Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deathsReport as inadecuate




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BMC Health Services Research

, 17:142

Health systems and services in low and middle income settings

Abstract

BackgroundA systematic analysis of trauma deaths is a step towards trauma quality improvement in Indian hospitals. This study estimates the magnitude of preventable trauma deaths in five Indian hospitals, and uses a peer-review process to identify opportunities for improvement OFI in trauma care delivery.

MethodsAll trauma deaths that occurred within 30 days of hospitalization in five urban university hospitals in India were retrospectively abstracted for demography, mechanism of injury, transfer status, injury description by clinical, investigation and operative findings. Using mixed methods, they were quantitatively stratified by the standardized Injury Severity Score ISS into mild 1–8, moderate 9–15, severe 16–25, profound 26–75 ISS categories, and by time to death within 24 h, 7, or 30 days. Using peer-review and Delphi methods, we defined optimal trauma care within the Indian context and evaluated each death for preventability, using the following categories: Preventable P, Potentially preventable PP, Non-preventable NP and Non-preventable but care could have been improved NPI.

ResultsDuring the 18 month study period, there were 11,671 trauma admissions and 2523 deaths within 30 days 21.6%. The overall proportion of preventable deaths was 58%, among 2057 eligible deaths. In patients with a mild ISS score, 71% of deaths were preventable. In the moderate category, 56% were preventable, and 60% in the severe group and 44% in the profound group were preventable. Traumatic brain injury and burns accounted for the majority of non-preventable deaths. The important areas for improvement in the preventable deaths subset, inadequacies in airway management 14.3% and resuscitation with hemorrhage control 16.3%. System-related issues included lack of protocols, lack of adherence to protocols, pre-hospital delays and delays in imaging.

ConclusionFifty-eight percent of all trauma deaths were classified as preventable. Two-thirds of the deaths with injury severity scores of less than 16 were preventable. This large subgroup of Indian urban trauma patients could possibly be saved by urgent attention and corrective action. Low-cost interventions such as airway management, fluid resuscitation, hemorrhage control and surgical decision-making protocols, were identified as OFI. Establishment of clinical protocols and timely processes of trauma care delivery are the next steps towards improving care.

AbbreviationsATLSAdvanced trauma life support

DICDisseminated intravascular coagulation

DPDefinitely preventable

ISSInjury severity score

LMICLow-middle income countries

NPNon-preventable

NPINon-preventable but care could have been improved

OFIOpportunities for improvement

PPPotentially preventable

TITCO-Indiatowards improving trauma care outcomes in India

WHOWorld Health Organization

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Author: Nobhojit Roy - Deepa Kizhakke Veetil - Monty Uttam Khajanchi - Vineet Kumar - Harris Solomon - Jyoti Kamble - Debojit Basa

Source: https://link.springer.com/







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