Title

The difference in impact of direct versus interfacility transfers in predicting 30 day mortality among adult road traffic crash victims presenting to the ED settings of three tertiary care hospitals in Karachi

Date of Award

2016

Document Type

Thesis

Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)

Department

Community Health Sciences

Abstract

Road traffic crashes are a leading cause of death globally among young people, and the main cause of death among those aged 15-29 years, currently Road Traffic Crashes are found to be the 9th leading cause of mortality amongst all age groups which is further predicted to become at the rh leading cause of mortality by year 2030. Health outcomes of Road Traffic Crash Victims are determined in 3 phases, Prevention of Crash, the crash phase, and after the crash(Post Crash Care). There exists gross disparity amongst low and middle income countries versus high income countries to the level of care received immediately post-crash. It is therefore important to Transfer the Crash Victims to the right hospital at the right time within the Golden Hour Of Trauma Care. In an immature and underdeveloped Trauma System, lack of Post-Crash Care and Delivery of Crash victims safely to Designated tertiary and Trauma Care facilities seem to be non -existent leading to delay in receiving post- crash care. STUDY OBJECTIVE: The objective of the study was to determine Mortality difference amongst Adult Road Traffic Crash patients who are directly transferred or indirectly gone,through various hospitals for definitive management of their injuries within the city of Karachi. METHODS: This was a multicenter, hospital based Prospective Cohort study held at three tertiary care hospitals in Karachi, world's 5th largest populous city, for a period of five months, from April- August, 2016. All adult patients presenting with Serious Injuries (AIS>=3), minimum one body Region were included in the study, excluding Dead On Arrivals(DOA's). Those participants who had underwent interfacility transfers were considered as exposed and directly transferred were considered as unexposed arm. Data was collected through structured questionnaire capturing all information relevant to injury severity, demographics and transfer related information 24/7 in the Emergencies of all three Tertiary care facilities. Primary outcome of the study was 30 day 3 Mortality on Follow up. Survival Analysis was performed to find association of Factors associated with 30 days Mortality of RTC victims with respect to Exposure status. RES ULTS: Out of 201 participants (N=91 in exposed, N=110 in Unexposed group), 14.2% had events(mortality) in Exposed Arm and 15.4% had events in Unexposed arm. We found No difference in Mortality amongst the Exposed and Unexposed Groups(a HR:1.01,CI:0.41- 2.89) .The final Model Predicted significant association of age, GCS,ISS,SBP , victims mode of Tran ;port with 30 day Mortality. There was an increased Risk of Death with increased Age, and Decr easing GCS. Injury severity was associated with an increase in Hazards of death (a HR:1 .07,CI:1.01-1.13) as well. Motorcycle Riders, Pedestrians and pillion riders had a 3 times High er risk of death as compared to occupants of cars, and heavy vehicles(a HR:3.96,CI:1.28- I 2.24). CONCLUSION: We found no significant difference in 30day Mortality of Road Traffic Crash Victims, with respect Mode of Transfer( Direct vs Interfacility)(preliminary data analysis) , however through this study , we found various factors that are associated with 30 day Mortality of RTC Victims, that can be addressed in structuring Post-Crash Care along with Road Safety Policies to reduce Road Traffic Crash Related Mortalities.

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