Evaluation of Pre-Hospital Time and Care on Patient Mortality in the Setting of Trauma Care: A Pilot Study in Gujarat, India

  • Ankura Patel Western University of Health Sciences - COMP-Northwest
  • John Carter Western University of Health Sciences - COMP-Northwest
  • Elisabeth Guenther Western University of Health Sciences - COMP-Northwest
Keywords: Golden Hour, Trauma, India

Abstract

Context: In the setting of acute trauma, it has been hypothesized that pre-hospital transport times in excess of 60 minutes will result in increased morbidity and mortality. The idea of a “golden hour” has been investigated deeply in developed countries; however, limited data exist on the relationship between time to treatment and mortality in trauma patients in developing countries such as India.

 

Objective: To determine if a correlation exists between pre-hospital time and mortality for trauma patients in Gujarat, India as well as identifying if other factors such as mechanism of injury and the use of ambulatory IV fluids affects patient mortality.

 

Methods: A retrospective chart review was performed for all patients presenting to Shreeji Trauma Care Centre (Vadodara, Gujarat, India) for trauma related injuries over a 60-day period. Data was compiled and entered into contingency tables for all nominal and ordinal data. GraphPad Prism 6.01™ was used for statistical analysis of the 2x2 contingency tables and two-tailed Fisher’s exact test was applied to attain direct p-values. Two-tailed Student’s t-test was used for comparisons of means.

 

Results: 109 patients presented with physical trauma (89 males); mean age 40 years (range 5–84 years). Most common causes were vehicular accidents (47%), fall from heights (17%) and assault (15%). Of the 75 patients who received care within 60 minutes, two died. 18 reached the hospital after 90 minutes, 3 of whom died. Increased time to treatment was statistically associated with decreased patient survival (p = 0.0001).

 

Conclusion: Increased time to treatment correlated with increased mortality, supporting the importance of the “golden hour” exists in developing countries. Further work is needed to elucidate additional factors that influence patient mortality in trauma patients.

Author Biography

Elisabeth Guenther, Western University of Health Sciences - COMP-Northwest

Dr. Elisabeth Guenther, MD, MPH

Associate Professor of Pediatrics

Western University of Health Sciences - COMP-Northwest

References

Lerner EB, Moscati RM. The Golden Hour: Scientific Fact or Medical "Urban Legend"?. Acad of Emerg Med. 2001;8:758-760.

World Health Organization. Prehospital trauma care systems. http://apps.who.int/iris/bitstream/10665/43167/1/924159294X.pdf. Accessed December 1, 2015.

Samplais JS, Lavoie A, Williams JI, Mulder DS, Kalina M. Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients. J Trauma. 1993;34:252-261.

Dinh MM, Bein K, Roncal S, Byrne CM, Petchell J, Brennan J. Redefining the golden hour for severe head injury in an urban setting: The effect of prehospital arrival times on patient outcomes. Injury. 2013;44:606-610.

Insurance Institute for Highway Safety Highway Loss Data Institute. Fatality Facts. http://www.iihs.org/iihs/topics/t/general-statistics/fatalityfacts/overview-of-fatality-facts. Accessed December 1, 2015.

Government of India - Ministry of Road Transport & Highways - Transport Research Wing - New Delhi. Road Accidents in India. http://morth.nic.in/writereaddata/mainlinkFile/File1465.pdf. Accessed December 1, 2015.

Joshipura MK, Shah HS, Patel PR, Divatia PA, Desai PM. Trauma care systems in India. Injury. 2003;34:686-692.

Rogers FB, Rittenhouse KJ, Gross BW. The golden hour in trauma: dogma or medical folklore? Injury. 2015;46:5525-5527.

Newgard CD, Schmicker RH, Hedges JR, et al. Emergency medical services intervals and survival in trauma: Assessment of the "golden hour" in a north american prospective cohort. Ann of Emerg Med. 2010;55:235-246.

Kleber C, Lefering R, KleberAJ, et al. Rescue time and survival of severely injured patients in Germany. Unfallchirurg. 2013;116:345-350.

Radjou AN, Mahajan P, Baliga DK. Where do I go? A trauma victim's plea in an informal trauma system. J Emerg Trauma Shock. 2013;6:164-170.

McIntosh B, Sheppy B, Rane S. An Indian Tragedy, an Indian Solution: Perspective of Managing Service Quality in Emergency Medical Services in India. The Journal of Global Health Care Systems. 2012;2(1).

Subhan I, Jain A. Emergency care in India: the building blocks. Int J Emerg 2010;3:207-211.

Pandey A, Ranhan R. Emergency (108) Calls To The Ambulance Service In The State Of Gujarat (India) That Do Not Result In The Patient Being Transported To Hospital: An Epidemiological Study. J Clin Diagn Res. 2009;3(3):1519-1522.

Fitzgerald M, Jamieson J, Tee JW, Dewan Y. Trauma systems development challenges the conventional medical hierarchy. Indian Journal of Neurotrauma. 2011;8:67-70.

Ramanujam P, Aschkenasy M. Identifying the need for pre-hospital and emergency care in the developing world: a case study in Chennai, India. J Assoc Physicians India. 2007;55:491-495.

Joshipura MK, Shah HS, Patel PR, Divatia PA. Trauma care systems in India - An overview. Indian J Crit Care Med. 2004;8:93-97.

Anand LK, Singh M, Kapoor D. Prehospital trauma care services in developing countries. Anaesthesia, Pain & Intensive Care. 2013;17:65-70.

Published
2017-12-19