Management of polytrauma patients in emergency department: An experience of a tertiary care health institution of northern India

doi:10.5847/wjem.j.issn.1920-8642.2013.01.003

Abstract

Abstract:

BACKGROUND: In a tertiary care institute of northern India, the emergency department receives an average of 6-7 patients with poly trauma every day. Of these patients, some come directly and many are referred from other hospitals from the region. Various problems are faced in the management of patients with poly trauma. This study aimed to elicit various complaints, suggestions and possible solutions in the management of patients with poly trauma.
METHODS: A retrospective cross sectional study was done on 210 patients in the emergency OPD for a period of 2 months. All the records of the patients with poly trauma were studied and the problems during their management were measured against 6 predetermined steps (step I to step VI).
RESULTS: In the younger generation, males were predominantly the primary victims of poly trauma injury, and road traffic accident was the major etiological factor. Injuries involving more than 2 specialties induced many problems during the management of patients with poly trauma. Of 210 patients we studied, 32 patients had problems at various steps and maximum problems in step III , i.e. co-ordination between various specialties in the management of patients with poly trauma.
CONCLUSION: A proper poly trauma management team and a well defined standard operative procedure are the keys to effective management of patients with poly trauma by minimizing the problems encountered.

Key words: Polytrauma, Emergency department, Triage

Puri Payal, Goel Sonu, Gupta Anil K, Verma Prachi. Management of polytrauma patients in emergency department: An experience of a tertiary care health institution of northern India[J]. World Journal of Emergency Medicine, 2013, 4(1): 15-19.

Figures/Tables 5

Table 1

Table 2

Table 3

Table 4

Figure 1.

References 10

1	President's Project: Support for VAMC Poly trauma Centers (from the American Legion Auxiliary website).
2	Matar ZS. The clinical profile of poly trauma and management of abdominal trauma in a general hospital in the central region of the kingdom of Saudi Arabia. The Internet J Surg 2008; 14:11
3	Stewart RM, Myers JG, Dent DL, Ermis P, Gray GA, Villarreal R, et al. Seven hundred fifty-three consecutive deaths in a level I trauma center: The argument for injury prevention. J Trauma 2003; 4:66-71.
4	Kunreuther H. Risk analysis and risk management in an uncertain world. Risk Anal 2002; 22:655-64. pmid: 12224739
5	D'Amours SK, Sugrue M, Deane SA. Initial management of the poly-trauma patient: a practical approach in an Australian major trauma service. Scand J Surg 2002; 91:23-33. doi: 10.1177/145749690209100105 pmid: 12075831
6	American College of Surgeons Committee on Trauma. Resources for optimal care of the injured patient. American College of Surgeons, Chicago: 1999.
7	Hassan A, Tesfayohannes B. Initial assessment of the polytrauma patient. Surgery 2009; 27:275-279.
8	Petrie D, Lane P, Stewart TC. An evaluation of patient outcomes comparing trauma team activated versus trauma team not activated using TRISS analysis. Trauma and Injury Severity Score. J Trauma 1996; 41:870-873.
9	Sarcevic A, Burd RS. Whats the story? Information needs of trauma teams. AMIA Annu Symp Proc 2008; 6:641-645.
10	Field K, Norton I. Australian triage tags: a prospective, randomised cross-over trial and evaluation of user preference. Emerg Med Australas 2012; 24:321-328. pmid: 22672173

Variables (service)	Number
Hospital
Total number of hospital beds	1 765
Bed occupancy rate	92.3
Average length of stay	8.4
Annual OPD	1 657 200
OPD patients per day	5 469
Indoor patients	64 745
Indoor patients per day	177
Total nurses	1 647
Emergency
Total beds	110
Average length of stay	7.2
Annual OPD	52 298
OPD patients per day	143
Indoor patients	32 334
Indoor patients per day	89
Nurses in emergency	196+1 DNS
Nurses in ES OPD	39

Steps	Procedure	Time limit
I	Assessment of the poly trauma patients by the general surgeon	Within 1 hour
II	Preparation of treatment plan, referral of the patient and information to different specialties	1 hour
III	Patient attended by different specialties as per the treatment plan	24 hours
IV	Patient attended by other specialties not initially planned by the General surgeon	24 hours
V	Clearance given by different specialties	24 hours
VI	Ultimate responsibility of the patient for the treatment and discharge	24 hours

Variables	Number (n=210)	Percentage (%)
Age (yr)
>15	22	10.47
15-30	78	37.14
31-45	52	24.76
46-60	40	19.04
61-65		SRFT
12	5.71	SRFT
76-90	6	2.85
Gender
Male	169	80.4
Female	41	19.5
Referral status
Referred patients	112	53
Direct patients	98	47
Area of origin
Punjab	78	37
Chandigarh	46	22
Haryana	32	15
Himachal pradesh	28	13
Uttar pradesh	10	5
Bihar	6	3
Address unknown	10	5
Causes of poly trauma
Road side accident	150	72
Fall from height	31	15
Railway accident	11	5
Burn	7	3
Gun shot injury	3	1
Others	8	4

Referral department	Number (n=671)	Percentage (%)
Orthopedics	184	27
Neurosurgery	149	22
Plastic surgery	114	17
Anesthesia	64	10
CTVS	55	8
ENT	39	6
Ophthalmic	29	4
General surgery	21	3
Urology	10	2
Dental	3	1
Obstetrics & gynecology	2	0.29
Psychiatry	1	0.14

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