Iran Journal of Nursing

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Najafi Ghezeljeh T, Chegini S, Haghani S, Namdar P. Influential Factors in the Survival Rate of Trauma Victims until Discharge from the Hospital. IJN 2021; 33 (128) :67-83
URL: http://ijn.iums.ac.ir/article-1-3401-en.html

Background & Aims: Trauma is an important public health concern in the world. With the advancement of science and technology and the industrialization of societies in the past century, trauma and its complications have become an important issue. Trauma is the most common cause of death and disability in people aged 1-44 years. Furthermore, trauma is the leading cause of reduced life expectancy and years of life lost worldwide. The most important measure to be taken in the event of a crisis is to maintain the survival of the casualty, prevent permanent complications before basic treatment, return the casualty to pre-injury living conditions as soon as possible, and provide emergency assistance quickly and intelligently. Since traumatic injuries may deteriorate without intervention and time resolution, posttraumatic survival rate largely depends on time. The chances of survival after trauma in the case of severely injured patients increase with their timely transfer to treatment centers. Pre-hospital emergency medical services (EMS) are an integral part of the healthcare delivery system and play a key role in the provision of pre-hospital services and patient transfer to medical centers. The purpose of such medical services is to provide appropriate treatment at the right place and time by using available resources. The correct operation of different parts of this system results in the rapid and timely dispatch of ambulances to the patientchr('39')s bedside and the prevention of death and disabilities. Qazvin province has a strategic location in terms of transportation and industry. Qazvin is the communication route of more than 13 provinces in Iran and a bridge between the capital and the northern and western regions, as well as Caucasus and European countries. Figures related to the traffic accidents in Qazvin province show that this province has a large share of road accidents due to the small geographical area in the country. The present study aimed to determine the influential factors in the survival of trauma victims until discharge from selected hospitals in Qazvin province during 2014-2018.
Materials & Methods: This retrospective correlational study was conducted on 835 trauma patients using the data of Qazvin Emergency Center during 2014-2018. All the cases of the air transport of injured patients were included in the study due to the small number of cases. Among the cases of transferring trauma patients via the ground route, the subjects were selected via stratified random sampling with an equal volume for each year of the study period. Data were collected using an information registration form consisting of data on personal characteristics, trauma characteristics, pre-hospital and hospital emergency procedures, patientchr('39')s clinical condition upon arrival at the patientchr('39')s bedside, transfer mode, consciousness level at different times, and vital signs at different times. Data collection tools were the emergency center information questionnaire and the hospital records of trauma victims. Data analysis was performed in SPSS 16 using Chi-square, t-test, and regression analysis at the significance level of P<0.05.
Results: Out of 835 trauma victims, 608 cases (72.8%) were male, and 227 cases (27.2%) were female. In terms of age distribution, the mean age of the injured subjects was 39±16.03 years (range: 18-98 years). The trauma pattern was pervasive in 106 patients (12.7%) and blunt in 729 patients (87.3%). Among the subjects, 59 cases (7.1%) died of trauma, of which 14 cases (23.7%) had penetrating trauma and 45 cases (76.3%) had blunt trauma. The mean body mass index of the trauma patients in the hospital was 25.88±4.44 kg/m². Underlying disease (P=0.03) and smoking habits (P=0.028) were significantly correlated with survival. The most common site of trauma was the limbs in 790 patients (94.6%). The type of trauma was blunt in 729 patients (87.3%) and 106 patients (12.7%), and the most common cause of trauma in 602 cases (72.1%) was vehicle accidents, while the least common causes were work-related accidents, explosion/lightning, and electric shocks (n=30; 3.6%). In addition, the mean severity of head, face, abdomen, upper limb, lower limb, and superficial anatomy injuries of the subjects was estimated at 22.66 ± 13.64, and the mean severity of head, face, abdomen, limbs, pelvis, and chest injuries of the subjects was 21.62 ± 14.23. The mean total duration of emergency services was one hour and 21 minutes (standard deviation: 33 minutes), and the mean duration of release operations was 25 minutes (standard deviation: 11 minutes). To investigate the influential factors in survival, a logistic regression model was used along with the inter-method reliability, and the variables affecting survival were analyzed by the regression model. According to the findings, the injury severity score (ISS; P=0.001) was significant in the regression model. In other words, a one-unit increased in the ISS reduced the chance of survival in the injured by 0.86. Furthermore, the chance of survival in the injured who had normal pupil and heart conditions was three and four times higher, respectively.
Conclusion: Proper and timely methods of diagnosis and treatment of trauma (especially the prevention of these injuries) are paramount. Due to the high prevalence of traffic accidents as the main cause of such injuries, cultural and social structures should be corrected in the field of driving and transportation improvement. Diagnosis of the severity of the injuries plays a key role in effective patient care and leads to reduced mortality and morbidity due to major trauma. Given the large number of road accidents, efforts must be made to develop the necessary care and protocols to prevent death following trauma in proportion to the severity of the patientchr('39')s injury. This requires the cooperation of various institutions, including the police, roads, and urban development.