Amato Stas, Bonnell Levi, Mohan Monali, Roy Nobhojit, Malhotra Ajai
Department of General Surgery, University of Vermont Medical Center, Burlington, Vermont, USA.
Department of General Internal Medicine, University of Vermont Medical Center, Burlington, Vermont, USA.
Trauma Surg Acute Care Open. 2021 Nov 18;6(1):e000719. doi: 10.1136/tsaco-2021-000719. eCollection 2021.
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.
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.
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.
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 3, retrospective cohort study.
比较高收入国家与低收入和中等收入国家（LMICs）之间经风险调整后的创伤死亡率，可用于确定特定患者群体和损伤模式，以便进行有针对性的干预。由于LMICs缺乏详细的患者和损伤数据，目前尚无此类比较。本研究旨在确定创伤死亡率的独立预测因素以及印度和美国之间的显著差异。
对两个创伤数据库进行回顾性队列研究。分析了2013年至2015年印度“改善创伤护理结果”项目数据库和美国国家创伤数据库中的人口统计学、损伤、生理、解剖学和结局数据。进行多因素逻辑回归分析以确定死亡率的显著独立预测因素。
纳入687407例成年创伤患者（印度11796例；美国675611例）。印度患者明显更年轻，男性占比更高，出现生理异常的比例更高，死亡率也更高（23.2%对2.8%）。在控制年龄、性别、生理异常和损伤严重程度后，在印度受伤是死亡率最强的预测因素（OR 13.85，95%CI 13.05至14.69）。亚组分析显示，损伤严重程度评分较低的患者死亡率差异最大。
在调整人口统计学、生理异常和损伤严重程度后，发现印度与创伤相关的死亡率显著更高。与美国的创伤患者相比，损伤严重程度评分较低的患者死亡率差异最为明显。虽然令人担忧，但这表明专注于标准及时创伤护理、早期影像学检查和规范化治疗途径的相对简单、低成本的干预措施可能会大幅改善印度以及其他潜在的LMICs的损伤死亡率。
3级，回顾性队列研究。
