Generation of Trauma Rush Call in Managing Patients With Road Traffic Injuries Visiting the Emergency Department: A Retrospective Analysis.

BACKGROUND

Road traffic injuries (RTIs) are currently the ninth most common cause of mortality and are expected to increase in the future. RTIs rank in the top three reasons why young people die. Because of the high incidence and mortality risk, proper trauma care has been prioritized for RTI patients who present to the emergency department. Making appropriate and prompt trauma emergency calls can save lives. Poor resource use and an increased burden of inquiry can result from the inappropriate development of trauma rush calls (TRCs). Therefore, this study aims to evaluate the appropriate generation of TRCs to manage patients with RTIs presenting to the emergency department (ED).

METHODS

A retrospective analysis was conducted at the ED of the private tertiary care hospital in Karachi, Pakistan. Patients with RTIs and TRCs generated for the management were included. Dead on arrival was excluded. A total of 322 patients were enrolled using convenient sampling. A standard Performa was developed to collect the data from medical records, including demographics, clinical characteristics, radiological findings, TRC characteristics, and disposition. Multivariable logistic regression analysis was applied to determine the TRC justified using odds ratios, considering a p-value ≤0.05 as significant.

RESULTS

Of the total 322 patients, the majority were males (n=266, 82.61%) between 21 and 40 years of age. Most patients reported injury/accident through high-speed vehicle crash (n=102, 31.68%). A Glasgow Coma Scale (GCS) score of <14 was recorded in 119 (36.96%) patients, and of 208 patients, 153 (73.55%) had positive computed tomography (CT) head findings, majorly subdural hematoma (n=43, 28.10%). CT cervical spine showed fractures in 14 patients (11.29%). Only one patient had both a positive CT abdomen and focused assessment with sonography in trauma (FAST), with a low systolic blood pressure (SBP) of 85 mmHg, and the CT abdomen showed a grade 3 spleen laceration. TRC was justified in 248 (77.01%) patients. Multivariable analysis showed that a GCS <14 [adjusted odds ratio (aOR) 3.03 (95% CI: 2.58-5.04)] and cervical collar [aOR 3.12 (95% CI: 1.63-5.98)] were the significant predictors for the TRC justified.

CONCLUSION

A GCS <14 and cervical collar significantly justify the generation of TRC. These findings are crucial in educating ED staff regarding optimal care delivery. The future deployment of resources depends on these findings for skill development.