A clinico-epidemiological study on trauma cases attending a tertiary care hospital in North India

Abstract

OBJECTIVES: Injuries are the leading cause of death in the first four decades of life and the third leading cause of death among all patients. Road traffic accidents (RTAs) is the most common cause of injury in India with varied reports of mortality ranging from 7% to 45%. There are several scoring systems to evaluate the severity of injury and predict mortality. However, the reliability of injury score as a mortality predictor is challenging. The purpose of this study was to assess the cause of trauma with its epidemiological correlates and to categorize patients of trauma using the New Injury Severity Score (NISS) and Injury Severity Score (ISS) with their comparison in terms of mortality prediction in the present scenario of trauma in India. MATERIALS AND METHODS: Between October 2015 and March 2017, 5122 injured patients meeting the inclusion criteria were enrolled in this prospective longitudinal study. Data of the patients were recorded as per the working pro forma; detailed description of injury, treatment given, ISS and NISS, and ultimate outcome (mortality occurring within 30 days) was documented at the time of arrival/admission and stay at the hospital. Patients were divided into the score groups of 0–8, 9–15, 16–25, 26–49, and ≥50. The patients who were discharged or referred to a higher center were also followed up to 30 days of admission and any mortality occurring was recorded. RESULTS: Totally 5122 patients were enrolled in the study, and injuries, NISS/ISS, and outcome as mortality were documented. The overall mortality was 525 (10.25%). RTA constituted 61.56% and mortality was two times higher than that in female. Patients arriving after 24 h had the highest mortality (16.22%) and time lag had a significant effect on outcome. Sensitivity and specificity of NISS/ISS in predicting mortality was 85.5%, 63% and 61.7%, 68.3%, respectively, and the sensitivity of NISS in predicting mortality is higher than ISS whereas the specificity of NISS is similar to ISS. CONCLUSION: The major cause of trauma in India is RTA and time lag has a significant effect on the prognosis of the patient, and NISS is a better scale and should be incorporated in management protocols and TRISS methodology.