Urban injuries in Tehran: demography of trauma patients and evaluation of trauma care.

Trauma now attracts more attention than ever before as a major cause of death and disability in developed and developing countries. To describe the characteristics and outcome of injuries in our environment, and to identify and discuss possible preventative and management protocols that may also be adopted in developing countries, we designed a prospective study on all trauma patients consecutively attending three emergency departments over a period of 1 year in Tehran, Iran. Among the total of 58013 patients studied, workers were the most vulnerable occupational group and deserve special preventative measures. The high frequency of traffic (especially pedestrian) accidents suggests that considerable progress is required in preventing these injuries. Our hospitalized patients were comparable with patients in the Major Trauma Outcome Study (m=0.890), and the z (-15.485) and w (-2.447) statistics showed an unsatisfactory quality of care, which may partly be due to less usage of ambulances, the long time of transportation to hospital, frequent referrals between centres, and delayed and inadequate resuscitation by the emergency services. Based on our findings and the fact that the positive effect of trauma systems on outcome has been well documented, we suggest that an integrated trauma system be established in Tehran to improve the quality of trauma care.

Characteristics and outcome of injured patients treated in urban trauma centers in Iran.

BACKGROUND: Because of the need to improve the quality of care of trauma patients in our country, we decided to evaluate the epidemiology and find the most powerful tool for prediction of survival. The Trauma and Injury Severity Score (TRISS) has been known as conventional method for this purpose. We planned to test its ability for prediction of survival of our trauma patients, and also we wanted to compare its ability with the New Injury Severity Score (NISS) in combination with Revised Trauma Score (RTS) and age. We used the most suitable model to evaluate the trauma care in our centers. METHODS: From the Tehran University data registry on trauma patients of three different hospitals during 1 year, we selected trauma patients admitted to hospital for at least 1 day and all those patients who were declared dead at the emergency department. Epidemiologic description of patients has been given and evaluation of TRISS and (NISS + RTS + age) for prediction of survival has been performed. We determined factors affecting mortality and morbidity, evaluated hospitals, and analyzed patients admitted directly and the patients transferred from other hospitals. RESULTS: A total of 2,662 patients had complete data necessary for the calculation of probability of survival based on the TRISS method. The population at risk for trauma was the young, especially students and industrial workers. The major mechanisms of trauma were road traffic crashes and falls. The time expenditure and means of transportation as well as the time of stay in emergency department all seemed to be far less than optimal. We found that TRISS has higher performance than (NISS + RTS + age). CONCLUSION: Based on our descriptive findings, we proposed some suggestions that seem to be necessary for improvement of trauma care in our centers. Among them were improved measures for prehospital service, and emergency department and other health care units of our centers. The findings of this study suggest that conducting trauma surgery training programs and direct transportation to trauma centers can improve the outcome of trauma patients. We conclude that small sample size, mixing penetrating trauma cases with blunt trauma cases, and differences in the mechanism of trauma between study populations may be responsible for the difference between our results and others.