Evolution of trauma management at a tertiary care hospital: A cohort study

Objective: To analyze the characteristics of polytrauma patients and to assess the outcome of trauma care as this specialty has evolved over the years at a university hospital. Methods: The study included all polytrauma patients treated between January 1998 and September 2005 at a tertiary care hospital in a megacity. Data of 1009 patients was collected prospectively and analyzed retrospectively. Patients were divided into two groups A and B, based on their presentation before and after the introduction of a formal trauma training course in 2002. The analysis included demographic data, injury severity score, vital signs including hemodynamics and GCS on admission, intubation rates, mortality and complications. Results: 435 patients were included in group A (1998-2001) whereas group B (2002-2005) comprised of 574 patients. The proportion of patients with accidental versus intentional injuries was similar in both groups. The mean injury severity score of group A was 11.9 whereas that of group B was 11.7. Almost 50% of patients were transferred from other hospitals. Transferred patients had significantly lower GCS (p < 0.001), higher ISS (p < 0.001) and longer ICU stays (p < 0.001) in both (A and B) patient groups, while in group A mortality was also higher (p = 0.018). A significantly higher number of patients in group B went into shock. The overall mortality rate was 9.7% for group A which significantly decreased to 5.7% for group B (p < 0.05). Conclusions: This study supports the view that as trauma care evolved at our hospital with the establishment of a formal training program, the mortality rates have significantly decreased.