An Analysis Of Trauma Epidemiology And Current State Of Trauma Care In Zhejiang Province

IntroductionTrauma is the fifth leading cause of death in China. Each year, about750,000deaths was caused by trauma and the disabled were more than5million, this number is expected to increase100,000each year. With the fast increasing number of vehicles, the traumatic events dominated in traffic crash have a tendency to increase steadily. In recent years, the trauma emergency medicine, including pre-hospital and hospital treatment, has been improved greatly. However, the current state of trauma epidemiology and trauma care performance of hospitals in different levels is not clear enough. The aim of present study was trying to explore the general rule of trauma happening and the problems may existed in present trauma system through the epidemiology study in10hospitals in Zhejiang province. The present study also analyzed the factors associated with trauma death and evaluated the trauma care performance in Zhejiang province in order to provide references to improve the success rate of trauma evaluation and treatment. Part I An analysis of trauma epidemiology and management of patients in Zhejiang provinceObjective:To identify the trauma epidemiology and current state of trauma care performance in pre-hospital and hospital stage through the epidemiology investigation in10hospitals in Zhejiang province. Discuss the problems may existed in trauma care and provide basis for the improvement of trauma care and prevention.Methods:A dedicated survey website was established, the data of multiple trauma in the hospitals from Jan1st to Dec31in2009was collected retrospectively. The information in pre-hospital, emergency room, ICU and operating room, was collected, and trauma scores including injury severity score etc. was calculated based on the injury severity. All the data was analyzed using SPSS18.0.Results:In the study period, a total of5503patients were collected in our database. Finally5464patients were enrolled in the final analysis after remove the replicate and invalid data. Among them, male makes up more than70percent. Finally,253patients died, the mortality rate is4.6%.The average age is44.16±17.71, most of the injury mechanism was blunt (95.14%). The most common reason of injury is traffic crash (56.69%) and fall from height (12.77%) takes second place. Most of the patients were fanner, head and face is the most common injury location. The average ISS score is13.54±14.38. The peak period of injury happened is between7am to8pm.65.4%of the patients get into the hospital in one hour. However, about5%patients had emergency length of stay more than2hours and1641patients had been transferred to ICU.Conclusion:The most common reason of injury is traffic crash. The majority of trauma victims are male adult and head-face is the most frequent injury area. The pre-hospital and hospital trauma care has many disadvantages compare with the western countries. Enhance the traffic safety publicity, allocate the pre-hospital emergency resources rationally, shorten the pre-hospital time, improve the links of trauma emergency services and strengthen trauma evaluation in ICU may benefit the outcomes of trauma patients. Part Ⅱ A multivariate analysis of trauma mortality in Zhejiang provinceObjective:To explore the risk factors of mortality in trauma patients and the way to improve trauma emergency service.Methods:Retrospectively review the data of trauma patients in8hospitals in Zhejiang province in2009and choosing possible variables related to the mortality of patients based on pre-hospital and hospital stage of trauma emergency, find the independent risk factors through univariate and multivariate analysis.Results:A total of3659patients were enrolled in this study.226trauma patients died and the mortality rate is6.18%. Following factors were related to mortality significantly after the univariate analysis:Age, trauma mechanism, injury severity score, Glasgow coma scale, coma on the scene, professional emergency treatment on the scene, intubation in the ambulance, debridement and hemostasis in the ambulance, low blood pressure at admission, closed drainage of pleural cavity, emergency operation, CVP monitoring in ICU, mechanical ventilation in ICU. After the multivariate analysis, six factors were independently related to the mortality as following:Glasgow coma scale (OR=0.69;95%CI:0.66-0.72), injury severity score (OR=2.79;95%CI:1.59-4.89), mechanical ventilation (OR=2.85;95%CI:1.89-4.28), low blood pressure at admission (OR=3.81;95%CI:2.20-6.60), age and professional emergency treatment on the scene (OR=0.62;95%CI:0.42-0.91)Conclusion:It has a great significance to investigate the risk factors of mortality for trauma patients. Severity of trauma and age were independently associated with the outcome of trauma. Besides, improve pre-hospital care, stabilize the trauma patients in early phase and use the monitoring equipments rationally in ICU may decrease the mortality further. PartⅢ An evaluation of the trauma care performance in Zhejiang province:a multi-hospital studyObjective:The objective of present study was to apply TRISS methodology to evaluate the trauma care performance of the hospitals in Zhejiang province and provide reference for clinical practice.Methods:A total of2193trauma patients were retrospectively collected in the5tertiary hospitals in Zhejiang province. Relevant information was collected, including demographic data, trauma mechanism, causes of injury, etc. The TRISS score was got though the calculation of ISS and RTS at the admission of emergency department. We compared our data with MOTS through the calculation of M value, standardized W statistic and its95%confidence interval to evaluate the trauma care performance.Results:In the study group, the average age was44.39years, among them,1661patients were male (75.74%). The most common reason of injury is traffic accident and the second is fall injury. The mortality rate according to the TRISS is13.22%, higher than the actual mortality rate9.75%. For all the patients, M=0.80, Ws=2.15,95%CI for Ws:1.54-2.77, indicating survival rate was significantly higher than MTOS. Besides, the survival rate of affiliated hospital and class A grade three hospital were also significantly higher than MTOS. The survival rate between class B grade three hospital and MTOS was not statistically significant.Conclusion:The average trauma care performance was outperformed than MTOS and this may associated with the development of trauma emergency system in recent years. However, the hospitals in different level still vary greatly in trauma treatment. TRISS overestimate the mortality in present patient group, this may associated with its old coefficients. Setting up the local trauma database and renew coefficients of TRISS may improve its predicting ability.