title: Early hospital mortality among adult trauma patients significantly declined between 1998-2011: three single-centre cohorts from Mumbai, India.
abstract: BACKGROUND
  Traumatic injury causes more than five million deaths each year of which about 90% occur in low- and middle-income countries (LMIC). Hospital trauma mortality has been significantly reduced in high-income countries, but to what extent similar results have been achieved in LMIC has not been studied in detail. Here, we assessed if early hospital mortality in patients with trauma has changed over time in an urban lower middle-income setting.
  
  
  METHODS
  We conducted a retrospective study of patients admitted due to trauma in 1998, 2002, and 2011 to a large public hospital in Mumbai, India. Our outcome measure was early hospital mortality, defined as death between admission and 24-hours. We used multivariate logistic regression to assess the association between time and early hospital mortality, adjusting for patient case-mix. Injury severity was quantified using International Classification of Diseases-derived Injury Severity Score (ICISS). Major trauma was defined as ICISS<0.90.
  
  
  RESULTS
  We analysed data on 4189 patients out of which 86.5% were males. A majority of patients were between 15 and 55 years old and 36.5% had major trauma. Overall early hospital mortality was 8.9% in 1998, 6.0% in 2002, and 8.1% in 2011. Among major trauma patients, early hospital mortality was 13.4%, in 1998, 11.3% in 2002, and 10.9% in 2011. Compared to trauma patients admitted in 1998, those admitted in 2011 had lower odds for early hospital mortality (OR = 0.56, 95% CI = 0.41-0.76) including those with major trauma (OR = 0.57, 95% CI = 0.41-0.78).
  
  
  CONCLUSIONS
  We observed a significant reduction in early hospital mortality among patients with major trauma between 1998 and 2011. Improved survival was evident only after we adjusted for patient case-mix. This finding highlights the importance of risk-adjustment when studying longitudinal mortality trends.
authors.affiliation: Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Gerdin
authors.affiliation: Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India; School of Habitat, Tata Institute of Social Sciences, Mumbai, India.
authors.forename: Nobhojit
authors.initials: N
authors.lastname: Roy
authors.affiliation: Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.
authors.forename: Satish
authors.initials: S
authors.lastname: Dharap
authors.affiliation: Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.
authors.forename: Vineet
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Department of Surgery, Seth G. S. Medical College & King Edward Memorial Hospital, Mumbai, India.
authors.forename: Monty
authors.initials: M
authors.lastname: Khajanchi
authors.affiliation: Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Tomson
authors.affiliation: Division of Orthopedics and Biotechnology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Li
authors.initials: L
authors.lastname: Felländer Tsai
authors.affiliation: Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: von Schreeb
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult