Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : PC01 - PC05 Full Version

Study of Trauma Profile and its Outcomes at a Tertiary Care Centre: Cohort Study of 1000 Cases


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/49103.15225
Bhupinder Singh Walia, Pankaj Dugg, Kanwaldeep Singh Aulakh, Sanjeev Sharma, Venita Kapur

1. Associate Professor, Department of Surgery, Government Medical College, Amritsar, Punjab, India. 2. Assistant Professor, Department of Surgery, Government Medical College, Amritsar, Punjab, India. 3. Assistant Professor, Department of Surgery, Government Medical College, Amritsar, Punjab, India. 4. Professor, Department of Surgery, Government Medical College, Amritsar, Punjab, India. 5. Professor (Retired), Department of Surgery, Government Medical College, Amritsar, Punjab, India.

Correspondence Address :
Dr. Pankaj Dugg,
Assistant Professor, Department of Surgery, Government Medical College, Amritsar, Punjab, India.
E-mail: dr_dugg@hotmail.com

Abstract

Introduction: Trauma has been the leading cause of mortality and morbidity. However, there are changes in pattern of trauma and their outcomes with time.

Aim: To study the mode and nature of injury and mortality associated with trauma of head, chest and abdomen.

Materials and Methods: A prospective cohort study was conducted on 1000 individuals that presented to emergency surgery ward from 2014 to 2019. Patients presented to emergency surgery of Government Medical College, Amritsar, Punjab, India were observed for various characteristics i.e., age group, mode of injury, site of injury, outcomes and management.

Results: The mean age of patients was 33.91±16.29 years with significant male predominance (n=794, 79.4%) (p-value 0.00001). Road Traffic Injuries (RTIs) were the most common mode of trauma affecting 490 patients (49%). Head injury was the most common of all injuries (n=834). Overall mortality was 3.6% (n=36). Mortality was higher in males (p-value 0.00933) and mortality rate of 25% was seen in age group of 61-70 years.

Conclusion: RTIs followed by assaults are the most common cause of trauma and it significantly affects young male population. However, mortality rate increases with increase in age group with higher rates in older age groups.

Keywords

Assault, Mortality, Road traffic injuries

Trauma is one of the leading threats to human life in this century involving all ages, sex, race and economic status. Injuries represent 12% of global burden of disease, making it the third most important cause of overall mortality and main cause of death in the age group of 1-40 years (1). Trauma is defined as physical injury which is due to the adverse effect of a physical force upon a person. These forces can be mechanical, thermal, ionising radiation and chemical (2). Approximately, a quarter of the 5.8 million deaths that occur from injuries are due to ‘RTI’ while suicide and homicide account for another quarter (3). Other main causes are falls, drowning, burns, poisoning and war (3). Globally, more than 90% of injury related deaths occur in low- and middle-income countries and almost twice the men die of injuries than women (3). RTIs are the 9th overall leading cause of Disability-Adjusted Life Years (DALYs) loss. The RTIs cause around 1.2 million deaths each year while number of injured could be as high as 50 million (1). In India, an estimated one million people die and 20 million are hospitalised due to trauma related injuries. National Crime Records Bureau (NCRB) reported that there were 413,457 deaths in road accidents in India in 2015 (4).

Majority of traumatic injuries are not life threatening but they impose a substantial burden on their families, communities, and society and health services/healthcare systems. Those who survive, it leaves life-long disabilities, pain and sufferings, time lost from work or family responsibilities and profound change in life style (2). In traumatic care and management time plays a very important role in shaping and providing a basis for initial medical response to the injured patient. The early assessment and management of the injured is largely protocol driven. Advanced Trauma Life Support (ATLS) system is commonly used worldwide as standardised protocol. The structure of ATLS include primary survey with simultaneous resuscitation, and identify and treat what is killing patient and sequence followed is airway, breathing, circulation and disability (Neurological). Then comes secondary survey to identify all other injuries and in the last definitive care to develop definitive management plan (4). The care of acutely injured people is public health issue that should involve bystanders and community members, healthcare professionals and healthcare systems. By identifying risk factors present within a community and creating solutions to decrease the incidence of injury, trauma referral systems can help to enhance the overall health of its population (5).

The aim of study was to know the incidence of surgical trauma, mode of injury, nature of injury, and mortality caused by traumati injuries.

Material and Methods

The prospective cohort study was conducted on 1000 patients admitted in emergency surgery ward in Department of General Surgery, Government Medical College, Amritsar, Punjab, India during a period of five years (November 2014 to October 2019). Approval from Institutional Ethics Committee was obtained (BFUHS/2k12/p-TH/1714). Non-probability sampling method was used.

Inclusion criteria: All cases of trauma of head, chest and abdomen presented to emergency surgery ward were included in the study.

Exclusion criteria: Exclusive injuries of extremities (injuries limited to extremities only) were excluded from the study.

Study Procedure

The study was focused on traumatic injuries of head chest and abdomen. Detailed history was taken regarding, mode of injury, nature of injury, site of injury and time of injury.

Investigations performed were:

1. Haemogram, Renal function tests, Blood grouping.
2. Radiological investigations:
(i) X-ray chest
(ii) Focused Assessment Sonography in Trauma (FAST)
(iii) Computed Tomography (CT) (if required)
(iv) X-ray of pelvis and limbs (if indicated).

Following surgical interventions were employed during this period for cases of head, chest and abdominal trauma:

1. Suturing of local lacerated wounds under local anaesthesia
2. Insertion of intercostal tube
3. Exploratory laparotomy under general anaesthesia.

Statistical Analysis

The statistical analysis was performed on Statistical Package for the Social Sciences (SPSS) software windows version 21.0. Association between the variables was done using Chi-square test keeping 0.05 significance level. The p-value <0.05 were considered significant.

Results

A total of 1000 patients who presented to emergency surgical ward with traumatic injuries were observed for various parameters.

Demographic profile: There were 794 (79.4%) male patients and 206 (20.6%) female patients and majority of them belonged to age group of 21-30 years. Only four cases were above 80 years of age (Table/Fig 1). There was significant association with regard to demographic profile with p-value of 0.00001. The youngest patient was 11-month-old female and oldest was an 89-year-old male. The mean age of patients was 33.91±16.29 years; 33.74±15.75 years for males and 34.50±18.27 years for females.

Mode of injury: Most common mode of injury were RTIs accounting for 49% followed by assaults {n=394 (39.4%)} (Table/Fig 2). Most commonly affected were males. However, no significant association was found with gender (p-value 0.237691).

Site of injury: It was observed that head injury was the most common site (83.4%) followed by extremities (41.6%) (Table/Fig 3).

Type of head injury distribution: Majority of patients had sustained lacerations (n=496) (Table/Fig 4). Majority had minor injuries while those with associated severe head injuries were referred to higher centre.

Type of chest injury distribution: Most of the patients sustained abrasions (Table/Fig 5). Out of 48 patients who had pneumothorax and haemothorax, 30 were managed with intercostal chest tube drainage.

Type of abdominal injury distribution: Most of the patients presented with blunt trauma (n=134). Thirty patients had solid organ injury in form of liver and splenic injury while 12 patients had small bowel injury in form of perforation of gut (Table/Fig 6). Overall 22 patients underwent exploratory laparotomy under general anaesthesia- 12 patients with history of penetrating trauma and 10 with blunt trauma. Out of 28 patients of penetrating trauma, eight left against medical advice.

Time taken from injury to arrival to hospital: Majority of patients arrived to hospital within 1-4 hours of injury. Only 10 patients reported to hospital after 2-3 days (Table/Fig 7).

Management profile and outcome in head injury patients: Most of patients were managed conservatively and discharged after 72 hours. 126 were referred to higher centre due to non-availability of neurosurgeon and 28 patients died (Table/Fig 8).

Management profile and outcome in chest injury patients: Out of 188 patients of chest trauma 30 patients required Intercostal Chest tube Drainage (ICD). Ten patients referred to higher centre due to associated head injuries (Table/Fig 9).

Management profile and outcome in abdominal injury patients: Out of 162 patients, eight patients died and four were referred due to associated head injuries. Twenty two patients underwent exploratory laparotomy (Table/Fig 10).

Mortality rate distribution: (Table/Fig 11) reveals majority of deaths occurred due to road traffic injuries. Out of 36 mortalities 32 were males and four were females, making mortality rate to be 4.03% in males and 1.94% in females (p-value 0.00933).

Age and sex mortality rate distribution: Majority of deaths have occurred in 5th decade followed by 7th and 6th decades of life (Table/Fig 12). Percentage mortality rate was higher in older age groups. However no significant association was found (p-value of 0.087074).

Discussion

The study was conducted on 1000 patients of trauma who presented to emergency surgery ward between 2014-2019 and the pattern of injury in terms of aetiology, management and outcome of head, chest and abdominal trauma were evaluated. In this study, majority of patients were males (n=794). This preponderance of males among those injured was consistent with data from World Health Organisation (WHO) (3). Other studies also showed a male predominance among injured as shown in (Table/Fig 13). The reason could be because mostly outdoor activities are carried out by males.

Majority of the patients belonged to age group of 21-40 (53%) (Table/Fig 1) (6),(7),(8),(9). In the study, conducted by Sogut O et al., most of injuries were suffered by those between 16-44 (57.6%) years of age and specifically in 30-44 age group (37.46%) (6). In another study, conducted by Kobusingye OC et al., majority of the injured patients were in age group of 21-40 years (51%) (10). The studies of Abhilash KP et al., and Kashid M et al., showed mean age to be 40.2±16.7 years and 42.45±15.7 years, respectively (11),(12). RTIs were the most common cause of traumatic injuries accounting for 49% followed by assaults (39.4%) and falls (9.6%) (Table/Fig 2). Similarly, another study conducted by Mitchell VT et al., showed road traffic crashes (45%) remain the leading cause of severe trauma, but there was a high prevalence of intentional and interpersonal violence too (42%) (13). However, Abhilash KP et al., and Kashid M et al., showed RTI followed by falls as common cause of trauma (11),(12). Beck B et al., also reported transport events and hangings were the most common cause of injury (32% and 24%, respectively) (14). In the present study, the assault cases were found to be common in male population (n=326) as compared to female patients (n=68) reflecting the aggressive behaviour of young male population.

Head injury remains the most common nature of injury constituting (n=834) (Table/Fig 3), while chest and abdominal injuries occurred in 188 and 162 patients, respectively. In study of Kashid M et al., most common part injured was head (n=1000; 37.7%) followed by chest (12%) (12). Most frequent cause of deaths reported by Osime OC et al., were head and neck trauma i.e., 53% of all deaths (7). Chalya PL et al., Kobusingye OC et al., also stated the same findings with head and injury seen in 95.5% cases and 44% cases, respectively (8),(10). In study conducted by Wang T et al., 77.86% of total fatality in RTIs were due to head trauma (15). Head injuries are common may be due to use of two wheelers in India is common and many drive without helmets.

Most of the head injury patients received scalp laceration. Majority are managed conservatively and discharged in satisfactory condition (n=440) (Table/Fig 8). Patient who required neurosurgical intervention had to be referred to higher centres (n=126). In study conducted by Bajracharya A et al., most cases were of haemorrhagic contusions and skull fractures which were 20.5% and 18.4% respectively (16). A 9% cases had epidural haematoma, 8.4% had subdural haematoma and 5.4% had traumatic subarachnoid haemorrhage (16). Kashid M et al., reported diffuse axonal injury as most common presentation of head injury (12).

In this study, 28 patients expired due to head injury which corresponds to mortality rate of 3.36%. Yattoo GH and Tabish A, showed mortality rate of 6.4% in head injury patients (17). In present study, 18.8% (n=188) had chest injury (Table/Fig 3). Most patients were managed conservatively. Out of 54 patients of haemothorax, pneumothorax and flail chest only 30 required ICD. These correspond to study conducted by Dalal S et al., where they managed 198 (out of 295) patients with ICD only (18).

Total patients in present study with abdominal trauma were 162 (Table/Fig 3). Most of them managed conservatively and only 22 required exploratory laparotomy. However, there were eight deaths which correspond to mortality rate of 4.94%. Bajracharya A et al., reported 14 cases of solid organ injury and 56 cases of gastrointestinal tract perforation (16). However, in present study there were 24 cases of gastrointestinal perforations and 30 cases of solid organ injury. Most of them were result of RTIs and falls. Only four cases of assault and one case of animal attack presented with abdominal injury.

The mortality was significantly higher in male population (p<0.05) (Table/Fig 11). RTIs were the commonest mode of injury leading to deaths. Mortality rate was higher in old age (Table/Fig 12). Study conducted in 2015 in Eastern Mediterranean Region showed overall mortality rate of 43.6 (Uncertainty Interval (UI) 38.5-48.5) per 100,000 in males, compared to a rate of 11.36 (UI 10.1-12.9) per 100,000 for female in transport injuries (19). Sogut O et al., reported mortality rate of 3.8% with males had 4.7% mortality as compared to females who had 1.8% (6). Bolandparvaz S et al., reported higher case fatality rate in males as compared to females (p<0.01) (9). Mitchell VT et al., showed that advancing age is risk factor for death, with mortality rates of 44.4% in those over 60 years and 25% in those who <60 years (13). In study conducted to see the mortality rates due to road injuries in Indian states it was found that deaths were higher in males (23.5-27.4 per 100000) as compared to females (7.2-9.1 per 100000) with overall age standardised death rates of 17.2 deaths per 100000. The global death rate for road injuries has decreased substantially from 1990 to 2017 but not much in India. Instead India’s share in global death rate has increased. To meet the Sustainable Development Goal (SDG) target by 2030 India needs to implement evidence-based road safety interventions, promote strong policies and traffic law enforcement, have better road and vehicle design, and improve care for road injuries (20).

Limitation(s)

The long-term follow-up and loss of function could not be assessed for the cases. The study was limited to few districts which are catered by the study centre.

Conclusion

Trauma is becoming leading cause of death in developed and developing nations. RTIs are the most common causes followed by assaults. Also, violence among young individuals is on rise. It erodes sense of security and safety so essential to the well-being of families and communities. Creating a society and environment that discourage aggressive and risky behaviours can curb this problem.

References

1.
Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, et al, editors. World report on road traffic injury prevention. Geneva: World Health Organisation, 2004.
2.
Handley R, Giannoudis PV. Introduction to trauma. In: Williams NS, Bulstrode CJK, O’Connell PR, editors. Bailey’s & Love, Short Practice of Surgery. 25th edition. London: Arnold; 2008. Pp. 271-74.
3.
Injuries and violence: the facts. Geneva, World Health Organisation, 2010.
4.
National Health portal. World Trauma Day 2019 [Internet]. MoHFW, Government of India; 2019 [updated 2019 Oct 21].
5.
Hoyt DB, Coimbra R. Trauma Systems. Surgical Clinics of North America 2007:87(1):21-35. Doi: 10.1016/j/suc.2006.09.012. PMID 17127121. [crossref] [PubMed]
6.
Sogut O, Sayhan MB, Gokdemir MT, Boleken ME, Behcet AL, Kose R, et al. Analysis of hospital mortality and epidemiology in trauma patients: A multi-center study. J Curr Surg. 2011;1(1):19-24. [crossref]
7.
Osime OC, Ighedosa SU, Oludiran OO, Iribhogbe PE, Ehikhamenor E, Elusoji SO. Pattern of trauma deaths in accident and emergency unit. Prehosp Disast Med. 2007;22(1):75-78. [crossref] [PubMed]
8.
Chalya PL, Gilyoma JM, Dass RM, McHembe MD, Matasha M, Mabula JB, et al. Trauma admissions to the intensive care unit at a reference hospital in Northwestern Tanzania. Scand J Trauma Resusc Emerg Med. 2011;19:61. Doi: 10.1186/1757-7241-19-61. [crossref] [PubMed]
9.
Bolandparvaz S, Yadollahi M, Abbasi HR, Anvar M. Injury patterns among various age and gender groups of trauma patients in Southern Iran: A cross sectional study. Medicine. 2017;96:41. [crossref] [PubMed]
10.
Kobusingye OC, Guwatudde D, Owor G, Lett RR. Citywide trauma experience in Kampala, Uganda: A call for intervention. Inj Prev. 2002;8:133-36. Doi: 10.1136/ip.8.2.133. [crossref] [PubMed]
11.
Abhilash KP, Chakraborthy N, Pandian GR, Dhanawade VS, Bhanu TK, Priya K. Profile of trauma patients in the emergency department of a tertiary care hospital in South India. J Family Med Prim Care. 2016;5:558-63. Doi: 10.4103/2249-4863.197279. [crossref] [PubMed]
12.
Kashid M, Rai SK, Nath SK, Gupta TP, Shaki O, Mahender P, et al. Epidemiology and outcome of trauma victims admitted in trauma centers of tertiary care hospitals- A multicentric study in India. Int J Crit Illn Inj Sci. 2020;10:09-15. [crossref] [PubMed]
13.
Mitchell VT, Scarlet MD, Amata AO. Trauma admissions to the ICU of the University Hospital of the West Indies, Kingston, Jamaica. Fall/Winter. 2001.
14.
Beck B, Smith K, Mercier E, Gabbe B, Bassed R, Mitra B, et al. Differences in the epidemiology of out-of-hospital and in-hospital trauma deaths. PLoS ONE. 2019;14(6):e0217158. https://doi.org/10.1371/journal.pone.0217158. [crossref] [PubMed]
15.
Wang T, Wang Y, Xu T, Li L, Huo M, Li X, et al. Epidemiological and clinical characteristics of 3327 cases of traffic trauma deaths in Beijing from 2008 to 2017: A retrospective analysis. Medicine. 2020;99:1. [crossref] [PubMed]
16.
Bajracharya A, Agrawal A, Yam BR, Agrawal CS, Lewis O. Spectrum of surgical trauma and associated head injuries at a university hospital in eastern Nepal. J Neurosci Rural Pract. 2010;1:02-08. [crossref] [PubMed]
17.
Yattoo GH, Tabish A. The profile of head injuries and traumatic brain injury deaths in Kashmir. Journal of Trauma Management & Outcomes. 2008;2:5. Doi: 10.1186/1752-2897-2-5. [crossref] [PubMed]
18.
Dalal S, Nityasha, Vashisht M, Dahiya R. Prevelance of chest trauma at an apex Institute of North India: A retrospective study. Internet J Surg. 2008;18(1):84-89. Doi: 10.5580/824. [crossref]
19.
GBD 2015. Eastern Mediterranean Region Transportation Injuries Collaborators. Transport injuries and deaths in the Eastern Mediterranean Region: Findings from the Global Burden of Disease 2015 Study. Int J Public Health. 2018;63(1):S187-98. [crossref] [PubMed]
20.
Dandona R. Mortality due to road injuries in the states of India: The Global Burden of Disease Study 1990-2017. The Lancet. 2020;5(2):e86-98. doi.org/10.1016/ S2468-2667(19)30246-4. [crossref]

DOI and Others

10.7860/JCDR/2021/49103.15225

Date of Submission: Feb 22, 2021
Date of Peer Review: May 21, 2021
Date of Acceptance: Jun 16, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 25, 2021
• Manual Googling: Jun 16, 2021
• iThenticate Software: Jul 07, 2021 (11%)

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