Open AccessTrain‐Associated Injuries Pose a Significant Burden on Trauma Care Systems of Emerging Economies
Author(s) -
Bagaria Dinesh Kumar,
Banerjee Niladri,
Gupta Amit,
Kumar Subodh,
Mishra Biplab,
Choudhary Narendra,
Kumar Abhinav,
Priyadarshini Pratyusha,
Sagar Sushma
Publication year - 2020
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-020-05563-6
Subject(s) - medicine , injury severity score , demographics , injury prevention , emergency medicine , trauma center , incidence (geometry) , retrospective cohort study , poison control , occupational safety and health , mortality rate , head injury , surgery , demography , physics , pathology , sociology , optics
Background The Indian railway system is the fourth largest in the world and causes about 15 deaths every day, due to intentional or unintentional reasons. This study presents a 5‐year retrospective analysis of patients injured due to train‐associated events, managed at a level‐1 trauma center in India. Materials and methods Hospital‐based trauma registry data of train‐associated injuries presenting between 2012 and 2016 were analyzed. Data from 726 patients were analyzed for demographics, injury events, injury regions, their management and outcomes. ISS and NISS were used to quantify the injury severity. Results Mean age was 33 years, with male‐to‐female ratio 86 to 14%. The majority of patients (62%) were between 20–40 years. The median ISS was 9 (IQR 4–16), median hospital stays 11 days (IQR6‐23), with in‐hospital mortality of 17.4%. Presence of head injury; ISS > 9 and CPR in ED were independent risk factors of mortality. Trespassers on the rail track had significantly more severe injuries compared to passengers (Median ISS 13 vs. 9, p = 0.012; Median NISS 22 vs.17, p = 0.015); however, mortality and hospital length of stay were not significantly different. Location of injury event (on platform or tracks) showed no difference between the severity of injuries, mortality and hospital length of stay. Conclusions Current study reports comprehensive injury patterns and outcomes of train‐associated injuries from a low‐ and middle‐income country (LMIC). Apart from the mortality, there is a high incidence of permanent disabilities from extremity amputations. No significant difference was noted in the severity and outcomes among patients injured on or off train platforms, emphasizing the need for comprehensive safety measures including enforcement and promoting safe behavior not only on locations like train tracks but equally at platforms.