Study of time to reach hospital and mode of transport used by trauma patients in India

Priti Patil

Background: Early hospitalization (golden hour) of trauma patients is important to increases

probability of survival. Mode of transport is important factor for trauma patient to reach

hospital.

Objective: To study the time elapsed between injuries to reach hospital and mode of

transport used intrauma patients

Settings: Towards Improved Trauma Care Outcomes (TITCO) registry collected from four

city medical college hospitals in India.

Methods: TITCO database was collected by prospective observational methods by trained

data collectors. We consider distribution of time elapsed between injury to reach hospital and

mode of transport as primary variables. Life status is compared with primary variables.

Logistic regression analysis was performed by considering mode of transport and time

elapsed as an independent variable.

Results: Among 16047 trauma patients, 27% reached within three hours of injury while 44%

reached in 4 to 24 hours of injury. In overall trauma registry majority of cases reached

hospital by ambulance (67%), followed by taxi/auto (12%), private car (11%) and

police/others (10%). While among direct transfers cases ambulance was used by 22%,

taxi/auto by 35%, police brought 23% and 20% by others. Compared to private vehicles odds

for taxi/auto, ambulance, police transfers and others were 1.157, 2.204, 2.63 and 2.953

respectively.

Conclusion: Among direct transfers cases limited use of ambulance is seen, which needs to

be enhanced for safety. In lieu of ambulance private vehicles and taxi/auto are appeared as

lifesaving options. No significant difference in time elapsed between injury to reach hospital

was observed in fatality as majority of cases were transferred.

Introduction

Mode of transport and time to reach hospital in case of trauma patients can be used for giving
timely treatment, allocation of resources and better facilities to patients. Trauma patients are
required to reach hospital within minimum time so that they can get early treatment and
surgical interventions if needed. The hour after the injury is treated as Golden Hour as there
are more chances of survival during that period.

The aim of this study is to observed the time elapsed between injuries to reach hospital and
mode of transport used in trauma patients. To determine whether there is association between
mortality and time to reach hospital from injury.

Methods

Study design
A retrospective observational study was conducted on the data from the Towards Improved
Trauma Care Outcomes (TITCO) project from India. TITCO was prospective, observational,
multi-center trauma registry, contains data of trauma patients admitted to four public
university hospitals in Mumbai, Delhi and Kolkata. TITCO data was collected from the
period from October 1, 2013 to September 30, 2015. Patient details of trauma cases were
recorded by trained data collectors at each identified center of TITCO.
Patients Characteristics
For this study, all the patients from TITCO database were included with life and/or limb
threatening injury. Patients presenting with history of trauma and admitted or died before
admission in study hospitals were included. Patients with isolated limb injury and brought
dead cases were excluded. Patients other than trauma admission were excluded.
Bias
Patients reached to trauma center by more than 24 hours are excluded from the study because
they may not come to the trauma center directly from the place of the injury. Total 4656
(29%) patients were not reached within 24 hours of injury. These cases are excluded from the
study.