Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths.

Abstract

A systematic analysis of trauma deaths is a step towards trauma quality improvement in Indian hospitals. This study estimates the magnitude of preventable trauma deaths in five Indian hospitals, and uses a peer-review process to identify opportunities for improvement (OFI) in trauma care delivery.All trauma deaths that occurred within 30 days of hospitalization in five urban university hospitals in India were retrospectively abstracted for demography, mechanism of injury, transfer status, injury description by clinical, investigation and operative findings. Using mixed methods, they were quantitatively stratified by the standardized Injury Severity Score (ISS) into mild (1-8), moderate (9-15), severe (16-25), profound (26-75) ISS categories, and by time to death within 24 h, 7, or 30 days. Using peer-review and Delphi methods, we defined optimal trauma care within the Indian context and evaluated each death for preventability, using the following categories: Preventable (P), Potentially preventable (PP), Non-preventable (NP) and Non-preventable but care could have been improved (NPI).During the 18 month study period, there were 11,671 trauma admissions and 2523 deaths within 30 days (21.6%). The overall proportion of preventable deaths was 58%, among 2057 eligible deaths. In patients with a mild ISS score, 71% of deaths were preventable. In the moderate category, 56% were preventable, and 60% in the severe group and 44% in the profound group were preventable. Traumatic brain injury and burns accounted for the majority of non-preventable deaths. The important areas for improvement in the preventable deaths subset, inadequacies in airway management (14.3%) and resuscitation with hemorrhage control (16.3%). System-related issues included lack of protocols, lack of adherence to protocols, pre-hospital delays and delays in imaging.Fifty-eight percent of all trauma deaths were classified as preventable. Two-thirds of the deaths with injury severity scores of less than 16 were preventable. This large subgroup of Indian urban trauma patients could possibly be saved by urgent attention and corrective action. Low-cost interventions such as airway management, fluid resuscitation, hemorrhage control and surgical decision-making protocols, were identified as OFI. Establishment of clinical protocols and timely processes of trauma care delivery are the next steps towards improving care.

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Published Version (Please cite this version)

10.1186/s12913-017-2085-7

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Roy, Nobhojit, Deepa Kizhakke Veetil, Monty Uttam Khajanchi, Vineet Kumar, Harris Solomon, Jyoti Kamble, Debojit Basak, Göran Tomson, et al. (2017). Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths. BMC health services research, 17(1). p. 142. 10.1186/s12913-017-2085-7 Retrieved from https://hdl.handle.net/10161/17224.

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Scholars@Duke

Solomon

Harris Scott Solomon

Fred W. Shaffer Associate Professor

As a medical anthropologist, I am interested in the dynamic relations between medicine and everyday social and political life. My work is primarily based in urban India, and I also conduct research in the US.

My most recent work is a book project, entitled Lifelines: The Traffic of Trauma (Duke University Press, 2022). Lifelines is an ethnographic study of road and railway injuries and of trauma surgery. Its aim is to understand injury and movement as problems that must be thought together, and argues that medicine itself must be understood in terms of movements. It is based on five years of ethnographic research on traffic accidents in Mumbai, primarily in the trauma ward of one of the city's largest public hospitals. Lifelines tracks traumatic injury as the accident moves through different domains: the conveyance of accidents to the hospital, triage, surgery, the involvement of families and police, intensive care, autopsy, and recovery with disability after discharge. The research for Lifelines was supported by a CAREER Award (Faculty Early Career Development Program) from the National Science Foundation Cultural Anthropology Program.  

Based on my research in the Mumbai trauma intensive care unit (ICU), and in the context of COVID-19, I am writing a collaborative ethnography with colleagues in Critical Care at Duke Hospital and the School of Medicine. This project is entitled Distressed Medicine. Funded by a National Science Foundation RAPID Award, our project studied conditions of adversity posed by COVID-19 to intensive care, and the creative responses ICU workers employ to adapt to them. Amidst the massive transformation in the US healthcare workforce due to the pandemic, the book examines COVID-19 as a problem of health work.

Another book project, entitled Edifice Complex, examines questions of trust, safety, and security in hospitals in the context of medical errors, cyberattacks, climate change, and violence. 

My earlier work examined the dynamic conditions between bodies and environments in India. My first book is entitled Metabolic Living: Food, Fat, and the Absorption of Illness in India (Duke University Press, 2016, read introduction here). As India becomes increasingly portrayed as the site of a shift from infectious to chronic disease burdens said to accompany economic development, my research explores the phenomenon of metabolism as an ethnographic, biomedical, and political rubric. With India's rising rates of obesity and diabetes as its backdrop, Metabolic Living examines relationships forged between food, fat, the body, and the city of Mumbai. The book draws on ethnographic fieldwork carried out in Mumbai's home kitchens, metabolic disorder clinics, and food companies, to better understand what have been termed India's "diseases of prosperity." 

I have also studied the development of corporatized medical care in Indian cities and its manifestation as medical tourism, and the politics of language and sexuality in India's HIV treatment clinical trials. 

I situate both my research and teaching at the interdisciplinary intersections of medical anthropology, South Asian studies, science and technology studies, the medical humanities/social medicine, and global health. Prior to anthropology, I studied linguistics and public health, and worked on global reproductive health and HIV policy. 


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