30-Day In-hospital Trauma Mortality in Four Urban University Hospitals Using an Indian Trauma Registry.

Abstract

In India, half of the annual 200,000 road traffic deaths occur in hospitals, but the exact in-hospital trauma mortality rate remains unknown. A research consortium of universities, with a mandate to reduce trauma mortality, measured the baseline 30-day in-hospital mortality rate. Between September 2013 and February 2015, trained data collectors collected on-admission demographic, physiological vital signs, and health service performance indicators (time of injury to admission, investigation, or intervention) on all patients with traumatic injuries admitted to four public university hospitals in three Indian megacities. Of the 11,202 hospitalized trauma patients, 21.4% died within 30days of hospitalization. The median age was 30years for survivors and 37years for non-survivors. The on-admission systolic blood pressure and Glasgow Coma Score was near-normal in survivors, but was significantly lower in non-survivors and associated with both early and late mortality (p=0.001). In the absence of a trauma system, there were process-of-care delays from injury to reaching and being examined, investigated, or operated in the hospital. Using a multi-institutional Indian registry, this study is the first to systematically document that the 30-day in-hospital trauma mortality was twice that found in similar registries from high-income countries. Physiological scoring of on-admission vitals was clinically useful to predict mortality. More research is needed to understand the causes of high mortality and time delays in the process of delivering trauma care in India, which has no prehospital or trauma system.