Early hospital mortality among adult trauma patients significantly declined between 1998-2011: three single-centre cohorts from Mumbai, India

• Published in: PloS one Vol. 9; no. 3; p. e90064
• Main Authors: Gerdin, Martin, Roy, Nobhojit, Dharap, Satish, Kumar, Vineet, Khajanchi, Monty, Tomson, Göran, Felländer Tsai, Li, Petzold, Max, von Schreeb, Johan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03-03-2014; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; CARE; Cohort Studies; Data processing; Female; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Health sciences; Hospital Mortality; Hospitals; Humans; Income; India; India - epidemiology; Injuries; Low income groups; Male; Males; MANAGEMENT; Medical research; Medicin och hälsovetenskap; Medicine; METAANALYSIS; Middle Aged; Mortality; OUTCOMES; Patients; Public health; Public Health, Global Health, Social Medicine and Epidemiology; Regression analysis; SEVERELY INJURED PATIENTS; SEVERITY SCORE; Studies; Surgery; SURVIVAL; Systematic review; SYSTEMS; Trauma; Trauma care; Trauma centers; Trends; VEHICLE CRASH MORTALITY; Wounds and Injuries - mortality; Young Adult; India
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0090064

Traumatic injury causes more than five million deaths each year of which about 90% occur in low- and middle-income countries (LMIC). Hospital trauma mortality has been significantly reduced in high-income countries, but to what extent similar results have been achieved in LMIC has not been studied in detail. Here, we assessed if early hospital mortality in patients with trauma has changed over time in an urban lower middle-income setting.
We conducted a retrospective study of patients admitted due to trauma in 1998, 2002, and 2011 to a large public hospital in Mumbai, India. Our outcome measure was early hospital mortality, defined as death between admission and 24-hours. We used multivariate logistic regression to assess the association between time and early hospital mortality, adjusting for patient case-mix. Injury severity was quantified using International Classification of Diseases-derived Injury Severity Score (ICISS). Major trauma was defined as ICISS<0.90.
We analysed data on 4189 patients out of which 86.5% were males. A majority of patients were between 15 and 55 years old and 36.5% had major trauma. Overall early hospital mortality was 8.9% in 1998, 6.0% in 2002, and 8.1% in 2011. Among major trauma patients, early hospital mortality was 13.4%, in 1998, 11.3% in 2002, and 10.9% in 2011. Compared to trauma patients admitted in 1998, those admitted in 2011 had lower odds for early hospital mortality (OR = 0.56, 95% CI = 0.41-0.76) including those with major trauma (OR = 0.57, 95% CI = 0.41-0.78).
We observed a significant reduction in early hospital mortality among patients with major trauma between 1998 and 2011. Improved survival was evident only after we adjusted for patient case-mix. This finding highlights the importance of risk-adjustment when studying longitudinal mortality trends.