Abstract
BackgroundTraumatic 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.MethodsWe 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.ResultsWe 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).ConclusionsWe 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.
Highlights
Traumatic injury causes more than five million deaths each year of which about 90% occur in low- and middleincome countries (LMIC)
Univariate analysis Our univariate logistic regression analyses (Table 3) showed that patients over 55 years of age had significantly higher odds of early hospital mortality compared to patients younger than 15 years of age (OR = 1.81, P-value = 0.026, 95% CI = 1.07–3.05)
Patients with railway injury (OR = 3.21, P-value,0.001, 95% CI = 2.26– 4.57), road traffic injury (OR = 1.78, P-value = 0.002, 95% CI = 1.24–2.55), or an unknown mechanism of injury (OR = 3.04, P-value = 0.004, 95% CI = 1.42–6.51) had significantly higher odds of early hospital mortality compared to patients with fall
Summary
Traumatic injury causes more than five million deaths each year of which about 90% occur in low- and middleincome countries (LMIC). A recent study estimated that almost two million lives could be saved each year, if hospital care for the injured, i.e. trauma care in LMIC can be improved and reach the same level as in highincome countries (HIC) [5]. It is currently unclear how such reduction can be achieved. These improvements in clinical care have been driven, in large part, by research progress, from the basic sciences to the systems and policy level
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