Trauma is accused for 148 death and 2,000 disability per every hour worldwide.6-8 According to the WHO reports trauma would rank third for DALY and low income countries would affect more since 2030.1,10,11 Global distribution of trauma outcome is unclear and neither health systems nor reports optimally cover the latter.3,6-8 Additionally, trauma is a negative outcome of variety of life aspects of human whether at individual level or at society. Therefore, regional health system could discover its noxious points making susceptibility for trauma. Since 50 years ago that trauma induced death prevention has been described many scientific states declared considering contributive factors to lessen mortality from trauma. This study was conducted to extend the burden of the latter issue.
Overall regional rate of trauma induced mortalities in our referral trauma bay was 1.5%. Others claimed 5-25% of mortality rate.12-14 Recent WHO report regarding trauma PDs noticed that about 20% of all annual trauma mortalities are preventable.10 Statistical analysis of this study after calculating the probability of survival via the TRISS method showed preventable death rate among victims over 18 years was about 55%. Although it seems a great number, identical studies regarded spectrum of this value from 1 to 81%.15,16 For example in Brazil, united states, New Zealand, Britain, and Iran PD frequency was 1,7, 24, 39, and 46% respectively.3 In case of certainly preventable death which in this study was 0.8%, other stated statistic was varied 0.5-4.2%.13,15,17-19 Notwithstanding the goal of trauma health care systems should be decrease PDs to as least as possible.
Although male victims like other studies were dominant (77 vs. 23%),3,6,11,15,17-21 younger ages and being male or female didn’t influence on survival probability in this study. However, opponents considered whether being female or being over 60-65 years could decrease survival rate.9,20,21
Post traumatic GCS ≥8 in this study was in association with better prognosis; namely patients with higher GCS than 7 had 3.3 times more chance to survive in comparison with some who had lower score(CI95%:1-10.3). Advocates declared that lower GCS was accompanied with either pre-hospital or in-hospital 10 to 13 times higher mortality rate respectively.20,21 The sensitivity for prediction of death in the latter study achieved to 68% for GCS≤5.5.20 Our survey manifested that GCS≥9 was accompanied with 60% sensitivity to predict preventability of trauma related mortality.
Another independent predictive factor for PDs in this study was SBP ≥80 mmHg (OR:14.1; CI95%:6.7-29.8). The systolic blood pressure over 82 mmHg was up to 68% sensitive to predict survival. Other authors have claimed that SBP lesser than 90 and 60 mmHg was contributed to 2.5 and 2.2 times more possibility for post traumatic death.20,21
This study showed that respiratory rate ≥20 per minute prior to every breathing assistance increased the probability of survival 1.7 times(CI95%:1-2.9). Based on our knowledge, no identical study was found to compare for the latter finding.
Analysis didn’t clarify power of prediction in case of ISS ≥16. However, some other authors opposed by believe in that the lower the ISS the higher the possibility of survival.20 Implicitly for the latter sensitivity and specificity were introduced 94 and 60% respectively if ISS was less than 9.20 These difference could be due to sample size and study method diversity. They involved every over 13 years old sufferer with both death and survive outcome.20 Other opponents defined ISS ≥27 as a cut point predicting pre-hospital mortality.22 Beside these contrasts, many other authors presented their findings in lined with us.1,3,12,17,22-25
Current study calculated that RTS ≥4.46 could be predictable for survival in trauma patients with 90% sensitivity (OR:4.9; CI95%:3.1-7.5). an identical study revealed that RTS ≥7.69 was respectively 95 and 67% sensitive and specific for predicting survival among trauma subjects.20 Again in the latter study pre-hospital death event was contributed with RTS<7.6 (OR:6; CI95%:2-13.7).20 Hence, calculated RTS is a reliable value to predict prognosis of trauma.
We found road-traffic accident as the trauma mechanism was a predicting factor for preventable death (Or:1.7; CI95%:1-3.1). Fortunately, it was also the most common among all type of trauma mechanisms (80%) followed by falling (15%). In almost all other studies road-traffic accident was the most prevalent mechanism.1,16,21,25
Regarding study errors, despite equivalence of external bleeding severity among all of the study subjects, insufficient external hemorrhage control was significantly more among PDs. Analysis revealed if bleeding control adequately it could promote survival rate 3.4 times more (CI9%:1.2-9.7). Similar studies manifested other type of errors including time errors mostly because of delay to initiate treatment (3-53%), clinical management errors consisting of inappropriate clinical judge (5-90%), false diagnosis (4-12%), and ineffective treatment (13%), and errors contributing to neglected injuries (6-40%).12,17,19,23 Undoubtedly regional aforementioned errors are exist irrespective to whether the type or the frequency. Therefore, continuous review of trauma health care system status recommends.
In this report, no statistical results implied on that other rest variables including regarded times and type of trauma, heart rate, positive FAST exam, type of emergent operations, and cause of death had neither difference nor enough power to predict survival. Considering limitations of the study, it should be noted that this retrospective study was performed in a single-center referral trauma hospital. Data was extracted from archived medical files of trauma victims through a section of time. Because all subjects were not eligible to enroll, data was limited to medical files registered either complete or readable.