PMID- 31761424 OWN - NLM STAT- MEDLINE DCOM- 20201201 LR - 20201201 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 51 IP - 2 DP - 2020 Feb TI - A profile of traumatic injury in the prehospital setting in India: A prospective observational study across seven states. PG - 286-293 LID - S0020-1383(19)30717-X [pii] LID - 10.1016/j.injury.2019.11.020 [doi] AB - BACKGROUND: Traumatic injury continues to be a leading cause of mortality and morbidity in low-income and middle-income countries (LMIC). The World Health Organization has called for a strengthening of prehospital care in order to improve outcomes from trauma. In this study we sought to profile traumatic injury seen in the prehospital setting in India and identify predictors of mortality in this patient population. METHODS: We conducted a prospective observational study of a convenience sample of patients using a single emergency medical services (EMS) system for traumatic injuries across seven states in India from November 2015 through January 2016. Any patient with a chief complaints indicative of a traumatic injury was eligible for enrollment. Our primary outcome was 30-day mortality. RESULTS: We enrolled 2905 patients. Follow-up rates were 76% at 2 days, 70% at 7 days, and 70% at 30 days. The median age was 36 years (IQR: 25-50) and were predominately male (72%, N = 2088), of lower economic status (97%, N = 2805 used a government issued ration card) and were from rural or tribal areas (74%, N = 2162). Cumulative mortality at 2, 7, and 30 days, was 3%, 4%, and 4% respectively. Predictors of 30-day mortality were prehospital abnormal mental status (OR 7.5 (95% CI: 4-14)), presence of hypoxia or hypotension (OR 4.0 (95% CI: 2.2-7)), on-scene mobility (OR 2.8 (95% CI: 1.3-6)), and multisystem injury inclusive of head injury (OR 2.3 (95% CI: 1.1-5)). CONCLUSIONS: EMS in an LMIC can transport trauma patients from poor and rural areas that traditionally struggle to access timely trauma care to facilities in a timeframe consistent with current international recommendations. Information readily obtained by EMTs predicts 30-day mortality within this population and could be utilized for triaging patients with the potential to reduce morbidity and mortality. CI - Copyright (c) 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved. FAU - Newberry, Jennifer A AU - Newberry JA AD - Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto 94304, CA, USA. Electronic address: newberry@stanford.edu. FAU - Bills, Corey B AU - Bills CB AD - Department of Emergency Medicine, University of Colorado 12401 E 17(th) Ave Aurora, CO 80045. Electronic address: corey.bills@ucsf.edu. FAU - Matheson, Loretta AU - Matheson L AD - Department of Emergency Medicine, University of Colorado 12401 E 17(th) Ave Aurora, CO 80045. Electronic address: lorettamatheson@stanford.edu. FAU - Zhang, Xinyuan AU - Zhang X AD - Stanford School of Medicine, Stanford University, 291 Campus Drive, Stanford 94305, CA, USA. Electronic address: xinyuan@stanford.edu. FAU - Gimkala, Aruna AU - Gimkala A AD - GVK Emergency Management and Research Institute, Devar Yamzal, Medchal Road, Secunderabad 500078, Telangana, India. Electronic address: aruna_g@emri.in. FAU - Ramana Rao, G V AU - Ramana Rao GV AD - GVK Emergency Management and Research Institute, Devar Yamzal, Medchal Road, Secunderabad 500078, Telangana, India. Electronic address: drgvramanarao@gmail.com. FAU - Janagama, Srinivasa R AU - Janagama SR AD - Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto 94304, CA, USA. Electronic address: srinu.j.rao@gmail.com. FAU - Mahadevan, Swaminatha V AU - Mahadevan SV AD - Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto 94304, CA, USA. Electronic address: mahadeva@stanford.edu. FAU - Strehlow, Matthew C AU - Strehlow MC AD - Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto 94304, CA, USA. Electronic address: strehlow@stanford.edu. LA - eng PT - Journal Article PT - Observational Study DEP - 20191111 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Emergency Medical Services/standards/*statistics & numerical data MH - Female MH - Health Services Accessibility/*standards MH - Humans MH - India/epidemiology MH - Logistic Models MH - Male MH - Middle Aged MH - Poverty MH - Prospective Studies MH - Time Factors MH - Wounds and Injuries/*mortality/*therapy MH - Young Adult OTO - NOTNLM OT - EMS OT - Falls OT - Global health OT - India OT - Prehospital OT - Road traffic accidents OT - Trauma COIS- Declaration of Competing Interest Two authors, Aruna Gimkala and G.V. Ramana Rao, are employees of the institute (GVK EMRI) operating the EMS system studied in this paper. They are responsible for quality improvement and research at their institution. There are no other conflicts of interest. EDAT- 2019/11/26 06:00 MHDA- 2020/12/02 06:00 CRDT- 2019/11/26 06:00 PHST- 2019/06/07 00:00 [received] PHST- 2019/10/12 00:00 [revised] PHST- 2019/11/10 00:00 [accepted] PHST- 2019/11/26 06:00 [pubmed] PHST- 2020/12/02 06:00 [medline] PHST- 2019/11/26 06:00 [entrez] AID - S0020-1383(19)30717-X [pii] AID - 10.1016/j.injury.2019.11.020 [doi] PST - ppublish SO - Injury. 2020 Feb;51(2):286-293. doi: 10.1016/j.injury.2019.11.020. Epub 2019 Nov 11.