Kumar Sumeet, Singh Siddharth, Singh Ritu, Gunjan Gagan, Dev Anand
Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND.
Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND.
Cureus. 2025 Apr 3;17(4):e81681. doi: 10.7759/cureus.81681. eCollection 2025 Apr.
Background Trauma remains a leading global cause of mortality, particularly in low-resource settings. Advanced Trauma Life Support (ATLS) training offers a standardized approach to trauma care, yet its impact in India remains underexplored. This study evaluates the effectiveness of ATLS training in reducing preventable trauma-related deaths and improving clinical decision-making at a tertiary care center in Bihar, India. Methods This mixed-methods cohort study was conducted from October 2021 to December 2024 and included 200 trauma patients aged ≥18 years. Patients were divided into two groups: pre-ATLS (retrospective; October 2021 to July 2024) and post-ATLS (prospective; August 2024 to December 2024). Mortality rates, trauma management errors, and survival outcomes were analyzed using Kaplan-Meier survival curves, chi-square tests, logistic regression models, and Cox proportional hazards regression. Additionally, structured interviews with healthcare providers supplemented the quantitative findings. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2019; IBM Corp., Armonk, NY, USA) and R software, Version 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria), with significance set at p < 0.05. Results ATLS training significantly reduced preventable deaths (from 30% to 15%) and potentially preventable deaths (from 40% to 25%). Trauma management errors, including delayed diagnoses and protocol deviations, also decreased post-training. Kaplan-Meier analysis demonstrated improved survival, while Cox regression identified ATLS training as an independent predictor of survival (HR = 0.62, 95% CI: 0.45-0.85, p = 0.003). Healthcare providers reported greater confidence in trauma assessment but highlighted concerns regarding accessibility, cost, and the need for refresher courses. Conclusions ATLS training enhances trauma care by reducing preventable mortality, minimizing errors, and boosting provider confidence. Expanding ATLS programs, particularly in resource-limited settings, is recommended. Future research should focus on long-term patient outcomes and the cost-effectiveness of ATLS implementation.
创伤仍然是全球主要的死亡原因，尤其是在资源匮乏的地区。高级创伤生命支持（ATLS）培训提供了一种标准化的创伤护理方法，但其在印度的影响仍未得到充分探索。本研究评估了ATLS培训在印度比哈尔邦一家三级护理中心减少可预防的创伤相关死亡以及改善临床决策方面的有效性。
本混合方法队列研究于2021年10月至2024年12月进行，纳入了200名年龄≥18岁的创伤患者。患者分为两组：ATLS培训前组（回顾性；2021年10月至2024年7月）和ATLS培训后组（前瞻性；2024年8月至2024年12月）。使用Kaplan-Meier生存曲线、卡方检验、逻辑回归模型和Cox比例风险回归分析死亡率、创伤管理错误和生存结果。此外，对医疗服务提供者进行的结构化访谈补充了定量研究结果。使用IBM SPSS Statistics for Windows，版本20.0（2019年发布；IBM公司，美国纽约州阿蒙克）和R软件，版本4.1.2（R统计计算基金会，奥地利维也纳）进行统计分析，显著性设定为p<0.05。
ATLS培训显著降低了可预防的死亡（从30%降至15%）和潜在可预防的死亡（从40%降至25%）。培训后，包括诊断延迟和方案偏差在内的创伤管理错误也有所减少。Kaplan-Meier分析显示生存率提高，而Cox回归确定ATLS培训是生存的独立预测因素（HR = 0.62，95% CI：0.45 - 0.85，p = 0.003）。医疗服务提供者报告称对创伤评估更有信心，但强调了在可及性、成本以及进修课程需求方面的担忧。
ATLS培训通过降低可预防的死亡率、减少错误并增强提供者信心来提高创伤护理水平。建议扩大ATLS项目，尤其是在资源有限的地区。未来的研究应关注长期患者结局以及ATLS实施的成本效益。
