M. Dasari1, S. D. David2, J. Puyana1, N. Roy2 1University Of Pittsburgh,Department Of Surgery,Pittsburgh, PA, USA 2TATA Institute Of Social Sciences,School Of Habitat,Mumbai, MAHARASHTRA, India
Introduction: The mean age of trauma patients can differ significantly between countries, based on prevalent mechanisms of injury and other factors. The differences in mortality based on age and country have not been analyzed previously. We hypothesized that severely injured trauma patients in India and the United States (US) have different risks of mortality based on age and mechanism of injury.
Methods: Two urban trauma registries from India (n=11,670), and the United States (n=14,155) between 2013-2015 were analyzed for patients with an Injury Severity Score (ISS) ≥ 15. We stratified patients into three age groups: 18-44, 45-64, and greater than 65 years of age. The primary outcome of in-hospital death was analyzed for the three most prevalent mechanisms of injury in both countries: falls, motor vehicle collisions (MVC) and assaults. Logistic regression was performed across the three age groups to compare the odds of death between the two countries while controlling for ISS.
Results: 1,709 patients from India and 1,526 patients from the U.S. met inclusion criteria. The mean age in India was 38.7 years (IQR: 25-49) and 55.2 years in the US (IQR: 35-73). Indian patients had a higher proportion of in-hospital death for all age groups and all mechanisms. Age-stratified mortality increased with age group in both countries for both falls and MVCs. Indian patients had higher age-stratified mortality than US patients who sustained falls or were in MVCs across all age groups; however, there was no significant difference in age-stratified mortality between the two countries who were victims of assault. After controlling for ISS, Indian patients in the 45 to 64-year age group had 6.7 times the odds of in-hospital death than US counterparts in the same age group; this was the highest odds of ISS-adjusted mortality across all other age groups and both countries (Table 1).
Conclusion: Increasing age group consistently correlated with increased age-stratified mortality for severely injured patients who sustained falls and MVCs in both countries. Significantly higher age-stratified mortality for falls and MVCs in India for all age groups suggest that there are pre-hospital and/or risk factors affecting adult patients who fall or are involved in MVCs in India that are different in the US. The adjusted odds of death was the highest within the 45 to 64-year age group in India. Differences in these pre-hospital and injury risk factors for fall and MVC patients, as well as the injuries affecting the middle age cohort in India compared to the US, can be an important subject of future research and injury prevention.
