ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Garkaz   O (1)
Salari Lak   Sh (*2)
Mehryar   H.R (3)
Khalkhali   H.R (3)






(*2) Public Health Department, Medical Sciences Faculty, Islamic Azad University, Tabriz Branch, Tabriz, Iran
(1) Epidemiology Department, Medicine Faculty, Urmia University of Medical Sciences, Urmia, Iran
(3) Emergency Medicine Department, Medicine Faculty, Urmia University of Medical Sciences, Urmia, Iran
(3) Epidemiology Department, Medicine Faculty, Urmia University of Medical Sciences, Urmia, Iran

Correspondence

Address: Tabriz Branch, Islamic Azad University, Soleyman Khater Street, Manzaryieh Square, Tabriz, Iran. Post Code: 5174745155.
Phone: 04134799169
Fax: 04134799169
salari@iaut.ac.ir

Article History

Received:  October  21, 2018
Accepted:  January 30, 2019
ePublished:  March 19, 2019

BRIEF TEXT


Accidents and injuries have historically been a threat to human health. One of the most common accidents is driving-induced injuries that endangers the human health ... [1-3].

… [4-11]. One of the most trusted systems used to assess the quality of hospital services and determine the expected survival is the Trauma Injury Severity Score (TRISS). In this method, trauma score and severity of injury consist of 3 sections, including physiological or revised trauma score (RTS), anatomical or injury severity score (ISS), and age [11-14]. … [15-17]. Major Trauma Outcome Study (MTOS) was conducted retrospectively by the American College of Surgeons in 1982 to estimate the outcome of large trauma in several trauma centers. Different methods such as Abbreviated Injury Scale (AIS), RTS, ISS, and a Severity Characterization of Trauma (ASCOT) are used to evaluate the severity of trauma in injured patients, but the TRISS method is more used because it uses a multi-criteria combination of indices [14]. In a study conducted by Dasmaak et al. in India [19], the number of dead individuals was 5 more than that of MTOS. The results of studies carried out by Esmaeili et al. [20], Khosravi and Ebrahimi [21] showed that the number of dead individuals was 7 and 4 more than that of MTOS, respectively. In all of the above studies, the low quality of hospital services to the injured was mentioned as the reason for the increased number of deaths. ... [22-24].

The aim of this study was to determine the survival rate of inpatient traffic injured and to assess the quality of health care services, using the TRISS method in Imam Khomeini Hospital of Urmia in 2016.

The present study is a cross sectional descriptive analytical study.

This study was carried out based on the data of inpatient traffic injured in Imam Khomeini Hospital of Urmia in 2016.

The inclusion criteria included injuries due to traffic accidents, residence in West Azarbaijan province neighborhoods in the last 3 months, the survival of the injured person during hospital admission, recording injured person's data in the trauma system of hospital, and the presence of at least one injury in the body. Samples were selected through multi-stage purposive sampling. Firstly, 2015 traffic injured were selected based on the above criteria; then, 860 injured were selected based on criteria including age above 50, ICU admissions, dispatched from other cities, and having a trauma of the head, abdomen, and face. Of these, 760 hospitalized patients were possible to be traced to determine the survival rate.

The data collection form included demographic variables, accidental variables, and TRISS indices. Survival predictor systems include TRISS, RTS, and ISS [25-27]. In the evaluation by TRISS, classification of physiological criteria was performed according to Table 1. To assess ISS, the body is divided into 6 parts including head, face, chest, abdomen, pelvis, and hinds. Also, based on severity, the injuries are divided into 6 groups, including mild, moderate, severe, serious, critical, and life threatening. To calculate the ISS, firstly, in each area, the AIS score is determined for the injured organ; then, the 3 injuries that have the highest scores of AIS are selected, and they are exponentiated and their sum is calculated (ISS=x2+y2+z2). The minimum ISS score is 3=12+12+12 and the maximum score is 75=52+52+52. The ISS score range is between 0 and 75, which increases with the increase in the score of injuries [8, 20, 28, 29]. RTS has 5 independent variables, including GCS, RR, SBP, chest expansion, and capillary refill. RTS score range is 0-12. The lowest score indicates the patient's worst condition. RTS has the highest coefficient of validity and penetration in the prognosis of patients with brain trauma [11, 15, 30]. Based on logistic regression analysis, a statistical model for predicting the outcome of injury in patients based on RTS is presented. In this model, RTS is calculated as follows: RTS=Total (Respiration)×0.2908-(SBP)×0.7326-(Consciousness)×0.9368 The range of RTS values is between 0-7.84. The RTS value is obtained, using 3 measured indices and putting the resulting number of each of them in the model. Using the RTS value, the patient's survival probability can be calculated based on the following formula: P=1/ (1+e-RTS+3/5718) The following formula was used to calculate survival probability in a group under the age of 15 years: Model=-0.4499+RTS+0.8085+ISS×0.0651+(Age stage)×(1.1360) In both cases, the patient survival rate is P(S)=1/1+elogit. The number of expected deaths in the TRISS model includes those, whose survival probability is less than 50%. In order to evaluate the quality of the hospital services, the W and Z statistics are calculated, using the following formulas: = (Number of observed deaths-Number of expected deaths) / √ (waiting for death number-waiting for live number) Z=(Number of observed deaths-Number of expected deaths)/√(Number of expected deaths-Number of expected survived) W=( Number of observed survived-Number of expected survived ×1000)/(All patients ) Finally, the results were compared with the results of MTOS. The positioning of the Z between -1.96 to +1.96 indicates no significant difference between the results of the study and the results of the MTOS [31]. To calculate TRISS online, visit http://www.trauma.org. The Kolmogorov-Smirnov test was also used to measure the normal distribution of the data. The data were analyzed by SPSS 16 software.

Of the 760 inpatient traffic injured, 562 (73.9%) were male and 198 (26.1%) were female (Table 2). Most injured were injured on the street. The most common type of injury mechanism in both male and female groups was non-penetrating. Most people were discharged from hospital as they were alive. The mean length of stay in the hospital was 5.69±4.09 days. The most injured were pedestrians. Most accidents occurred in interurban areas in both genders (Table 3). The number of the observed deaths was 69, while the expected deaths were 60, of which 9 deaths were more than expected. The W score was 9 and the Z score was calculated as +0.02 (Diagram 1). The level of consciousness in GCS was between 13 and 15 in 625 recovered injured and in 25 dead individuals, respectively. The highest RR was between 10 and 29 in both recovered injured and dead individuals, respectively. The highest SBP in both recovered injured and dead individuals was above 89 mm Hg, respectively (Table 4). There was a significant difference between the mean of RTS and ISS in both recovered and dead groups (Table 5).

… [32-34]. In a study carried out by Vernon et al., in the United States, the Z and W scores were 2.1 and +8, respectively. In this study, fewer injuries were reported to die than MTOS, which was due to an increase in the quality of hospital services for the injured [33]. The results showed that 562 (73.9%) were male and 198 (26.1%) were female, and the ratio of female to male was 4:1. This result is likely to be due to women's cultural conditions and their constraints on driving, which is consistent with the results of a study conducted by Soltani Nejad et al. [35]. ... [36, 37]. In the Esmaeili et al.’s study, the mean ISS was 12.4±4.3 for the recovered injured and 36.9 ± 8.9 for the dead individuals, and the mean RTS was 7.19 ± 0.93 for the recovered injured and 0.44 ± 35.4 for the dead individuals [20]. In this study, the mean RTS in the dead individuals was less than the recovered injured, while the mean ISS in the dead individuals was more than the recovered injured, which is consistent with the results of studies performed by Chan et al. [38] and Chaudhry et al. [39]. Of the 69 the dead individuals, 61 had ISS>20; injured with high ISS are more likely to die. The high ISS, along with multiple damage to different parts of the body, if RTS is <5, increases the probability of death. The results are consistent with the results of studies carried out by Saidi et al. [37], Akhavan Akbari and Mohammadian [40], and Paffrath et al. [41].

Since the TRISS study shows the quality of hospital services for injured in traffic accidents, it is suggested that periodic studies be carried out with the aim of recognizing the quality of hospital services, and if the results of TRISS studies are reduced, the study of MTOS is planned to improve the quality of hospital services.

The limitations of this study included insufficiency of the data and the lack of proper cooperation of the injured to track the survival status.

Being male, having less education than diploma, free job, being pedestrians, living in urban areas, occurrence of traffic accidents in street, interurban accidents, and head trauma are risk factors of reducing survival rate. Also, the quality of hospital care based on TRISS assessment is lower than MTOS.

The administrative and financial support of Deputy of Research and Technology of Urmia University of Medical Sciences, the cooperation of the injured family, and the staff of Imam Khomeini Hospital of Urmia are appreciated.

There is no conflict of interest.

This study was approved by Ethics Committee of Urmia University of Medical Sciences as a thesis in the postgraduate degree in Epidemiology.

This study was funded by the Deputy of Research and Technology of Urmia University of Medical Sciences.

TABLES and CHARTS

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