RESUMO
BACKGROUND: In India, most of the deaths due to road traffic accidents (RTAs) occur within 24 h of the accident. Hence, this study aimed to assess the proportion of RTA victims reaching the health-care facilities within the golden hour. MATERIALS AND METHODS: This cross-sectional study was conducted in a tertiary care center in South India between August and September 2017. All RTA victims who were admitted for treatment in the emergency department during the study period were included. Data were collected using structured, pretested, and validated pro forma. Hospital exit outcomes between those who reached within 1 h and those who did not were expressed as proportion with a 95% confidence interval (CI). The factors associated with hospital exit outcomes were analyzed using a Chi-square test. RESULTS: Among 626 RTA victims, the mean (standard deviation) age was 37.4 (2.6) years, and about 83% (n = 521) were male. More than one-third (37%) of the RTAs occurred on urban roads (n = 235, 37.5%). A total of 424 (67.7%) were referred from other hospitals. The mean time taken for RTA victims to reach any health-care facility was 3 h. More than half (n = 346, 55% [95% CI: 51.3-59.2]) of the RTA victims had reached a health-care facility within the golden hour. Among those who reached beyond the golden hour, one-fourth (n = 77, 27.5%) were delayed due to the unavailability of transporting vehicles. Delay in communication (n = 59, 21.1%), prolonged travel (n = 41, 14.6%), lack of knowledge about nearby facilities (n = 39, 13.9%), nonavailability of attenders (n = 35, 12.5%) and financial issues (n = 29, 10.4%) were the other reasons for the delay. CONCLUSION: Almost half of the RTA victims reached the health-care facilities after the golden hour. Unavailability of ambulances or vehicles for transport and delay in communication were the important factors that played a role in the delay.
RESUMO
BACKGROUND: Pediatric trauma is emerging as an epidemic worldwide; the epidemiology of pediatric trauma is different in different parts of the world. There are very few studies describing the pediatric trauma in developing countries. OBJECTIVES: The objectives of this study were to assess the type, mechanism, and extent of trauma among pediatric trauma patients and its association with clinical outcome. METHODOLOGY: This was a prospective observational study conducted in the department of emergency medicine and trauma at a tertiary care hospital in South India from September 2015 to March 2017. All children aged <12 years with a history of injuries irrespective of the cause for attending our trauma center were included in the study. OBSERVATIONS AND RESULTS: Of the 911 children enrolled, 63.9% sustained injuries at home. The leading modes of injury were fall at level ground (26.9%), road traffic accidents (RTAs) (25.5%), and fall from height (16.8%). Majority of RTA victims were two-wheeler pillion riders (40.5%) and pedestrians (31.9%). Nearly 49% of children had head and maxillofacial injuries. Polytrauma was found in 3.6% of children. Based on the Pediatric Trauma Score (PTS), 72.6% of children had mild trauma and 6.1% severe trauma. Totally, 18.9% of children required inpatient management, 7.5% surgical intervention, and 1.8% expired. CONCLUSIONS: Most of injuries in children occurred at home. This was followed by injuries on road. The leading cause of polytrauma was RTA. RTA victims were more likely to have severe injuries and poor outcome. They were more likely to require inpatient management compared to those who fell from height or fell at level ground. Glasgow Coma Scale and PTS may be used reliably to assess the severity of injuries sustained by children.
