used in patients with poor prognosis of underlying malignancy. It may be used by general surgeons due to familiarity with anatomy of the relevant structures and lack of need for microsurgical skill. CONCLUSION The POSSG can be used in reconstruction of abdominal wall defects of any size by general surgeons.
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Affiliation(s)
- Priyadarshini Manay
- Department of General Surgery, Seth G.S. Medical College, K.E.M Hospital, Parel, Mumbai 400012, India.
| | - Monty Khajanchi
- Department of General Surgery, Seth G.S. Medical College, K.E.M Hospital, Parel, Mumbai 400012, India
| | - Ram Prajapati
- Department of General Surgery, Seth G.S. Medical College, K.E.M Hospital, Parel, Mumbai 400012, India
| | - Rajeev Satoskar
- Department of General Surgery, Seth G.S. Medical College, K.E.M Hospital, Parel, Mumbai 400012, India
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