Abstract
:Background:The Philippine General Hospital (PGH) is the pioneer in trauma care in the country, being the first to create a dedicated Trauma Service in 1989. The service has not conducted a review of its admissions and mortalities since 1992. The purpose of this study is to describe the mortality patterns of this service.Methods:A descriptive and retrospective 3-year review, covering January 2004 June 2007, was conducted using an electronic patient database. Review of patient records included: population demographics, mechanism of injury, length of stay prior to death, and the cause of death.Results:Of the 4947 patients admitted to the Division of Trauma during the study period, there were 231 (4.7%) deaths. The most common mechanisms of injuries were stab wounds (32.9 %), vehicular crashes (28.6 %), and gunshot wounds (25.5 %). Multiple organ failure/Sepsis (37.7 %) was the most frequent causes of death, followed by Exsanguinations (27.7 %), Central Nervous System failure (18.6 %) and other causes (10.8%). Forty four (66.7 %) of the 66 patients who died within the first 24 hours died from Exsanguinations, while 66 (61.1 %) of the 8 patients who died after 72 hours died from Multiple organ failure/Sepsis.Conclusions:Intentional causes of injury (i.e. penetrating interpersonal violence) caused the majority of trauma deaths in this series from the Philippine General Hospital. This highlights the need for prioritizing a public health approach to violence prevention in the Philippines. Further research must be conducted to identify risk factors for interpersonal violence. Early identification of lethal injuries that may cause exsanguinations and definitive control of hemorrhage should be the primary focus to prevent acute deaths, within 24 hours of admission. Further adjuncts to the definitive treatment of hemorrhage, the critical care of TBI and MOF/Sepsis are needed to reduce deaths occurring more than 72 hours after admission.
Highlights
A ccidents, injuries from hereon, are one of the leading causes of mortality in the Philippines, presently they are the 4th leading cause of death for all ages
Data was collected from the Integrated Surgical Information System (ISIS) of the Department of Surgery, an electronic and online database that has been in use since January 1, 2004
Patients with isolated burns, neurologic, orthopedic, ophthalmologic or otorhinolar-yngologic injuries excluded in this profile of PGH: The Philippine General Hospital, GSW: gunshot wound, SW: stab wound, MVC: motor vehicle crash, BA: blunt assault journal homepage : http://www.jivresearch.org
Summary
A ccidents (external causes of death), injuries from hereon, are one of the leading causes of mortality in the Philippines, presently they are the 4th leading cause of death for all ages. The top five leading causes of death due to injury in the Philippines, for all ages, are assault, transport accidents, accidental drowning and submersion, intentional self-harm and accidental falls.[1]. In response to these trends, the Philippine Department of Health included injury prevention in the National Objectives for Health (2005-2010). Conclusions: Intentional causes of injury (i.e. penetrating interpersonal violence) caused the majority of trauma deaths in this series from the Philippine General Hospital. This highlights the need for prioritizing a public health approach to violence prevention in the Philippines. Further adjuncts to the definitive treatment of hemorrhage, the critical care of TBI and MOF/Sepsis are needed to reduce deaths occurring more than 72 hours after admission
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