Comparing trauma mortality of injured patients in India and the USA: a risk-adjusted analysis.

Autor:	Amato S; Department of General Surgery, University of Vermont Medical Center, Burlington, Vermont, USA., Bonnell L; Department of General Internal Medicine, University of Vermont Medical Center, Burlington, Vermont, USA., Mohan M; Department of Health Systems Strengthening, Care India, Bihar, Patna, India., Roy N; The George Institute for Global Health, New Delhi, India.; WHO Collaborating Centre for Research in Surgical Care Delivery, Mumbai, India., Malhotra A; Department of General Surgery, University of Vermont Medical Center, Burlington, Vermont, USA.
Jazyk:	angličtina
Zdroj:	Trauma surgery & acute care open [Trauma Surg Acute Care Open] 2021 Nov 18; Vol. 6 (1), pp. e000719. Date of Electronic Publication: 2021 Nov 18 (Print Publication: 2021).
DOI:	10.1136/tsaco-2021-000719
Abstrakt:	Objectives: Comparisons of risk-adjusted trauma mortality between high-income countries and low and middle-income countries (LMICs) can be used to identify specific patient populations and injury patterns for targeted interventions. Due to a paucity of granular patient and injury data from LMICs, there is a lack of such comparisons. This study aims to identify independent predictors of trauma mortality and significant differences between India and the USA. Methods: A retrospective cohort study of two trauma databases was conducted. Demographic, injury, physiologic, anatomic and outcome data were analyzed from India's Towards Improved Trauma Care Outcomes project database and the US National Trauma Data Bank from 2013 to 2015. Multivariate logistic regression analyses were performed to determine significant independent predictors of mortality. Results: 687 407 adult trauma patients were included (India 11 796; USA 675 611). Patients from India were significantly younger with greater male preponderance, a higher proportion presented with physiologic abnormalities and suffered higher mortality rates (23.2% vs. 2.8%). When controlling for age, sex, physiologic abnormalities, and injury severity, sustaining an injury in India was the strongest predictor of mortality (OR 13.85, 95% CI 13.05 to 14.69). On subgroup analyses, the greatest mortality difference was seen in patients with lower Injury Severity Scores. Conclusion: After adjusting for demographic, physiologic abnormalities, and injury severity, trauma-related mortality was found to be significantly higher in India. When compared with trauma patients in the USA, the odds of mortality are most notably different among patients with lower Injury Severity Scores. While troubling, this suggests that relatively simple, low-cost interventions focused on standard timely trauma care, early imaging, and protocolized treatment pathways could result in substantial improvements for injury mortality in India, and potentially other LMICs. Level of Evidence: Level 3, retrospective cohort study. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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