Background and aim: Car crashes are among the prevalent incidents seriously threatening public health. This study aimed to assess the survival and quality of hospital care for patients of car accidents in Western Azerbaijan, Iran.
Methods: This cross-sectional study was conducted on 1,697 trauma victims admitted to Imam Khomeini hospital in Urmia, Iran, during 2016. The data, including systolic pressure, Glasgow Coma Scale, respiratory rate prior to admittance, severity of injuries based on surgery description, limbs and brain computed tomography scan, and diagnostic ultrasound by an specialist, were collected from medical records. The survival chance of patients was estimated using Trauma and Injury Severity Score (TRISS). To evaluate the quality of hospital service, Z and W statistics were utilized.
Results: Out of 1,697 admitted victims, 1,226 (72.3%) and 471 (27.7%) subjects were male and female, respectively. The patients were within the age range of 15-54 years, including 901 (75%) male and 296 (25%) female subjects. The predominant educational levels were under diploma and illiterate in male and female patients, respectively. The mean values of the Revised Trauma Score for the recovered and deceased patients were 7.75±0.38 and 6.19±1.59, respectively; however, the mean values of the Injury Severity Score for the recovered and deceased patients were 14.57±13.72 and 52.03±27.02, respectively, indicating a statistically significant difference between the two groups. The number of observed mortalities was 69; nevertheless, the expected mortalities were 60 cases. Furthermore, the quantified W and Z statistics were -9 and 0.02, respectively.
Conclusions: The results showed that the observed mortality exceeded the expected morality indicating the low quality of hospital care.
Papalimperi AH, Athanaselis SA, Mina AD, Papoutsis II, Spiliopoulou CA, Papadodima SA. Incidence of fatalities of road traffic accidents associated with alcohol consumption and the use of psychoactive drugs: a 7-year survey (2011-2017). Exp Ther Med. 2019;18(3):2299-306. doi: 10.3892/etm.2019.7787. [PubMed: 31410180].
McManus F, Waite P, Shafran R. Cognitive-behavior therapy for low self-esteem: a case example. Cogn Behav Pract. 2009;16(3):266-75. doi: 10.1016/j.cbpra.2008.12.007.
Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, et al. World report on road traffic injury prevention. Geneva: World Health Organization; 2004.
Mohan D. Analysis of road traffic fatality data for Asia. Proceedings of the Eastern Asia Society for Transportation Studies (The 9th International Conference of Eastern Asia Society for Transportation Studies). Eastern Asia Society for Transportation Studies, South Korea; 2011. doi: 10.11175/eastpro.2011.0.351.0.
Entezami N, Hashemi-Nazari SS, Soori H, Khosravi A, Ghadirzadeh MR. Epidemiology of fatal road traffic accidents in Northern provinces of Iran during 2009 to 2010. Saf Prom Inj Prev. 2015;3(1):1-8.
Khademi A, Moradi SE. Statistical study of traffic casualties at Noruz of 2008 in Iran (from 15 march 2008 to 3 April 2008). Sci J Forensic Med. 2009;15(1):21-8.
Shojaei A, Moradi S, Alaeddini F, Khodadoost M, Ghadirzadeh MR, Khademi A. The association between completed suicides and season of the year in an Iranian population. Iran J Public Health. 2013;42(3):293-7. [PubMed: 23641406].
Soori H, Ainy E, Iranfar M. Road traffic status in the world and Iran: review of results from the World Health Organization. J Saf Prom Inj Prev. 2013;1(2):53-62.
Ainy E, Soori H, Ganjali M, Le H, Baghfalaki T. Estimating cost of road traffic injuries in Iran using willingness to pay (WTP) method. PLoS One. 2014;9(12):e112721. doi: 10.1371/journal.pone.0112721. [PubMed: 25438150].
Watts HF, Kerem Y, Kulstad EB. Evaluation of the revised trauma and injury severity scores in elderly trauma patients. J Emerg Trauma Shock. 2012;5(2):131-4. doi: 10.4103/0974-2700.96481. [PubMed: 22787342].
Norouzi V, Feizi I, Vatankhah S, Pourshaikhian M. Calculation of the probability of survival for trauma patients based on trauma score and the injury severity score model in fatemi hospital in ardabil. Arch Trauma Res. 2013;2(1):30-5. doi: 10.5812/atr.9411. [PubMed: 24396787].
Wright JH, Brown GK, Thase ME, Basco MR. Learning cognitive-behavior therapy: an illustrated guide. New York: American Psychiatric Pub; 2017.
Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma score and the injury severity score. J Trauma. 1987;27(4):370-8. [PubMed: 3106646].
Moore EE, Moore FA. American association for the surgery of trauma organ injury scaling: 50th anniversary review article of the Journal of Trauma. J Trauma. 2010;69(6):1600-1. doi: 10.1097/TA.0b013e318201124e. [PubMed: 21150537].
Baker SP, o'Neill B, Haddon Jr W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-96. [PubMed: 4814394].
Deshmukh VU, Ketkar MN, Bharucha EK. Analysis of trauma outcome using the TRISS method at a tertiary care centre in Pune. Indian J Surg. 2012;74(6):440-4. doi: 10.1007/s12262-011-0404-5. [PubMed: 24293896].
Esmaeili ED, Sadeghi-Bazargani H, Vahdati SS, Shokouhi G, Safaiyan A, Lak SS. Assessment of survival and hospital care quality in patients with traffic injury in east Azerbaijan. Trauma Mon. 2017;22(5):e35303. doi: 10.5812/traumamon.35303.
Khosravi AH, Ebrahimi HO. To evaluate the outcomes of patients with truma admitted to the imam hossein hospital, shahrood using the trauma and injury severity score (TRISS). Iran J Epidemiol. 2008;4(2):35-41.
Davoodi F, Hashemi-Nazari SS, Ghadirzadeh MR. An epidemiology study of road traffic accidents resulting in death: in Lorestan province in 2012. Safety Promot Inj Prev. 2016;3(4):257-62.
Rodríguez JM, Peñaloza RE, Montoya JM. Road traffic injury trends in the city of Valledupar, Colombia. A time series study from 2008 to 2012. PLoS One. 2015;10(12):e0144002. doi: 10.1371/journal.pone.0144002. [PubMed: 26657887].
Macinko J, Mullachery P, Silver D, Jimenez G, Neto OL. Patterns of alcohol consumption and related behaviors in Brazil: evidence from the 2013 National Health Survey (PNS 2013). PLoS One. 2015;10(7):e0134153. doi: 10.1371/journal.pone.0134153. [PubMed: 26230389].
Tirtayasa PM, Philippi B. Prediction of mortality rate of trauma patients in emergency room at Cipto Mangunkusumo Hospital by several scoring systems. Med J Indonesia. 2013;22(4):227-31. doi: 10.13181/mji.v22i4.603.
Ghadirzadeh M, Shojaei A, Khademi A, Khodadoost M, Kandi M, Alaeddini F, et al. Status and trend of deaths due to traffic accidents from 2001 to 2010 in Iran. Iran J Epidemiol. 2015;11(2):13-22.
Masoumi K, Forouzan A, Barzegari H, Darian AA, Rahim F, Zohrevandi B, et al. Effective factors in severity of traffic accident-related traumas; an epidemiologic study based on the Haddon matrix. Emergency. 2016;4(2):78-82. [PubMed: 27274517].
Xiong L, Zhu Y, Li L. Risk factors for motorcycle-related severe injuries in a medium-sized city in China. AIMS Public Health. 2016;3(4):907-22. doi: 10.3934/publichealth.2016.4.907. [PubMed: 29546203].
Vernon DD, Furnival RA, Hansen KW, Diller EM, Bolte RG, Johnson DG, et al. Effect of a pediatric trauma response team on emergency department treatment time and mortality of pediatric trauma victims. Pediatrics. 1999;103(1):20-4. doi: 10.1542/peds.103.1.20. [PubMed: 9917434].
Fani‐Salek MH, Totten VY, Terezakis SA. Trauma scoring systems explained. Emerg Med. 1999;11(3):155-66. doi: 10.1046/j.1442-2026.1999.00039.x.
Hariharan S, Chen D, Parker K, Figari A, Lessey G, Absolom D, et al. Evaluation of trauma care applying TRISS methodology in a Caribbean developing country. J Emerg Med. 2009;37(1):85-90. doi: 10.1016/j.jemermed.2007.09.051. [PubMed: 18584995].
Mohyuddin GR, Alam Z, Malik UZ, Shakil O, Haq AU. Revised trauma score as a predictor of outcome in trauma cases: experiences at a tertiary care hospital in Karachi, Pakistan. J Ayub Med Coll Abbottabad. 2015;27(3):584-6. [PubMed: 26721013].
Hasnani R, Arshad SZ, Zafar H. Prediction model for survival of trauma patients. J Independ Stud Res. 2012;10(1):24.
Madar R, Adini B, Greenberg D, Waisman Y, Goldberg A. Perspectives of health professionals on the best care settings for pediatric trauma casualties: a qualitative study. Isr J Health Policy Res. 2018;7(1):12. doi: 10.1186/s13584-018-0207-2. [PubMed: 29587869].
Akbari GA, Mohammadian A. Comparison of the RTS and ISS scores on prediction of survival chances in multiple trauma patients. Acta Chir Orthop Traumatol Cech. 2012;79(6):535-9. [PubMed: 23286687].
Pathak S, Jindal A, Verma A, Mahen A. An epidemiological study of road traffic accident cases admitted in a tertiary care hospital. Med J Armed Forces India. 2014;70(1):32-5. doi: 10.1016/j.mjafi.2013.04.012. [PubMed: 24623944].
Khorrami Z, Nazari SS, Ghadirzadeh MR. An epidemiology study of deaths from road traffic accidents. Saf Promot Inj Prev. 2017;4(4):217-24.
Khatibi SR, Dinpanah H, Maajani K, Khodadost M, Khodadost B, Kakhki S, et al. The burden of road traffic injuries in the northeast of Iran: the result of a population-based registry. J Inj Violence Res. 2020;12(1):63-72. doi: 10.5249/jivr.v12i1.1265. [PubMed: 31849366].
Ahadi M, Moghadam GF. Analysis of accident data within the city and provide solutions to reduce losses. Transp Technol. 2012;7(19):25-32.
Chan CKO, Yau KK, Cheung MT. Trauma survival prediction in Asian population: a modification of TRISS to improve accuracy. Emerg Med J. 2014;31(2):126-33. doi: 10.1136/emermed-2012-201831. [PubMed: 23314210].
Chaudhry N, Naqi SA, Qureshi AU. Effectiveness of TRISS to evaluate trauma care in a developing country. Emerg Med. 2012;2(124):2-7. doi: 10.4172/2165-7548.1000124.
Saidi H, Mutiso BK, Ogengo J. Mortality after road traffic crashes in a system with limited trauma data capability. J Trauma Manag Outcomes. 2014;8(1):4. doi: 10.1186/1752-2897-8-4. [PubMed: 24524582].
Paffrath T, Lefering R, Flohé S, TraumaRegister DGU. How to define severely injured patients?--an Injury Severity Score (ISS) based approach alone is not sufficient. Injury. 2014;45(Suppl 3):S64-9. doi: 10.1016/j.injury.2014.08.020. [PubMed: 25284238].
Hashmi ZG, Haider AH, Zafar SN, Kisat M, Moosa A, Siddiqui F, et al. Hospital-based trauma quality improvement initiatives: first step toward improving trauma outcomes in the developing world. J Trauma Acute Care Surg. 2013;75(1):60-8. doi: 10.1097/TA.0b013e31829880a0. [PubMed: 23778440].
Mazandarani PD, Heydari K, Hatamabadi H, Kashani P, Danesh YJ. Acute physiology and chronic health evaluation (APACHE) III score compared to trauma-injury severity score (TRISS) in predicting mortality of trauma patients. Emergency. 2016;4(2):88. [PubMed: 27274519].
Lotfi MH, Montazer M, Lashkardoost H, Shamsi F, Askari M, Hamedi E, et al. Road traffic accidents in Yazd province, Iran: a longitudinal study (2012–2016). Arch Trauma Res. 2018;7(2):68-72. doi: 10.4103/atr.atr_9_18.