Characteristics of Trauma Patients Who Died at UGM Academic Hospital (RSA UGM)

Febriana Prananingrum; Humaera Elphananing Tyas; Aditya Bagas Caswita; Radyan Artha Dewa Rachmat; Rina Widyastuti; Ade Febrina Lestari; Darwito Darwito; Yanasta Yudo Pratama

doi:10.22146/ahj.v6i1.94712

Characteristics of Trauma Patients Who Died at UGM Academic Hospital (RSA UGM)

https://doi.org/10.22146/ahj.v6i1.94712

Febriana Prananingrum^(1*), Humaera Elphananing Tyas⁽²⁾, Aditya Bagas Caswita⁽³⁾, Radyan Artha Dewa Rachmat⁽⁴⁾, Rina Widyastuti⁽⁵⁾, Ade Febrina Lestari⁽⁶⁾, Darwito Darwito⁽⁷⁾, Yanasta Yudo Pratama⁽⁸⁾

(1) UGM Academic Hospital
(2) UGM Academic Hospital
(3) UGM Academic Hospital
(4)
(5) UGM Academic Hospital
(6) UGM Academic Hospital
(7) UGM Academic Hospital
(8) Universitas Islam Indonesia
(*) Corresponding Author

Abstract

BACKGROUND : Trauma becomes the main health problem worldwide due to its high mortality rate. Traffic accidents are a trauma with a high incidence and death rate in Indonesia, specifically in Yogyakarta. Factors causing trauma-related death are the lack of hospital infrastructure, the lack of quality human resources, the lack of standardization of trauma management, and the limited number of hospitals providing comprehensive trauma services. This research aims to identify the characteristics of trauma patients who died while receiving medical treatment at UGM Academic Hospital and to analyze the mortality of patients according to the trimodal distribution to prepare this hospital to become a trauma center hospital.

METHOD : This quantitative descriptive research used a cross-sectional method. Data were taken from medical records of patients admitted to the ER of UGM Academic Hospital in 2018-2023 based on predetermined inclusion and exclusion criteria. The research was conducted from March to November 2023.

RESULT : This research involved 58 patients consisting of 42 (72.4%) male and 16 (27.6%) female patients. The most common cause of death was brain injury (63%), followed by spinal cord injury (13.7%), multi-organ failure and sepsis (8.6%), cardiac and respiratory arrest (6.8%), and comorbidities patients (6.8%).

CONCLUSION : The majority of trauma patients who died at the UGM Academic Hospital are male and aged 60-80 years with the main cause of death of brain injury. The patient dies at the late death stage based on trimodal distribution of death time.

Keywords

Trauma, Death Rate, Trauma Centre

Full Text:

PDF

References

Wright, C.A.; Houseknecht, E. A National Evaluation of the Effect of Trauma-Center Care on Mortality. J. Trauma Nurs. 2006, 13, 150. 2. Committee on Trauma. Resources for optimal care of the injured patient: 1999. Chicago: American College of Surgeons, 1998. 3. MacKenzie EJ, Hoyt DB, Sacra JC, et al. A national inventory of hospital trau- ma centers. JAMA 2003;289:1515-22 4. Gauss T, Ageron FX, Devaud ML, Debaty G, Travers S, Garrigue D, Raux M, Harrois A, Bouzat P; French Trauma Research Initiative. Association of Prehospital Time to In-Hospital Trauma Mortality in a Physician-Staffed Emergency Medicine System. JAMA Surg. 2019 Dec 1;154(12):1117-1124. doi: 10.1001/jamasurg.2019.3475. PMID: 31553431; PMCID: PMC6764001. 5. Trunkey DD. Trauma. Sci Am. 1983;249:28–35 6. Gunst M, Ghaemmaghami V, Gruszecki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc (Bayl Univ Med Cent). 2010 Oct;23(4):349-54. doi: 10.1080/08998280.2010.11928649. PMID: 20944754; PMCID: PMC2943446. 7. Smith J, Plurad D, Inaba K, Talving P, Lam L, Demetriades D. Are All Level I Trauma Centers Created Equal? A Comparison of American College of Surgeons and State-Verified Centers. The American Surgeon. 2011;77(10):1334-1336. doi:10.1177/000313481107701013 8. Wiratama, B.S.; Chen, P.-L.; Chao, C.-J.; Wang, M.-H.; Saleh, W.; Lin, H.-A.; Pai, C.-W. Effect of Distance to Trauma Centre, Trauma Centre Level, and Trauma Centre Region on Fatal Injuries among Motorcyclists in Taiwan. Int. J. Environ. Res. Public Health 2021, 18, 2998. https://doi.org/10.3390/ijerph18062998 9. Ramadiputra, Gamal, Yoyos Dias Ismiarto, and Herry Herman. "Survey Penyebab Kematian Berdasarkan Prosedur Advance Trauma Life Support (ATLS) pada Pasien Multiple Trauma di Instalasi Gawat Darurat (IGD) Bedah Rumah Sakit Hasan Sadikin Bandung Periode Januari–Juli 2014." Syifa’MEDIKA 9 (2018): 10-15. 10. Oyeniyi, Blessing T., et al. "Trends in 1029 trauma deaths at a level 1 trauma center: impact of a bleeding control bundle of care." Injury 48.1 (2017): 5-12. 11. Candefjord, Stefan., Linn Asker, and Eva-Corina Caragounis. "Mortality of trauma patients treated at trauma centers compared to non-trauma centers in Sweden: a retrospective study." European journal of trauma and emergency surgery (2020): 1-12. 12. World Health Organization. Global Injuries and violence (2018) 13. World Health Organization. Global Status Report on Road Safety (2018) 14. The United Nations : Sustainable Development Goal 3, Ensure Healthy Lives and Promote Well-Being for All at All Ages 2019 15. https://www.bps.go.id/indicator/17/513/1/jumlah-kecelakaan-korban-mati-luka-berat-luka-ringan-dan-kerugian-materi.html 16. http://bappeda.jogjaprov.go.id/dataku/data_dasar/index/548-data-kecelakaan-dan-pelanggaran-lalu-lintas?id_skpd=39 17. Mariana, Anni Tiurma, and Fatwa Sari Tetra Dewi. "Cedera akibat kecelakaan lalu lintas di Sleman: data HDSS 2015 dan 2016." Berita Kedokteran Masyarakat 34.5 (2018). 18. Dewan, Michael C., et al. "Estimating the global incidence of traumatic brain injury." Journal of neurosurgery 130.4 (2018): 1080-1097. 19. Champion, H.R., Sacco, W.J. & Hunt, T.K. Trauma severity scoring to predict mortality. World J. Surg. 7, 4–11 (1983). https://doi.org/10.1007/BF01655906 20. Mikhail JN, Harris YD, Sorensen VJ. Injury severity scoring: influence of trauma surgeon involvement on accuracy. J Trauma Nurs. 2003;10:43–7. 21. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Gann DS, Gennarelli T, et al. Progress in characterizing anatomic injury. J Trauma. 1990;30:1200–7. 22. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96. 23. Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. An overview of the injury severity score and the new injury severity score. Inj Prev. 2001;7:10–3. 24. Osler T, Glance L, Buzas JS, Mukamel D, Wagner J, Dick A. A trauma mortality prediction model based on the anatomic injury scale. Ann Surg. 2008;247:1041–8. 25. Champion HR. Trauma scoring. Scand J Surg. 2002;91:12–22. 33. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, 26. Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29:623–9. 27. Restrepo-Álvarez, Camilo Andrés, et al. "Trauma severity scores." Colombian journal of anesthesiology 44.4 (2016): 317-323. 28. DeBritz, James N., and Andrew N. Pollak. "The impact of trauma centre accreditation on patient outcome." Injury 37.12 (2006): 1166-1171. 29. Moore, Lynne, et al. "Mortality in Canadian trauma systems." Annals of surgery 265.1 (2017): 212-2 30. Menkes RI. 2017. Keputusan Menteri Kesehatan Republik Indonesia Nomor Hk.01.07/Menkes/132/2017 Tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana Trauma. 31. MacKenzie, E.J., dkk. (2006). A National Evaluation of the Effect of Trauma-Center Care on Mortality. The New England Journal of Medicine, 354:366-78 32. Kim JS, Jeong SW, Ahn HJ, Hwang HJ, Kyoung KH, Kwon SC, Kim MS. 2019. Effects of Trauma Center Establishment on the Clinical Characteristics and Outcomes of Patients with Traumatic Brain Injury : A Retrospective Analysis from a Single Trauma Center in Korea. Ulsan. J Korean Neurosurg Soc. 33. Guizzo WA, de-Souza BS, Welhermann V, de-Silva AB, Jabur GR, Menini-Stahlschidt CM, Von-Bahten LC. 2020. Trauma in Curitiba: multifactorial assessment of victims admitted to a university hospital. Curitiba. Rev. Col. Bras 34. Lakmal, M.A.C., Ekanayake, E.M.D.N.K., Kelum, S.H.P. et al. Hospital-Based Case Series Analysis of Road Traffic Trauma Patients in Sri Lanka. Indian J Surg 83 (Suppl 1), 120–125 (2021). https://doi.org/10.1007/s12262-020-02473-8 35. Abate SM, Abafita BJ, Bekele T. 2020. Prevalence of Traumatic Brain Injury Among Trauma Patients in Ethiopia: Systematic Review and Meta-Analysis. Dilla Town. The ANNALS of AFRICAN SURGERY 36. Claire E. Baker, Phil Martin, Mark H. Wilson, Mazdak Ghajari, David J. Sharp, The relationship between road traffic collision dynamics and traumatic brain injury pathology, Brain Communications, Volume 4, Issue 2, 2022, fcac033, https://doi.org/10.1093/braincomms/fcac033 37. Trunkey DD. Trauma. Sci Am. 1983;249:28–35. [PubMed] [Google Scholar] 38. Sobrino, J., & Shafi, S. (2013). Timing and causes of death after injuries. Proc (Bayl Univ Med Cent), 26(2):120-3. doi: 10.1080/08998280.2013.11928934. PMID: 23543966; PMCID: PMC3603725. 39. Meislin H, Criss EA, Judkins D, Berger R, Conroy C, Parks B, Spaite DW, Valenzuela TD. Fatal trauma: the modal distribution of time to death is a function of patient demographics and regional resources. J Trauma. 1997;43(3):433–440. [PubMed] [Google Scholar] [Ref list] 40. Grindlinger GA, Skavdahl DH, Ecker RD, Sanborn MR. Decompressive craniectomy for severe traumatic brain injury: clinical study, literature review and meta-analysis. Springerplus 2016; 5 (1605): 1–12. 41. Sumardi, F.S., Hamzah., Rahardjo, S., & Bisri, T. (2018). Tatalaksana kraniektomi dekompresif pada pasien cedera otak traumatik disertai peningkatan tekanan tinggi intrakranial menetap. Jurnal Neuroanestesi Indonesia, Vol. 7, No. 3. Diakses dari https://inasnacc.org/ojs2/index.php/jni/article/view/19/pdf. 42. Van Veen E, Aerdts S, van den Brink W. decompressive (hemi)cranictomy for refractory intracranial hypertension after traumatic brain injury. Critical Care 2006; 10: 458–63. 43. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, dkk. Surgical management of traumatic parenchymal lesions. Neurosurgery 2006; 58: 25–46. 44. Mori K, Nakao Y, Yamamoto T, Maeda M. Early external decompressive craniectomy with duroplasty improves functional recovery in patients with massive hemispheric embolic infarction: timing and indication of decompressive surgery for malignant cerebral infarction. Surg Neurol. 2004; 62: 420–30. 45. Ziai WC, Port JD, Cowan JA, Garonzik IM, Bhardwaj A, Rigamonti D. Decompressive craniectomy for intractable cerebral oedema: experience of a single centre. J Neurosurg Anaesthesiol. 2003; 15: 25–32. 46. Meier U, Lemcke J, Reyer T, Grawe A. Decompressive craniectomy for severe head injury in patients with major extracranial injuries. Acta Neurochir 2006; 96: 373–6. 47. National Trauma Research Institute, Australia. The DECRA trial: early decompressive craniectomy in patients with severe traumatic brain injury; 2009. Available from: http:// clinicaltrials.gov/show/NCT00155987 [cited 27 September 2009]. 48. Raslan A, Bhardwaj A. Medical management of cerebral edema. Neurosurg Focus 2007; 22 (5): 1–12. 49. Tagliaferri F, Zani G, Iaccarino C, Ferro S, Ridolfi L, Basaglia N, dkk. Decompressive cranictomies, facts and fiction: retrospective analysis of 526 cases. Acta Neuro (Wien) 2012; 154 (5): 919-26 50. Jiang JY, Xu W,Li WP, Xu WH, Zhang J, Bao YH, dkk. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized control study. J Neurotrauma 2005; 22 (6): 623-8 51. Honeybul S. Decompressive craniectomy for severe traumatic brain injury: a review of its current status. J Neurol Neurophysiol 2012; 3 (7): 1–6. 52. Santana-Cabrera L, Pérez-Acosta G, Rodríguez-Escot C, Lorenzo, Torrent R, Sánchez-Palacios M. Complications of postinjury decompressive craniectomy. Int J Crit Illn Inj Sci 2012; 2 (3): 186–8. 53. Galgano M, Toshkezi G, Qiu X, Russell T, Chin L, Zhao LR. Traumatic Brain Injury: Current Treatment Strategies and Future Endeavors. Cell Transplant. 2017 Jul;26(7):1118-1130. doi: 10.1177/0963689717714102. PMID: 28933211; PMCID: PMC5657730. 54. Sadewo W,Soemitro DW,Ashari S,Tandian D,Tobing HG. (2011). Sinospsis Ilmu Bedah Saraf. Jakarta. Sagung Seto. 55. Yatsushige H. [Surgical Management of a Post-traumatic Intracranial Hematoma]. No Shinkei Geka. 2021 Sep;49(5):977-985. Japanese. doi: 10.11477/mf.1436204480. PMID: 34615757.

DOI: https://doi.org/10.22146/ahj.v6i1.94712