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