Hussain, Hardawani Mohd
(2011)
Epidemiology and patterns of trauma deaths
in Hospital Universiti Sains Malaysia, Kubang
Kerian, Kelantan.
Masters thesis, Universiti Sains Malaysia.
Abstract
Trauma is an ever increasing problem and it is the leading cause of morbidity and
mortality in the under 40s age group in most developed and developing countries
including Malaysia. The lack of research into trauma epidemiology is well known. The
paucity of information has led to conclusion that proper epidemiological studies
cannot be conducted in the absence of meaningful data. The objective of this study is
to examine patterns of anatomical injury in victims of trauma death and to determine
the probability of survival of trauma death patients. This was a retrospective evaluation of 75 consecutive of trauma files at Hospital
Universiti Sains Malaysia, of all trauma death during I year period, beginning I st
January 2008 until 31st December 2008. Patients who fulfill the inclusion criteria were
selected for the study. Patients were analyzed for injury severity by standard scoring
systems (Abbreviated Injury Scale [AIS], Revised Trauma Score [RTS], and Injury
Severity Score [ISS], and Trauma and Injury Severity Scale [TRISS] methodology. 75 patients were enrolled. 84% (n=63) were male and 16% (n=l2) were female and all
are Malays. Mean age group was 43.0 (SD=27.0). 45 (60%) patients were younger
than 55 years old. Blunt injuries 73(97.33%) were the dominant mechanism in fatal
trauma whereas penetrating injuries were only 2(2.67%). Majority of trauma death was
due to MV A 82.67% (n=62). Total numbers with normotensive SBP (2: 90mmHg)
versus hypotensive {<90 mmHg) on arrival were 73 and 2 patients, respectively. For
normal respiration (RR 10-29/min) versus respiratory distress (RR>29 /min or
<l O/min); the numbers found to be 72 and 3 patients respectively. Noted 18 patient
with no or only minor and moderate head injury (GCS2:9) versus 57 patients with
severe head injury (GCS<9). Cross-tabulated for age, victims {<55 years) were had a deranged cerebral status (GCS~8; X2-test, df= I, p<0.05) on arrival
compare to older victims. The predominant cause of death was CNS injury in 77.3%
(n=58), followed by SIRS/MOF in 18.7% (n=l4), exsanguinations 2.7 %( n=2) and
others 1.3 %( n= I). Median of ISS was 25 (range: 9-54). The overall mean ISS score
was 27 .6±8.6. There was statistically significant difference in the RTS for the three
time to death groups (acute:< 48hrs; early: 3-7days; late >7 days) (F=9.820, p < 0.05).
When using the Trunkey classification of immediate, early and late deaths, we found
that a trend of deaths, clustering in a bimodal-like fashion when stratified according to
cause of death. By using TRISS methodology, 62 (82.7%) patient had a Ps >0.5 and 41
of them were judged "frankly preventable" cPs>0.75). Despite a probability of survival above 80%, the early management has thrown up
possibilities for prevention of trauma death, improving treatment strategies and
enhancing trauma research. Focus on injury prevention is imperative, particularly for
brain injuries. The figures from this study, mandate further exploration of
preventability issues, management improvements, and areas of clinical awareness that
should be apply not only to this trauma system, but also to similar systems as general.
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