(A17) Epidemiology of Non-Vehicular Trauma Patients in the Prehospital Setting in India

Abstract

Background

Non-vehicular trauma (NVT) accounts for 8% of all calls to the GVK Emergency Management and Research Institute (EMRI), which provides prehospital emergency care to 85 million residents of Andhra Pradesh, India. This study describes the characteristics and outcomes of patients with NVT transported by GVK EMRI.

Methods

All patients with NVT were prospectively enrolled over 28 12-hour periods (equally distributed over each hour of the day and day of the week) during July/August 2010. Patients not found at the scene, refusing service, or reporting self-inflicted injuries were excluded. Real-time demographic and clinical data were collected from prehospital care providers using a standardized questionnaire. Follow-up patient information was collected at 48-hours and 30-days following injury.

Results

A total of 1,569 patients were enrolled. Follow-up rates were 72% at 48 hours and 71% at 30 days. The mean patient age was 40 (SD = 18) and 67% were male. Adults (ages 18–64) accounted for most patients (80%), followed by elderly (age > 64, 12%) and children (age < 18, 8%). Of the patients, 71% were from rural/tribal areas and 89% from lower socioeconomic strata. Eighty-two percent called within 1 hour of injury. Median call-to-scene time was 19 minutes (SD = 15) and scene-to-hospital time was 25 minutes (SD = 21). Most patients suffered blunt injuries (85%) with falls accounting for 43% of all injuries. Of the injuries, 56% were accidents and 43% assaults. Most injuries involved head/neck (48%) and extremities (44%). Cumulative mortality rates prior to hospital arrival, at 48-hours and at 30-days were 1.1%, 3.2%, and 4.9% respectively. Falls accounted for 69% of all deaths. Falls and age > 65 were predictors of mortality (p < 0.0001). Of NVT survivors, 56% returned to baseline function and 28% were in significant pain or bed bound at 30-days post-injury.

Conclusion

This initial study of prehospital NVT patients in India reveals that falls and elderly age were highly associated with death.