PROSPECTIVE STUDY OF TRAUMA CASES IN RED ZONE HOSPITAL TUANKU JAAFAR- AN ANALYSIS OF THE DEMOGRAPHIC PATTERN, TIME GAP AND OUTCOME

Abstract

Trauma database collection at hospital level is essential in improving trauma management, clinical research and quality care.  A prospective study of trauma cases in Red Zone, Hospital Tuanku Jaafar, Seremban (HTJS) was conducted from January to May 2021 with a total number of 41 patients. The objective of the study is to highlight the time gap in trauma management which involves time of early management by the emergency team, primary imaging by radiology team, review by respective trauma teams and time of disposition of patient for intervention. Additionally, the study aims to propose protocol to shorten the time gap. Data was collected from the trauma checklist forms available in Red Zone HTJS. 92.7% of the patients were male and majority was from the age group of 20 – 29 years old, mean: 34. We found that there were significant time gaps in between patients’ review in Emergency Department, primary imaging, review by primary teams, as well as definitive plan. The average time gap from patient’s arrival to primary imaging is 85 minutes. We found that 35% and 29% of the cases were reviewed by the surgical and orthopedic team respectively more than 30 minutes after patient’s arrival. There is also some discrepancy in the time of review by both primary teams (surgical: mean 67 minutes vs orthopedic mean: 45 minutes). There is a long length of patient stay in the Emergency Department prior to disposition where 85% of the cases showed length of stay of more than 5 hours in Emergency Department (mean 434 minutes). The severity of the injury is measured by using the Trauma GAP score. The percentage of patients in the GAP categories for low, moderate and high risk were 2%, 15% and 83% respectively. There were 8 death cases, in which 2 patients died in Emergency Department within 24 hours. We found that there is a good correlation of 0.784 in between GAP score and mortality. From these analyses, a hospital protocol such as Trauma Team Activation can be developed to shorten the time gap and subsequently improve the trauma care.