Impact of time of arrival in emergency unit on estimation of injuries and overall care of trauma victims.

BACKGROUND

Outcomes of trauma victims largely depends upon available resources, not only in terms of location of high level trauma center near the area where incident takes place but also on staff and equipment available at that particular center at that particular time. This study used retrospective charts review to ascertain whether trauma patients presenting during the night time would have delayed in establishing injuries after necessary investigations and higher in-hospital mortality than those trauma patients arriving during the day time at our hospital.

METHODS

This was a cross sectional study, conducted in department of Surgery, Aga Khan University Hospital, Karachi. Data was obtained from patients charts by a single investigator. By random sampling technique, 146 patients admitted between 1st January 2018 to 31st December 2018inthe Emergency Department of the Aga Khan University Hospital, Karachi were included. Patients were placed into two groups. Those arriving in hospital from 7 am to 7 pm were labeled as day time group while those who presented from 7 pm to 7 am were labeled as night time group. Difference in mortality in each group and time required for carrying out investigations and admissions to definite care were recorded and compared among both groups.

RESULTS

A total of 146 patient charts were reviewed, with 73 patients each in both day time (DT) and night time (NT) groups. Out of 146 trauma victims 123(82.2%) were male and 23(17.8%) were female. Mean age in our population was 37.4 years (±14.3). Road traffic accident (RTA) was the most common cause in 121 patients (82.9%). Time required to conduct trauma services was shorter and significant in DT group as compared to NT group. There was significant difference observed in time required for admission in each group, with mean of 6hours and 40 minutes ± 4 hours,22 minutes in DT group and 8 hours, 36 minutes (± 5 hours,11 minutes in NT group (p = 0.03). However there was no significant difference in mortality observed in both groups.

CONCLUSIONS

In our hospital time of arrival has no impact on overall mortality of trauma patients. However time to carryout necessary investigations for stable trauma patients and their admissions to definite care is longer as compared to day time arrival of emergency trauma patients.