Abstract
PURPOSE: Trauma, a leading cause of disability and death globally, underscores the critical importance of timely medical intervention, particularly within the "golden hour" following injury. Yet, in low-middle-income countries, the absence or fledgling state of emergency medical systems (EMS) exacerbates mortality rates. This study aims to retrospectively analyze mortalities at a level 1 trauma center in India, comparing patients who received prehospital care with those who did not. METHODS: Conducted at a level 1 trauma center in India from April 2019 to April 2020, this retrospective observational study included trauma patients who died during hospitalization. Exclusions comprised (1) patients deceased upon arrival, (2) patients receiving cardiopulmonary resuscitation, and (3) non-trauma deaths. Demographics, clinical profiles, causes of death, and transportation methods were scrutinized. Data encompassed patient transport details, clinical assessments, interventions, length of stay, and causes of death. Statistical analysis was performed using SPSS 14, with statistical significance set at p<0.05. RESULTS: Among 55,277 trauma patients, 311 mortalities were recorded. Most were male (n=261, 83.9%), aged 21-40 years (n=133, 42.8%), with blunt trauma being the predominant cause (97.4%). The majority of patients had road traffic injuries (n=180, 57.9%) and falls (n=95, 30.5%). Threatened airway (n=144, 46.3%), tachycardia (n=159, 51.1%), and hypotension (n=74, 23.8%) were common on patients' arrival. Traumatic brain injuries (70.4%) prevailed. Private vehicles transported 46.6% of patients, while only 7.0% arrived within the golden hour. Although patients who received prehospital care experienced delayed hospital arrival, they exhibited higher oxygen saturation and systolic blood pressure. CONCLUSION: Augmentation of prehospital care and EMS infrastructure in low-resource settings is crucial to mitigating trauma mortality. Although prehospital care delayed hospital arrival, it positively impacted physiological parameters and potentially improved patient outcomes. This study underscores the imperative of timely interventions and comprehensive EMS development to address the global trauma burden effectively.