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VOLUME 27 , ISSUE 1 ( January, 2023 ) > List of Articles

Original Article

Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey

Kanwalpreet Sodhi, Ruchira Wasudeo Khasne, Gunjan Chanchalani, Ganshyam Jagathkar, Venkat Raman Kola, Mahesh Mishra, Shrikant Sahasrabudhe, Rajesh C Mishra, Amrish Patel, Ankur R Bhavsa, Haider Abbas, Pragyan Kumar Routray, Pramod Sood, Prasad Anant Rajhans, Reshu Gupta, Kapil Dev Soni, Manender Kumar

Keywords : Advanced trauma life support-trained emergency room physician, e-FAST, Trauma, Trauma center, Trauma code, Trauma team

Citation Information : Sodhi K, Khasne RW, Chanchalani G, Jagathkar G, Kola VR, Mishra M, Sahasrabudhe S, Mishra RC, Patel A, Bhavsa AR, Abbas H, Routray PK, Sood P, Rajhans PA, Gupta R, Soni KD, Kumar M. Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey. Indian J Crit Care Med 2023; 27 (1):38-51.

DOI: 10.5005/jp-journals-10071-24384

License: CC BY-NC 4.0

Published Online: 31-12-2022

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Trauma is the leading cause of death in India resulting in a significant public health burden. Indian Society of Critical Care Medicine (ISCCM) has established a trauma network committee to understand current practices and identify the gaps and challenges in trauma management in Indian settings. Material and methods: An online survey-based, cross-sectional, descriptive study was conducted with high-priority research questions based on hospital profile, resource availability, and trauma management protocols. Results: Data from 483 centers were analyzed. A significant difference was observed in infrastructure, resource utilization, and management protocols in different types of hospitals and between small and big size hospitals across different tier cities in India (p < 0.05). The advanced trauma life support (ATLS)-trained emergency room (ER) physician had a significant impact on infrastructure organization and trauma management protocols (p < 0.05). On multivariate analysis, the highest impact of ATLS-trained ER physicians was on the use of extended focused assessment with sonography in trauma (eFAST) (2.909 times), followed by hospital trauma code (2.778 times), dedicated trauma team (1.952 times), and following trauma scores (1.651 times). Conclusion: We found that majority of the centers are well equipped with optimal infrastructure, ATLS-trained physician, and management protocols. Still many aspects of trauma management need to be prioritized. There should be proactive involvement at an organizational level to manage trauma patients with a multidisciplinary approach. This survey gives us a deep insight into the current scenario of trauma care and can guide to strengthen across the country.

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  1. Indian Society for Trauma and Acute Care. Trauma in India: Factfile. Available at: Accessed on: 14 December 2022.
  2. Misra P, Majumdar A, Misra MC, Kant S, Gupta SK, Gupta A, et al. Epidemiological study of patients of road traffic injuries attending emergency department of a trauma center in New Delhi. Indian J Crit Care Med 2017;21(10):678–683. DOI: 10.4103/ijccm.IJCCM_197_17.
  3. Department of expenditure, Government of India. Classification of Indian Cities, Office Memorandum, Government of India. Available at: Accessed on: 1 September 2022.
  4. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-centre care on mortality. N Engl J Med 2006;354(4):366–366. DOI: 10.1056/NEJMsa052049.
  5. Magnone S, Allegri A, Belotti E, Castelli CC, Ceresoli M, Coccolini F, et al. Impact of ATLS guidelines, trauma team introduction, and 24-hour mortality due to severe trauma in a busy, metropolitan Italian hospital: A case–control study. Ulus Travma Acil Cerrahi Derg 2016;22(3):242–246. DOI: 10.5505/tjtes.2015.19540.
  6. Lo CJ, Hsu YE, Hsiao HY, Liu CP. Evaluation of a revised in-hospital trauma activation protocol according to clinical outcome for patients with major trauma. Formosan J Surg 2013;46(6):195–199. DOI: 10.1016/j.fjs.2013.07.003.
  7. Connolly R, Woo MY, Lampron J, Perry JJ. Factors associated with delay in trauma team activation and impact on patient outcomes. CJEM 2018;20(4):606–613. DOI: 10.1017/cem.2017.389.
  8. Eid MM, Al-Kaisy M. A look on trauma code activation in a major trauma centre in UAE: A descriptive study. J Emerg Practice Trauma 2020;6:82–86. DOI: 10.34172/jept.2020.16.
  9. Feldhaus I, Carvalho M, Waiz G, Igu J, Matthay Z, Dicker R, et al. The feasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: A systematic review. Trauma Surgery and Acute Care Open 2020;5:e000424. DOI: 10.1136/tsaco-2019-000424.
  10. Grossman MD. The role of emergency medicine physicians in trauma care in North America: Evolution of a speciality. Scand J Trauma Res Emerg Med 2009;17:37. DOI: 10.1186/1757-7241-17-37.
  11. Van Olden GD, Meeuwis JD, Bolhuis HW, Boxma H, Goris RJ. Clinical impact of advanced trauma life support. Am J Emerg Med 2004;22(7):522–525. DOI: 10.1016/j.ajem.2004.08.013.
  12. Aluisio AR, Barry MA, Martin KD, Mbanjumucyo G, Mutabazi ZA, Karim N, et al. Impact of emergency medicine training implementation on mortality outcomes in Kigali, Rwanda: An interrupted time-series study. Afr J Emerg Med 2019;9(1):14–20. DOI: 10.1016/j.afjem.2018.10.002.
  13. Holliman CJ, Mulligan TM, Suter RE, Cameron P, Wallis L, Anderson PD, et al. The efficacy and value of emergency medicine: a supportive literature review. Int J Emerg Med 2011;4:44. DOI: 10.1186/1865-1380-4-44.
  14. Bhoil R, Kumar R, Kaur J, Attri PK, Thakur R. Diagnosis of traumatic pneumothorax: A comparison between lung ultrasound and supine chest radiographs. Indian J Crit Care Med 2021;25(2):176–180. DOI: 10.5005/jp-journals-10071-23729.
  15. Hamada SR, Delhaye N, Kerever S, Harrois A, Duranteau J. Integrating eFAST in the initial management of stable trauma patients: The end of plain film radiography. Ann Intensive Care 2016;6(1):62. DOI: 10.1186/s13613-016-0166-0.
  16. Netherton S, Milenkovic V, Taylor M, Davis PJ. Diagnostic accuracy of e-FAST in the trauma patient: A systematic review and meta-analysis. CJEM 2019;21(6):727–738. DOI: 10.1017/cem.2019.381.
  17. Zileli M, Osorio-Fonseca E, Konovalov N, Cardenas-Jalabe C, Kaprovoy S, Mlyavykh S, et al. Early management of cervical spine trauma: WFNS spine committee recommendations. Neurospine 2020;17:710–722. DOI: 10.14245/ns.2040282.141.
  18. Gesu E, Bellone P, Bonzi M, Bertani GA, Brignolo Ottolini B, Bosco P, et al. Management of patients with cervical spine trauma in the emergency department: A systematic critical appraisal of guidelines with a view to developing standardized strategies for clinical practice. Intern Emerg Med 2021;16(8):2277–2296. DOI: 10.1007/s11739-021-02838-1.
  19. Dong WH, Yan WQ, Song X. Zhou WQ 1 2, Chen Z. Fluid resuscitation with balanced crystalloids versus normal saline in critically ill patients: A systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2022;30:28. DOI: 10.1186/s13049-022-01015-3.
  20. Rowell SE, Fair KA, Barbosa RR, Watters JM, Bulger EM, Holcomb JB, et al. On behalf of the PROMMTT Study Group. The impact of pre-hospital administration of lactated Ringer's solution versus normal saline in patients with traumatic brain injury. J Neurotrauma 2016;33(11):1054–1059. DOI: 10.1089/neu.2014.3478.
  21. Uchida K, Nishimura T, Hagawa N, Kaga S, Noda T, Shinyama N, et al. The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma. BMC Emerg Med 2020;20(1):26. DOI: 10.1186/s12873-020-00322-1.
  22. Sperry JL, Minei JP, Frankel HL, West MA, Harbrecht BG, Moore EE, et al. Early use of vasopressors after injury: caution before constriction. J Trauma 2008;64(1):9–14. DOI: 10.1097/TA.0b013e31815dd029.
  23. Vincent JL, Quintairos ESA, Couto L Jr, Taccone FS. The value of blood lactate kinetics in critically ill patients: A systematic review. Crit Care 2016;20(1):257. DOI: 10.1186/s13054-016-1403-5.
  24. Häske D, Böttiger BW, Bouillon B, Fischer M, Gaier G, Gliwitzky B, et al. Analgesia in patients with trauma in emergency medicine-a systematic review and meta-analysis. Dtsch Arztebl Int 2017;114(46):785–792. DOI: 10.3238/arztebl.2017.0785.
  25. Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, et al. The CRASH-2 trial: A randomised controlled trial and economic evaluation of the effects of TXA on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technology Assessment 2013;17(10):1–79. DOI: 10.3310/hta17100.
  26. Roberts I, Shakur–Still H, Aeron–Thomas A, Belli A, Brenner A, Chaudary MA, et al. Effects of TXA on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): A randomised, placebo-controlled trial. Lancet 2019;394(10210):1713–1723. DOI: 10.1016/S0140-6736(19)32233-0.
  27. Gulati A, Jain D, Agrawal NR, Rahate P, Choudhuri R, Das S, et al. Resuscitative effect of centhaquine (Lyfaquin®) in hypovolemic shock patients: A randomized, multicentric, controlled trial. Adv Ther 2021;38:3223–3265. DOI: 10.1007/s12325-021-01760-4.
  28. Cook AM, Jones GM, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, et al. Guidelines for the acute treatment of cerebral edema in neurocritical care patients. Neurocritical Care 2020;32(3):647–666. DOI: 10.1007/s12028-020-00959-7.
  29. Aiolfi A, Benjamin E, Khor D, Inaba K, Lam L, Demetriades D, et al. Brain trauma foundation guidelines for intracranial pressure monitoring: Compliance and effect on outcome. World J Surg 2017;41:1543–1549. DOI: 10.1007/s00268-017-3898-6.
  30. Han J, Yang S, Zhang C, Zhao M, Li A. Impact of intracranial pressure monitoring on prognosis of patients with severe traumatic brain injury: A PRISMA systematic review and meta-analysis. Medicine (Baltimore) 2016;95(7):e2827. DOI: 10.1097/MD.0000000000002827.
  31. Rønning P, Helseth E, Skaga NO, Stavem K, Langmoen IA. The effect of ICP monitoring in severe traumatic brain injury: A propensity score–weighted and adjusted regression approach. J Neurosurg 2019;131:1896–904. DOI: 10.3171/2018.7.JNS18270.
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