A profile of traumatic injury in the prehospital setting in India: A prospective observational study across seven states. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Newberry, Jennifer A.; Bills, Corey B.; Matheson, Loretta; Zhang, Xinyuan; Gimkala, Aruna; Ramana Rao, G.V.; Janagama, Srinivasa R.; Mahadevan, Swaminatha V.; Strehlow, Matthew C.
• Is Part Of: Injury. Volume 51:Issue 2(2020)
• Page Start: 286
• Page End: 293
• Publication Date: 2020-02
• Subjects: Trauma -- EMS -- Global health -- Prehospital -- Falls -- Road traffic accidents -- India; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.11.020
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: A free-of-charge emergency medical service (EMS) in India treats and transports primarily economically disadvantaged patients (97%) suffering traumatic injuries. Even from rural areas in India, EMS was able to transport most patients within 2 h (90%). The most common mechanisms of traumatic injury seen by EMS in India were falls (42%) and road traffic accidents (41%). EMTs consistently assessed mental status, pulse, blood pressure, and respiratory rate (94% of all patients). Age, abnormal mental status, abnormal blood pressure or oxygenation, mobility, and multi-system injury were predictive of 30-day mortality. Abstract: Background: Traumatic injury continues to be a leading cause of mortality and morbidity in low-income and middle-income countries (LMIC). The World Health Organization has called for a strengthening of prehospital care in order to improve outcomes from trauma. In this study we sought to profile traumatic injury seen in the prehospital setting in India and identify predictors of mortality in this patient population. Methods: We conducted a prospective observational study of a convenience sample of patients using a single emergency medical services (EMS) system for traumatic injuries across seven states in India from November 2015 through January 2016. Any patient with a chief complaints indicative of a traumatic injury was eligible for enrollment. Our primary outcome was 30-day mortality. Results: We enrolled 2905 patients. Follow-up rates were 76% at 2 days, 70% at 7 days, and 70% at 30 days. The median age was 36 years (IQR: 25–50) and were predominately male (72%, N = 2088), of lower economic status (97%, N = 2805 used a government issued ration card) and were from rural or tribal areas (74%, N = 2162). Cumulative mortality at 2, 7, and 30 days, was 3%, 4%, and 4% respectively. Predictors of 30-day mortality were prehospital abnormal mental status (OR 7.5 (95% CI: 4–14)), presence of hypoxia or hypotension (OR 4.0 (95% CI: 2.2–7)), on-scene mobility (OR 2.8 (95% CI: 1.3–6)), and multisystem injury inclusive of head injury (OR 2.3 (95% CI: 1.1–5)). Conclusions: EMS in an LMIC can transport trauma patients from poor and rural areas that traditionally struggle to access timely trauma care to facilities in a timeframe consistent with current international recommendations. Information readily obtained by EMTs predicts 30-day mortality within this population and could be utilized for triaging patients with the potential to reduce morbidity and mortality.