title: Predicting early mortality in adult trauma patients admitted to three public university hospitals in urban India: a prospective multicentre cohort study.
abstract: BACKGROUND
  In India alone, more than one million people die yearly due to trauma. Identification of patients at risk of early mortality is crucial to guide clinical management and explain prognosis. Prediction models can support clinical judgement, but existing models have methodological limitations. The aim of this study was to derive a vital sign based prediction model for early mortality among adult trauma patients admitted to three public university hospitals in urban India.
  
  
  METHODS
  We conducted a prospective cohort study of adult trauma patients admitted to three urban university hospitals in India between October 2013 and January 2014. The outcome measure was mortality within 24 hours. We used logistic regression with restricted cubic splines to derive our model. We assessed model performance in terms of discrimination, calibration, and optimism.
  
  
  RESULTS
  A total of 1629 patients were included. Median age was 35, 80% were males. Mortality between admission and 24 hours was 6%. Our final model included systolic blood pressure, heart rate, and Glasgow coma scale. Our model displayed good discrimination, with an area under the receiver operating characteristics curve (AUROCC) of 0.85. Predicted mortality corresponded well with observed mortality, indicating good calibration.
  
  
  CONCLUSIONS
  This study showed that routinely recorded systolic blood pressure, heart rate, and Glasgow coma scale predicted early hospital mortality in trauma patients admitted to three public university hospitals in urban India. Our model needs to be externally validated before it can be applied in the clinical setting.
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, King Edward Memorial Hospital, Mumbai, India.
authors.forename: Monty
authors.initials: M
authors.lastname: Khajanchi
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, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.
authors.forename: Satish
authors.initials: S
authors.lastname: Dharap
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: Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhoi
authors.affiliation: Department of Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India.
authors.forename: Makhan Lal
authors.initials: ML
authors.lastname: Saha
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: D000328:Adult; D001794:Blood Pressure; D002138:Calibration; D002947:Cities; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate; D006760:Hospitalization / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D011379:Prognosis; D011446:Prospective Studies; D013599:Systole; D014947:Wounds and Injuries / Q000453:epidemiology*