(1) Department of Orthopaedics, C S M Medical university, Lucknow
(2) Department of General Surgery, AIIMS, Patna
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The objectives of this study were to outline the effect of referral from peripheral hospitals on mortality in patients admitted to the trauma centre of Chattrapati Shahuji Maharaj Medical University and to describe inter-hospital transfer.
Patients admitted on all Mondays of a year and eight randomly selected Mondays and Wednesdays were enrolled and compared. Demographic and clinical profiles of patients presenting directly to the Trauma Centre of CSMMU and those referred from peripheral hospitals were compared. Transfer vehicle was evaluated and accompanying personnel were interviewed to ascertain the clinical status of the patients during transfer, details of the transfer process, training of the transfer personnel, adequacy of the transfer vehicle and its outfitted monitoring equipment.
Five hundred seventy two patients were enrolled in the study including 327 referred and 245 directly admitted patients. There was 27 % mortality in the referred group and 22% mortality in the directly admitted group (p value 0.20). Despite similar ISS patients referred from peripheral hospitals had lower GCS ( p value 0.029), and higher TRISS (p value 0.01) Referred group had greater delay in presentation (p value 0.0001) to the trauma centre and longer duration of hospital stay (p value 0.013). The date and time of injury, GCS score, pupil size and reaction was not documented in transfer record in any of the 327 referred patients. Referral time, pulse rate and blood pressure were recorded in transfer records in 13.71%, 34.38% and 34.25% cases respectively. On arrival 71 patients had a GCS score of less than 8. Of these, none had been intubated in the referral hospital or on way. Ambulances were used for transfer in 15.12% cases. Equipment to measure blood pressure, intravenous access and fluids, and suctioning were present in 95.91%, 61.22%, and 44.89% of ambulances respectively.
Referral from a peripheral hospital results in significant delay in presentation to the trauma centre but does not affect mortality adversely. There is a need to devise a national referral policy.