Trauma care in India: A review of the literature

Wesson, Hadley K.H.; Kwong, Mimmie

doi:10.1016/j.surg.2017.01.027

Cited by 19 publications

(13 citation statements)

References 40 publications

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“…Based on the analysis of relevant studies and media reports, different challenges in this field were identified. These included challenges pertaining to patients, trauma care providers, government agencies, such as traffic police, transport, and highways department, as well as policymakers (5)(6)(14)(15)(16)(17). Some of the suggested mechanisms are presented in (Table 2).…”

Section: Discussionmentioning

confidence: 99%

A Narrative Review of Trauma Care Delivery in India: Challenges and Opportunities

Saddikuti

Galwankar

2021

jsurgery

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It is estimated that the cost of road accidents in India is around 3% of the Gross Domestic Product of the country. On average, 400 persons die daily in road accidents in India, and cities, such as New Delhi and the national capital region are on the top of the list of road accident causalities. Based on the Basilica agreement, the Indian government has initiated various policy changes and infrastructure development along the national highways which include the redesign of blindspots on the roads and the infliction of heavy penalties for the violation of traffic rules and compliances. On the academic front, the Indo-US Emergency Medicine forum has inaugurated an academic college for emergency medicine in India that cooperates with various government and private healthcare providers and policymakers for the improvement of emergency/trauma care delivery. Lately, few business schools and healthcare educational institutes have focused on interdisciplinary training and research centers in the area of emergency care delivery. Policymakers are also proactively working with various organizations to implement new rules and compliance mechanisms. This prospective study entails a detailed review of the literature using keywords in the PubMed journals, news articles, and media reports. Authors encountered studies in the area of trauma care delivery in India and other countries in their comprehensive field research. Almost 100% of the cases were medico-legal and only one case out of 100 was an insured patient. Furthermore, 87% of the cases were new and only 13% were review cases. Based on the conducted analysis, the number of accidents reduced across the country after the implementation of the New Motor Vehicle Act in the year 2019. It is worth mentioning that, the government launched awareness programs for the public as well. Some of the major challenges identified included lack of coordination and institutional mechanisms for an integrated emergency care delivery, poor referral processes, inadequate ambulance services, lack of third-party coordination, and poor in-hospital resources, particularly in public healthcare organizations. Apart from these, there was an acute shortage of trained emergency medicine experts at all levels. Trauma care delivery is a complex issue and its accomplishment requires good coordination and collaboration among stakeholders. The study identified various challenges and opportunities for the improvement of trauma care delivery in India. There is an immense need and opportunity for the modification of the emergency care delivery system through the introduction of appropriate changes in the transportation policy, emergency care delivery models, institutional mechanisms, such as referral process, and appropriate resource allocation at different levels of care delivery system.

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Section: Discussionmentioning

confidence: 99%

A Narrative Review of Trauma Care Delivery in India: Challenges and Opportunities

Saddikuti

Galwankar

2021

jsurgery

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“…However, this certainly requires support from a good emergency service system so that it can increase the provision of first aid for traffic accident victims [10]. Pre-hospital care that is carried out in an organized manner is proven to reduce mortality and disability that occurs due to emergency conditions [19].…”

Section: Fostering Pre-hospital Servicementioning

confidence: 99%

Expectation of administering the first aid for traumatic victims during the absence of pre-hospital service

Anita

Hariyanti

Suharsono

2021

IJPHS

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Traffic incidents become typical cases of trauma outside of hospitals. The integrated-emergency nursing system outside of hospitals becomes an important component to minimize any worsening condition of the traumatic victims. However, this pre-hospitalized service system has not been formally established in several cities or municipalities. This research aims to explore various hopes of the trauma-victim aid process in a region that has not applied pre-hospitalized emergency service formally. This research was carried out by implementing a qualitative research method and a case study approach to identify the themes. The research was conducted in Konawe municipality, from February until March 2020. It was done by interviewing eight participants consisting of the citizens, traffic police officers, hospital party, and health agency. Four themes result from this research. Establishing the pre-hospitalized emergency service, socializing the first aid for the incident victims, training dealing with the first aid of taking care of trauma victims, and promoting socialization for all citizens about the emergency numbers of health service institutions which could be immediately contacted when an accident occurs. There is a need for an emergency service system establishment and development.

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“…5 6 Over 20% of the world's trauma deaths occur in India, 7 where injuries have been identified as a major public health problem. [8][9][10][11] Furthermore, in a Delphi study of injury-related deaths in India, over half of the deaths were deemed preventable. 12 Trauma research and monitoring is an essential component of advanced trauma systems that have evolved in HICs.…”

Section: Introductionmentioning

confidence: 99%

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

Amato

Bonnell

Mohan

et al. 2021

Trauma Surg Acute Care Open

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ObjectivesComparisons 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.MethodsA 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.Results687 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.ConclusionAfter 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 evidenceLevel 3, retrospective cohort study.

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Trauma care in India: A review of the literature

Cited by 19 publications

References 40 publications

A Narrative Review of Trauma Care Delivery in India: Challenges and Opportunities

A Narrative Review of Trauma Care Delivery in India: Challenges and Opportunities

Expectation of administering the first aid for traumatic victims during the absence of pre-hospital service

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

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