Pattern of trauma in a rural hospital and factors affecting mortality in trauma patients
Keywords:Factors affecting trauma outcome, Mortality, Revised trauma score (RTS), Injury severity score (ISS)
Background: Trauma is associated with human civilization since ancient times. With the modern urbanization and increase in motor vehicles incidence and pattern of trauma changed. Hence the present study was conducted to study the pattern of trauma in a rural population admitted to a Kasturba Hospital Sewagram (Rural Hospital) and to detect factors affecting the mortality of trauma patients.
Methods: A prospective randomized controlled trial was conducted in Department of general surgery, Kasturba Hospital, Mahatma Gandhi Institute of Medical Sciences, Sewagram. A total number of 1525 trauma patients were studied over a period of 2 yrs. The detail examination was done and findings were recorded. All the factors affecting
mortality of trauma patients were studied.
Results: Trauma affects younger population more with a male predominance. Incidences of vehicular accidents are more than the non-vehicular accidents and other modes of trauma. Head injury was most common type of injury as observed in the present study. Advancing age and polytrauma were the main factors for high mortality. The mortality increased as the Revised Trauma Score decreased. While mortality increased with increasing Injury Severity Score and vice versa.
Conclusions: Age, sex, mechanism and type of injury affect the mortality in Trauma Patients. The mortality increased as the Revised Trauma Score decreased while mortality increased with increasing Injury Severity Score.
David H, Wisner MD. History and current status of trauma scoring system. Arch Surg. 1992;127:111-7.
Champion HR. A revision of the Trauma Score.J Trauma. 1989;29(5):623-9.
Foreman BP. Usefulness of the abbreviated injury score and the injury severity score in comparison to the Glasgow coma scale in predicting outcome after traumatic brain injury. J Trauma. 2007;62(4):946-50.
Gill M. A comparison of five simplified scales to the out-of-hospital Glasgow Coma Scale for the prediction of traumatic brain injury outcomes. Acad Emerg Med. 2006;13(9):968-73.
Champion HR. An anatomic index of injury severity.J Trauma. 1980;20(3):197-202.
Gururaj G. Injuries in India: A national Perspective, NCMH Background papers – Burden of Diseases in India. 2004;325-47.
Copes WS. The injury severity score revisited. J Trauma. 1988;28(1):69-77.
Attar F, Simms P. How age, injury severity score and revised trauma score relate to the probability of survival in our trauma patients and if these correlate with predictive outcome; University Hospital Sintrel, Liverpool, UK; Poster presentation , ITACCS, Spring. 2005.
Baker SP, Nell BO. The injury severity score: an update. J Trauma. 1976;16(11):882-5.
Morris JA. Mortality in Trauma Patients: The Interaction between host factors an severity. J Trauma. 1990;30(12):1476-82.
Schwab WC. Trauma in geriatric patient. Arch Surg. 1992;127:701-6.
Gabbe BJ, Cameron PA, Finch CF. Is the revised trauma score still useful? ANZ J Surg. 2003;73(11):944-8.
Zafar H, Rehmani R. Registry based trauma outcome: perspective of developing country. Emerg Med J. 2002;19:391-4.
Kuhls GA. Predictors of mortality in adult trauma patients: the physiological trauma score is equivalent to the trauma and injury severity score. J Am Coll of Surg. 2002;194(6):695- 704.
Rabbani A, Mollini M. Application of trauma and injury severity score and A severity characterization of trauma score to trauma patient in a setting different from Major Trauma Outcome Study. Arch. Iranian Med. 2007;10(3):383-6.
Ott R. Prognostic value of trauma scores in pediatric patients with multiple injuries. J Trauma. 2000;49(4):729-36.
Copes WS. Comparison of Abbreviated Injury scale 1980 and 1985 versions. J Trauma. 1988;28(2):78-86.
Kaweski S. Effect of prehospital fluids on survival in trauma. J Trauma. 1990;30(10):1215-9
Fedakar R. A comparison of life threatening injury concept in the Turkish penal code and trauma scoring system. Turkish J of Trauma and Emerg Surg. 2007;13(3):192-8.
Lett RR. The comparison of injury severity instrument performance using likelihood ratio and ROC curve analyses. J Trauma. 1995;38(1):142-51.