Factors Predicting outcome of patients with polytrauma in tertiary center of western Nepal

Introduction: Trauma is a public health issue associated with substantial socioeconomic impacts and major adverse clinical outcomes. No single study has previously investigated the predictors of mortality in a general trauma population. In this study, we assessed different clinico-biochemical parameters to investigate the associations between those parameters and their effects in outcome of a polytrauma patient. Methods: An analytical study was done in between January 2020 to December 2020 in patients with polytrauma admitted to intensive care unit Department of Surgery in Manipal Teaching Hospital to assess the effect of various socio-demographic and clinic-radiologic variables in outcome (Glasgow outcome scale) of polytrauma patients. All the categorical data were tested using chi square test or Fischer Exact test and continuous variables were tested using student’s “t” test. P value <0.05 was determined significant. Those independent variables significant on univariate analysis were then subjected to binary logistic regression and the data was presented as level of significance, odds ratio and 95% confidence interval. Analysis was done using SPSS 23.0. Results: Out of 67 patients, 34 had favorable GOS and 33 had unfavorable GOS. Injury Severity Score (ISS) (P<0.01), abnormal pupils (P<0.01), RBS (0.04), low GCS during presentation (<0.01), higher CT Marshal Grade (0.01) had strong associations with unfavorable outcome in polytraumatic patient. ISS was the only significant parameter when all the other significant variables were kept constant in binary logistic regression model (OR=1.18, 95% CI=1.08-1.28). Conclusion: Injury Severity Score, abnormal pupils during presentation, high level of blood sugar after polytrauma, low GCS during presentation, higher CT Marshal Grade are strong predictors in outcomes of polytraumatic patient.


Introduction:
Trauma is a public health issue and associated with substantial socioeconomic impacts and major adverse clinical outcomes. No single study has previously investigated the predictors of mortality across all stages of care (pre-hospital, emergency room, surgical center and intensive care unit) in a general trauma population.
The term "polytrauma" has been used interchangeably with multi trauma and has been frequently defined in terms of AIS and other clinic-biochemical parameters. In this study, we hypothesized that different clinicobiochemical parameters may predict the outcomes in polytraumatized patient. To pursue this question, we utilized retrospective data from our center to investigate the associations between those parameters and their effects in outcome of a polytrauma patient.

Methods:
An analytical study was done in between January 2020 to December 2020 in patients with polytrauma admitted Outcome was assessed as Glasgow outcome scale (GOS) at discharge of the patients ( Table 1). The total outcome score was noted from the chart of the patients and was dichotomized in to two groups; favorable GOS (GOS 4 and 5) and unfavorable GOS (GOS 1,2 and 3). Patients with incomplete data were also excluded from the study.
Since the study was done in peak period of COVID, we find it important to mention that none of the COVID positive patients were included in this study as such positive patients were managed in separate ICU as per our hospital policy and thus the records did not contain any patients with COVID.
Various Clinic-demographic parameters were tested for association against outcome groups for association. All the categorical data were tested using chi square test or Fischer Exact test whenever chi-square was not feasible (any cells value less than 5) and continuous variables were tested using student's "t" test. P value <0.05 was determined significant. Those independent variables significant on univariate analysis were then subjected to binary logistic regression and the data was presented as level of significance, odds ratio and 95% confidence interval. Analysis was done using SPSS 23.0.  Table 3.

Discussion:
In our context, hypotension and altered sensorium during presentation, multiple bodily injuries, failure to reach the trauma center by the golden time, trauma under the influences of drugs or alcohol are the main issues in emergency and trauma medicine. 4 Although the transportation time may be short, polytrauma patients admitted to a trauma center usually already have a state of shock, hypoxia and coagulopathy. There is evidence that the disarrangement of the biochemical parameters occurs immediately after trauma and is directly proportional with each other. [5][6][7] The main objective of this study was to assess those parameters and their role in predicting the outcomes in polytrauma patients.
In our study, 77.7% of the population has unfavorable outcomes as they were under the influence of alcohol as  showed age and GCS yields higher discriminatory power in mortality prediction in trauma. 16 Similarly, abnormal pupillary response and higher Marshall CT grades were also found to have association with unfavorable outcomes in our study implication higher the degree of TBI, poorer the outcome in polytrauma.
Conclusions: Injury Severity Score, abnormal pupils during presentation, high level of blood sugar after polytrauma, low GCS during presentation, higher CT Marshal Grade are strong predictors in outcomes of polytraumatic patient.