National Trauma Database Jan 2008 to Dec 2008-Third Report
MINISTRY OF HEALTH,
MALAYSIA
National Trauma Database
January 2008 to December 2008
Third Report
MOH/S/CRC/14.10(TR)
National Trauma Database
Ministry of Health Malaysia
NATIONAL TRAUMA DATABASE
JANUARY 2008 TO DECEMBER 2008
THIRD REPORT
Edited by
Sabariah Faizah Jamaluddin
Mahathar Abd Wahab
Fatahul Laham Mohamed
Ismail Mohd Saiboon
Mohd Idzwan Zakaria
Mohd Yusof Abdul Wahab
A publication of the
National Trauma Database
And
Clinical Research Centre, Ministry of Health
July 2010
©National Trauma Database, Malaysia
Published by the
National Trauma Database (NTrD)
Hospital Sungai Buloh
Jalan Hospital
47000 Sungai Buloh
Selangor Darul Ehsan
Malaysia
Tel
Fax
Email
Website
: 603-6145 4333
: 603-6157 2727
: ntrd@acrm.gov.my
: http://www.acrm.org.my/ntrd
Disclaimer
This report has been supplied by NTrD. The interpretation and reporting of these data are
the responsibility of the editors.
Suggested citation
The suggested citation for this report is as follows:
Sabariah Faizah Jamaluddin, Mahathar Abd Wahab, Fatahul Laham Mohamed,
IsmailMohd Saiboon, Mohd Idzwan Zakaria, Mohd Yusof Abdul Wahab (Eds)
NATIONAL TRAUMA DATABASE JANUARY 2008 TO DECEMBER 2008 - THIRD
REPORT, Malaysia 2010.
Electronic version
The electronic version of this report can be downloaded at http://www.acrm.org.my/ntrd
ACKNOWLEDGEMENTS
The National Trauma Database Committee would like to thank all those who have
participated and contributed to our third report, from January 2008 to December 2008.
We would like to especially thank the following:
1.
All centre coordinators, doctors, medical assistants and staff nurses from the
Emergency Departments of the participating hospitals. Without their commitment,
hard work, timely data collection and submission, this report would not be
possible.
2.
The Clinical Research Centre for its technical support, especially Dr Lim Teck
Onn, Dr Goh Pin Pik and Dr Jamaiyah Haniff, for their continuous support and
guidance.
3.
The Ministry of Health, Malaysia for the research grants to set up the registry.
i
INTRODUCTION
The purpose of this report is to provide a descriptive analysis of patients hospitalised with
major trauma in participating Ministry of Health (MOH) hospitals in Malaysia for 2008.
The data source for this report is the National Trauma Database (NTrD). Major trauma
cases were selected based on the following criteria:
i.
ii.
iii.
iv.
v.
Patients who died from injuries after admission.
Patients with Injury Severity Score (ISS) of >(more than) 15.
Patients admitted to Intensive Care Units (ICUs) or High Dependency Wards
(HDWs) for >(more than) 24 hours and who were mechanically ventilated.
Urgent surgery within 24 hours for intra-cranial, intra-thoracic, intraabdominal, or fixation for pelvic or spinal injuries.
All severe head injury patients rated 3-8 on the Glasgow Coma Scale (GCS)
The National Trauma Database 2008 – Third Report provides information about the
profile of persons with major trauma who were admitted to participating hospitals
throughout Malaysia.
The report is presented in Five Chapters:
Chapter 1 provides an overview on the demographics of the patients, including gender,
age group, race, admission time, admission day and admission type.
Chapter 2 discusses the injury details of the patients, such as injury mechanisms, injury
intent, injury causes, injury places, medical reviewers, disposition, ICU admission, and
systolic BP. The patients were also rated on the Glasgow Coma Scale (GCS), Revised
Trauma Score (RTS), Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS).
Chapter 3 describes the operative management carried out on patients, including the
management of operations and procedures.
Chapter 4 provides information on the outcome of the patients, which is then categorised
according to age groups, injury mechanisms, injury causes, injury places, the
mechanisms, causes and places of injury, admission types, systolic BP, GCS, RTS, AIS,
ISS, and ICU admission. The probability of survival is also measured using the Trauma
Revised Injury Severity Score (TRISS) methodology which includes the RTS, ISS,
mechanisms of injury and patient’s age.
Chapter 5 includes the total length of stay in hospital and ICU.
The limitations of the study are:
i.
Under reporting - The reported data came from less than the actual number of
cases.
ii
ii.
Missing data - Missing values not included in the analysis makes the sample
size for some of the time periods shorter than others.
Hopefully the information in this report will be used to implement strategies to strengthen
and improve trauma care in the country.
About NTrD
The National Trauma Database (NTrD) is a service initiated and supported by the
Ministry of Health (MOH) to collect information about trauma incidences in Malaysia,
and to evaluate its risk factors and treatment in the country. Such information will be of
use to the MOH, Non-Governmental Organisations, private healthcare providers and
other interested parties in programme planning and evaluation, leading to trauma
prevention and control.
The NTrD is co-sponsored by the following organisations of the Ministry of Health
Malaysia:
i.
ii.
iii.
iv.
Emergency Medical and Trauma Services
Neurosurgery Services
Surgery Services
Clinical Research Centre
The objectives of the NTrD are to:
1. Determine the frequency, mechanisms of injury and distribution of major trauma in
Malaysia. The statistics and data will be of importance in determining precisely the
private and public resources utilised in its management.
2. Determine the outcome and probability of survival of trauma patients.
3. Evaluate major trauma management practices in the participating hospitals and to come
up with guidelines for improved trauma care.
4. Determine the effectiveness and impact of the introduction of improved practices.
5. Stimulate and facilitate research on major trauma and its management.
The key data sources identified for this database are:
All Emergency Physicians and Neurosurgeons in Malaysia beginning with those
currently working in the MOH, and later extending to those beyond MOH (private
organisation, universities (private and university hospitals) and the Armed Forces),
for data on Major Trauma and Head Injury patients in the country.
iii
METHOD OF DATA COLLECTION
Coverage
In 2008 there were eight participating MOH hospitals. The number of these centres has
increased as with the previous two reports involving the May 2006 to April 2007 cases
and January 2007 to December 2007 cases.
Registration method
One Notification Form, called the Case Report Form (CRF), is employed in data
collection (Refer to Appendix A). The CRF gathers information on patient demography,
admission, injury details, clinical details, diagnostic and operative procedures, in-hospital
outcome and Injury Severity Scores. The CRFs are used as part of the clinical record. The
completed forms are sent to NTrD where the data is analysed, interpreted and presented
in regular reports and disseminated to the users. The participation of Source Data
Providers (SDPs) is entirely voluntary.
The data transferred to NTrD is kept strictly confidential with access only to authorised
individuals working in the NTrD.
Statistical analysis
This report is a descriptive analysis. All data is described in terms of percentages except
continuous data like length of stay (LOS). Missing data was ignored and the analysis
confined to available data. The TRISS methodology is used for the probability of survival
which incorporates ISS, RTS, mechanisms of injury and the patient’s age.
iv
MEMBERS OF THE STEERING COMMITTEE OF THE NTrD
1.
Dr Lim Teck Onn
(Chairman)
2.
Dr Sabariah Faizah
Jamaluddin
(Co-Chairman)
Dr Fatahul Laham
Mohamed
3.
4.
Dr Jamaiyah Bte Haniff
5.
Dr Mahathar
Wahab
6.
Dr Hoo Ling Ping
Bin
Clinical Research Centre,
Ministry of Health
Bte Head of Department
Emergency Department,
Hospital Sungai Buloh
Bin Head of Department
Emergency Department,
Hospital Sultanah Bahiyah
Head of Unit
Clinical Epidemiology Unit,
Clinical Research Centre
Abdul Emergency Physician
Emergency Department,
Kuala Lumpur Hospital
Consultant Biostatistician,
ClinResearch Sdn. Bhd.
SUPPORTING STAFF OF THE NTrD
1.
Role
Clinical Registry Manager (CRM)
2.
3.
4.
5.
6.
7.
Clinical Data Manager
Medical Reviewer
Clinical Epidemiologist
Clinical Economist
Consultant Biostatistician
Biostatistician
8.
9.
10.
11.
Web Application Developer
Desktop Publisher
Database Admin
Network Admin/ Engineer
Team member
Mr Mohd Fadhleen Bin Dom (October
2007 - July 2009)
Ms Lithnes Kalaivani Palniandy (July
2009 – present)
Ms Teo Jau Shya
Ms Anne John Michael
Dr Jamaiyah Bte Haniff
Dr Shanti Varatharajan
Dr Hoo Ling Ping
Ms Lena Yeap
Ms Siti Norhazrina Bte Abd Wahab
Mrs Sayani Bte Sabran
Mrs Azizah Bte Alimat
Ms Lim Jie Ying
Mr Adlan Bin Abdul Rahman
v
LIST OF PARTICIPATING CENTRES
1. Selayang Hospital
Department
Head of Department
Members
: Emergency and Trauma
: Dr Mohamed Alwi Bin Haji Abdul Rahman
: MA Hushaimi Bin Husin
: SN Afidah Bte Ibrahim
Department
Head of Department
Members
: Surgery
: Dr Fijerald Henry
: Dr Geeverughese C. George
: Dr Nor Azira Bte Ismail
2. Kuala Lumpur Hospital
Department
Head of Department
Coordinator
Members
: Emergency and Trauma
: Dato’ Dr Abu Hassan Asaari Bin Abdullah
: Dr Mahathar Bin Ab Wahab
: MA Mohd Ariff Bin Mohd Yusoff
: MA Mudzaffar Shah Bin Abdul Ghaffar
Department
Head of Department
Coordinator
Members
: Neurosurgery
: Mr Mohammed Saffari Bin Mohammed Haspani
: Mr N. Ramesh Narenthiranathan
: Dr Rahmat Bin Harun @ Haron
: MA Mohd Fariz Bin Mohd Zaini
3. Sultanah Bahiyah Hospital
Department
Head of Department
Members
: Emergency and Trauma
: Dr Fatahul Laham Bin Mohamed
: Dr Zaidah Bte M. Arif
: MA M Kamil Bin Din
: SN Hapisiah Bte Abu Kasim
Department
Head of Department
Coordinator
Members
: Surgery
: Mr Mohan Nallusamy
: Dr Wan Khamizar Bin Wan Kazim
: Dr Wan Najmi Bin Wan Daud
: Dr Jasjit Singh Nijhar
: MA Syahrulamri Bin Abdullah
vi
4. Pulau Pinang Hospital
Department
Head of Department
Members
: Emergency and Trauma
: Dr Teo Aik Howe
: MA Raj Kumar a/l Paramasiven
Department
Head of Department
Members
: Neurosurgery
: Mr K Ravindran a/l Kateerayson
: Dr Noor Hazlina Bte Zainuddin
: Dr Regunath a/l Kandasamy
: MA Mohd Imri Bin Ibrahim
5. Sultanah Aminah Hospital
Department
Head of Department
Members
: Emergency and Trauma
: Dr Md Saed Bin Mian
: MA Raschidi Bin Abdul Karim
: MA Radzman Bin Che Rus
: MA Ahmad Salimi Bin Mohd Noor
: MA Norzamzuri Bin Zakaria
Department
Head of Department
Members
: Surgery
: Mr Johari Siregar Bin Adnan
: Mr Noor Azman Bin A Rahman
: MA Rahmad Bin Jaafar
: SN Nurul Saadah Bte Saruan
6. Sungai Buloh Hospital
Department
Head of Department
Members
: Emergency and Trauma
: Dr Sabariah Faizah Jamaluddin
: MA Mazlan Bin Zakariya
: SN Asmalida Bte Md Emran
: MA Nik Mohd Kamil Bin Mat Taib
: MA Fairuz Zaman Bin Bohari
7. Tengku Ampuan Rahimah Hospital
Department
Head of Department
Coordinator
Members
: Emergency and Trauma
: Dr Ahmad Tajuddin Bin Mohamad Nor
: Dr Ranjini Sivaganabalan
: SN Marykutty Mathews
: Ms Mogana Krishnan
: SN Kartini Bte Ahmad
vii
8. UKM Medical Centre
Department
Head of Department
Coordinator
Members
: Emergency and Trauma
: Assoc Prof Dr Ismail Bin Mohd Saiboon
: Dr Muhammad Radhi Ahmad
: MA Abdul Karim Bin Mustafa
: MA Syed Hairul Zamaah Bin Said Abu Bakar
: MA Mohammad Azizi Bin Abu Bakar
: MA Bala Krishnian a/l Muniandy
viii
ABBREVIATIONS
AIS
BP
CRC
CRF
GCS
HDW
ICU
ISS
MOH
NTrD
OP
RTS
SDP
TRISS
Abbreviated Injury Scale
Blood Pressure
Clinical Research Centre
Case Report Form
Glasgow Coma Score
High Dependency Ward
Intensive Care Unit
Injury Severity Score
Ministry of Health
National Trauma Database
Operation Procedure
Revised Trauma Score
Source Data Provider
Trauma Revised Injury Severity Score
GLOSSARY
Disease Register
The on-going systemic collection, analysis and
interpretation of specific disease data essential to the
planning, implementation and evaluation of clinical and
public health practices, closely integrated with
dissemination of these data to those who need to know. The
final link in the chain is the application of these data to the
management, prevention and control of the disease. A
registration system includes a functional capacity for data
collection, analysis and dissemination, linked to clinical and
public health programmes.
Site
The location of a SDP reporting data on registrable patients
to the registry.
Source Data Providers
The individuals or institutions that report the required data
to the registry.
Sponsors
The individuals or institutions that own the registry.
Expert Panel
Individuals who are subject matter experts i.e. Emergency
Physicians and Neurosurgeons. The expert group will keep
abreast of the latest development in this area. They should
be convened to decide on the initial data collection process,
develop the Performa and data content, as well as a guide
for future development. They ensure that the database has a
sound technical as well as scientific basis.
ix
EDITORIAL TEAM
Chief Editor
:
Dr Sabariah Faizah Bte Jamaluddin
Members
:
Dr Mahathar Bin Abd Wahab
Dr Fatahul Laham Bin Mohamed
Assoc Prof Dr Ismail Bin Mohd Saiboon
NTrD
:
Ms Lithnes Kalaivani Palniandy
EXPERT PANEL ON REPORT WRITING
1. Dr Sabariah Faizah Bte Jamaluddin
2. Dr Mahathar Bin Abd Wahab
3. Dr Fatahul Laham Bin Mohamed
4. Assoc Prof Dr Ismail Bin Mohd Saiboon
5. Dr Mohd Idzwan Bin Zakaria
6. Mr Mohd Yusof Bin Abdul Wahab
x
Head
Emergency and Trauma Department,
Sungai Buloh Hospital
Emergency Physician
Emergency and Trauma Department
Kuala Lumpur Hospital
Emergency Physician
Emergency and Trauma Department
Sultanah Bahiyah Hospital
Emergency and Orthopaedic Surgeon
Emergency Medicine Department
University Kebangsaan Malaysia
Medical Centre
Emergency Physician
Emergency and Trauma Department
University Malaya Medical Centre
Consultant Surgeon
Department of Surgery
Tengku Ampuan Rahimah Hospital
CONTENTS
Acknowledgements
i
Introduction
ii
Method of Data Collection
iv
Members of the Steering Committee of the NTrD
v
Supporting Staff of the NTrD
v
List of Participating Centres of NTrD
vi
Abbreviations and Glossary
ix
Editorial Team
x
Expert Panel on Report Writing
x
Contents
xi
Report Summary
1
Listing of Tables
6
Listing of Figures
8
Chapter 1: Demographics
10
Chapter 2: Injury Details
21
Chapter 3: Operation Management
43
Chapter 4: Outcome
47
Chapter 5: Length of Stay
64
Appendix A: Notification Form and Follow- Up Form
72
xi
REPORT SUMMARY
CHAPTER 1: DEMOGRAPHICS
In 2008, a total of 147,607 trauma patients were admitted to the Emergency
Department of the eight participating centres. Out of these, 0.8 % were major
trauma patients. Majority of these cases (59.6 %) were direct admissions. The
highest admission of major trauma patients was from Centre B with a total of
41,617 patients (22.3 %).However, most of these cases from this centre were
referral cases in which most of the referrals were from other hospitals with
specialists. Centre H had the highest number of direct admission cases (100 %).
Majority of the major trauma patients were male (87.7 %), within the age groups
of 15-24 (32.4 %) and 25-34 (23 %). The Malays was the highest group (48.0%)
and 14.7 % of the total admissions were foreigners.
Friday was the busiest day with 15.6 % admissions, followed by Thursday (15.2
%). Most of the admissions occurred in the evening between 1801h and 2400h
(30.1 %).
CHAPTER 2: INJURY DETAILS
About ninety three percent (93.2 %) of major trauma cases were recorded as blunt
injury with about eighty eight percent (88.4 %) of the cases being unintentional.
Road traffic accidents contributed to 74.3 % of cases as compared to other causes
of injury. The most common road traffic accidents, 62 %, involved motorcycle
riders. Most of these cases were initially reviewed by the emergency and surgical
medical officers or trainees, 92.2 % and 79.8 % respectively. About twenty nine
percent (28.7 %) of major trauma cases were admitted to the general wards after
management in emergency departments. A total of 40.4 % cases were admitted to
ICUs.
1
About sixty two percent (61.8 %) of major trauma cases had systolic BP greater
than 120mmHg, while only 6.5 % of cases had systolic BP less than 90mmHg.
Most of the major trauma cases had Glasgow Coma Scale (GCS) of 3 to 8
(51.7%). Most of the intra-cranial injuries recorded were due to traumatic
subdural haemorrhage (43.7 %).
About thirty percent (29.6 %) of patients had low Revised Trauma Score (RTS) of
between 0 to =85
Age Group
Table 1.4. Major Trauma Cases by Age Group
Age group
>0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
≥85
TOTAL
No.
24
58
395
280
143
130
77
78
27
8
1220
14
%
1.97
4.75
32.38
22.95
11.72
10.66
6.31
6.39
2.21
0.66
100
50
45
40
35
30
25
20
15
10
Orang Asli
Not Available
Bumiputra Sabah
Bumiputra Sarawak
Other Malaysian
Foreigner
Indian
0
Chinese
5
Malay
Percentage of Major Trauma Cases (%)
Figure 1.5. Major Trauma Cases by Race
Race
Table 1.5. Major Trauma Cases by Race
Race
No.
%
Malay
Chinese
Indian
Orang Asli
Bumiputra Sabah
Bumiputra Sarawak
Other Malaysian
Foreigner
Not Available
TOTAL
586
255
184
0
4
5
6
179
1
1220
48.03
20.9
15.08
0
0.33
0.41
0.49
14.67
0.08
100
15
Figure 1.6. Time of Admission for Major Trauma Cases
30
Percentage of Major Trauma Cases (%)
28
26
24
22
20
18
16
14
12
10
8
6
4
2
0
0001-0600
0601-1200
1201-1800
1801-2400
Time of Admission
Table 1.6. Time of Admission for Major Trauma Cases
Time of Admission (Hours)
0001-0600
0601-1200
1201-1800
1801-2400
TOTAL
No.
283
264
305
367
1219
*1 case has no information on “Time of Admission”
16
%
23.22
21.66
25.02
30.11
100
Figure 1.7. Day of Admission for Major Trauma Cases
Percentage of Major Trauma Cases (%)
16
14
12
10
8
6
4
2
0
Sunday
Monday
T uesday
Wednesday
T hursday
Friday
Saturday
Day
Table 1.7. Day of Admission for Major Trauma Cases
Admission (Days)
No.
%
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
TOTAL
168
168
164
161
185
190
184
1220
13.77
13.77
13.44
13.2
15.16
15.57
15.08
100
17
Figure 1.8. Type of Admission for Major Trauma Cases
Percentage of Major Trauma Cases (%)
70
60
50
40
30
20
10
0
Direct
T ransferred / Referral
Admission Type
Table 1.8. Type of Admission for Major Trauma Cases
Admission Type
No.
%
Direct
Transferred / Referral
TOTAL
725
491
1216
59.62
40.38
100
*4 cases has no information on “Admission Type”
18
Figure 1.8a. Type of Admission for Major Trauma Cases by Centre
Direct
Transfer
Percentage of Major Trauma Cases (%)
100
80
60
40
20
0
A
B
C
D
E
F
G
H
Centre
Table 1.8a. Type of Admission for Major Trauma Cases by Centre
Centre
A
B
C
D
E
F
G
H
TOTAL
Transferred / Referred
From
No.
%
Direct
No.
%
63
78
112
82
45
81
173
91
725
94.03
28.89
70
50.93
47.37
68.64
68.11
100
59.62
4
192
48
79
50
37
81
0
491
*4 cases has no information on “Admission Type”
19
5.97
71.11
30
49.07
52.63
31.36
31.89
0
40.38
Total
67
270
160
161
95
118
254
91
1216
Figure 1.9. Type of Admission Referred From for Major Trauma Cases
Percentage of Major Trauma Cases (%)
45
40
35
30
25
20
15
10
5
0
Hospital with Specialist
Private Hospital
Hospital without Specialist
Private Clinics
Health Clinics
Source of Referral
Table 1.9. Type of Admission Referred From for Major Trauma Cases
Source of Referral
No.
%
Hospital with Specialist
Hospital without Specialist
Health Clinics
Private Hospital
Private Clinics
TOTAL
212
207
28
32
10
491
43.18
42.16
5.7
6.52
2.04
100
20
Chapter 2: INJURY DETAILS
Figure 2.1. Mechanism of Injury for Major Trauma Cases
Percentage of Major Trauma Cases (%)
90
80
70
60
50
40
30
20
10
0
Blunt
Penetrating
Burns
Mechanism of Injury
Table 2.1. Mechanism of Injury for Major Trauma Cases
Mechanism of Injury
No.
%
Blunt
Penetrating
Burns
TOTAL
1136
72
11
1219
93.19
5.91
0.9
100
* 1 case has no information on “Mechanism of Injury”
21
Figure 2.2. Major Trauma Cases by Injury Intent
Percentage of Major Trauma Cases (%)
80
60
40
20
Child Neglect/ Maltreatment
Domestic Violence
Intentional Self Harm
Intentional Assault
Intent Cannot be Determined
Unintentional
0
Injury Intent
Table 2.2. Major Trauma Cases by Injury Intent
Injury Intent
No.
%
Unintentional
Intentional Self Harm
Domestic Violence
Intent Cannot be Determined
Child Neglect / Maltreatment
Intentional Assault
TOTAL
1079
9
0
73
0
66
1220
88.44
0.74
0
5.98
0
5.41
100
22
70
60
50
40
30
20
Sports injury
Gunshot Wound
Burns
Others
Unknown
Industrial Accident
Stabbing
Fall under 2 metre
Other Assault
0
Fall over 2 metre
10
Road Traffic Accident
Percentage of Major Trauma Cases (%)
Figure 2.3. Major Trauma Cases by Cause of Injury
Cause of Injury
Table 2.3. Major Trauma Cases by Cause of Injury
Cause of Injury
No.
%
Road Traffic Accident
Industrial Accident
Fall over 2 meter
Fall under 2 meter (about one door’s height)
Sports injury
Burns
Stabbing
Gunshot Wound
Other Assault
Others
Unknown
TOTAL
900
20
89
59
1
10
28
8
58
18
20
1211
74.32
1.65
7.35
4.87
0.08
0.83
2.31
0.66
4.79
1.49
1.65
100
* 9 cases have no information on “Cause of Injury”
23
70
60
50
40
30
20
Front Seat Passenger
Back Seat Passenger
Bicyclist
Driver
Motorcycle Pillion
Pedestrian
0
Not Available
10
Motorcycle Rider
Percentage of Major Trauma Cases (%)
Figure 2.3a. Major Trauma Cases by Type of Road Traffic Accident
Type of Road Traffic Accident
Table 2.3a. Major Trauma Cases by Type of Road Traffic Accident
Type of Road Traffic Accident
No.
%
Motorcycle Rider
Motorcycle Pillion
Driver
Front Seat Passenger
Back Seat Passenger
Bicyclist
Pedestrian
Not Available
TOTAL
557
55
52
11
18
24
70
111
898
62.03
6.12
5.79
1.22
2
2.67
7.8
12.36
100
*2 cases have no information on “Type of Road Traffic Accident”
24
80
70
60
50
40
30
20
Sports Recreational Area
School / Kindergarten / Nursery
Unspecified Place
Residential
Other Specified Place
Trade / Service Area
Not Available
Industrial / Construction Area
0
Home
10
Road/Street/Highway
Percentage of Major Trauma Cases (%)
Figure 2.4. Major Trauma Cases by Place of Injury
Place of Injury
Table 2.4. Major Trauma Cases by Place of Injury
Place of Injury
No.
%
Road/Street/ Highway
Home
Industrial / Construction Area
School / Kindergarten / Nursery
Sports Recreational Area
Trade / Service Area
Residential Institution
Other Specified Place
Unspecified Place
Not Available
TOTAL
950
87
77
4
3
17
9
16
4
53
1220
77.87
7.13
6.31
0.33
0.25
1.39
0.74
1.31
0.33
4.34
100
25
Figure 2.5. Category of Initial Reviewing Officer in ED for Major Trauma Cases
Emergency Physician
Surgeon
Percentage of Major Trauma Cases (%)
100
90
80
70
60
50
40
30
20
10
0
Medical Officer / T rainee
Specialist / Consultant
Category of Initial Reviewing Officer
Table 2.5. Category of Initial Reviewing Officer in ED for Major Trauma Cases
Emergency
Surgeon
Physician
Category of Initial Reviewing Officer
No.
%
No.
%
Medical Officer/Trainee
Specialist/Consultant
TOTAL
* Included cases with both category of “Initial Reviewing Officer”
26
1136
92.21
764
79.83
96
7.79
193
20.17
1232
100
957
100
Figure 2.6. Disposition of Major Trauma Cases from ED
Percentage of Major Trauma Cases (%)
30
25
20
15
10
5
0
General Ward
OT
ICU
Mortuary
HDW
Other Hospital
AOR
Disposition from ED
Table 2.6. Disposition of Major Trauma Cases from ED
Disposition From ED
No.
%
ICU
OT
General Ward
Mortuary
AOR
HDW
Other Hospital
Not Available
TOTAL
275
284
348
118
4
100
80
5
1214
22.65
23.39
28.67
9.72
0.33
8.24
6.59
0.41
100
*6 cases have no information on “Disposition from ED”
27
Figure 2.7. ICU Admission for Major Trauma Cases
60
Percentage of Major Trauma Cases (%)
55
50
45
40
35
30
25
20
15
10
5
0
Yes
No
ICU Admission
Table 2.7. ICU Admission for Major Trauma Cases
ICU Admission
No.
%
Yes
No
TOTAL
490
723
1213
40.4
59.6
100
*7 cases have no information on “ICU Admission”.
28
Figure 2.7a. ICU Admissions for Major Trauma Cases by Centre
Yes
No
Percentage of Major Trauma Cases (%)
80
70
60
50
40
30
20
10
0
A
B
C
D
E
F
G
H
ICU Admissions
Table 2.7a. Total ICU Admissions for Major Trauma Cases by Centre
ICU admissions
Centre
A
B
C
D
E
F
G
H
TOTAL
Yes
No.
22
71
71
95
60
39
101
31
490
Total
No
%
32.84
26.1
44.38
59.01
61.86
33.05
40.73
34.44
40.4
No.
45
201
89
66
37
79
147
59
723
*7 cases have no information on “ICU Admission”.
29
%
67.16
73.9
55.63
40.99
38.14
66.95
59.27
65.56
59.6
67
272
160
161
97
118
248
90
1213
Figure 2.8. Major Trauma Cases by Systolic BP
65
Percentage of Major Trauma Cases (%)
60
55
50
45
40
35
30
25
20
15
10
5
0
1-49
50-75
76-89
90-120
>120
Systolic BP
Table 2.8. Major Trauma Cases by Systolic BP
Systolic BP
No.
%
1-49
50-75
76-89
90-120
>120
TOTAL
2
36
40
378
738
1194
0.17
3.02
3.35
31.66
61.81
100
*26 cases have no information on “Systolic BP”.
30
Figure 2.9. Major Trauma Cases by Glasgow Coma Scale (GCS)
55
Percentage of Major Trauma Cases (%)
50
45
40
35
30
25
20
15
10
5
0
13-15
9-12
3-8
GCS
Table 2.9. Major Trauma Cases by Glasgow Coma Scale (GCS)
Glasgow Coma Scale (GCS)
No.
%
13-15
359
29.64
9-12
226
18.66
3-8
626
51.69
TOTAL
1211
100
*9 cases have no information on “GCS”.
31
Percentage of Traumatic Brain Injured Patients (%)
Figure 2.10. Traumatic Brain Injuries for Major Trauma Cases
50
45
40
35
30
25
20
15
10
5
0
Intracranial Injury
Others
Skull and Facial
Bones Fracture
Open Head Wound
Traumatic Brain Injury
Table 2.10. Traumatic Brain Injuries for Major Trauma Cases
Traumatic Brain Injury
No.
%
Open Head Wound
Skull and Facial Bones Fracture
Intracranial Injury
Others
TOTAL
124
324
813
340
1601
7.75
20.24
50.78
21.24
100
* Included cases with more than one type of “Traumatic Brain Injury”.
32
Figure 2.11. Intracranial Injury for Major Trauma Cases
40
35
30
25
20
15
10
Focal brain injury
Intracracnial injury, unspecified
Intracranial injury with prolonged coma
Diffuse brain injury
Epidural haemorrhage
Traumatic cerebral oedema
Traumatic subarachnoid haemorrhage
Traumatic subdural haemorrhage
0
Other intracranial injuries
5
Concussion
Percentage of Intracranial Injury(%)
45
Intracranial Injury
Table 2.11. Intracranial Injury for Major Trauma Cases
Intracranial Injury
No.
Concussion
174
Traumatic cerebral oedema
160
Diffuse brain injury
50
Focal brain injury
8
Epidural hemorrhage
52
Traumatic subdural hemorrhage
395
Traumatic subarachnoid hemorrhage
195
Intracranial injury with prolonged coma
25
Others
173
Intracranial injury, unspecified
14
TOTAL
1246
* Included cases with more than one type of “Intracranial Injury”.
33
%
19.27
17.72
5.54
0.89
5.76
43.74
21.59
2.77
19.16
1.55
100
Figure 2.12. Major Trauma Cases by RTS
Percentage of Major Trauma Cases (%)
30
25
20
15
10
5
0
0-0.99
1-1.99
2-2.99
3-3.99
4-4.99
5-5.99
6-6.99
RTS
Table 2.12. Major Trauma Cases by RTS
RTS
No.
%
0-0.99
1-1.99
2-2.99
3-3.99
4-4.99
5-5.99
6-6.99
7-7.84
TOTAL
165
4
13
20
159
320
208
331
1220
13.52
0.33
1.07
1.64
13.03
26.23
17.05
27.13
100
34
7-7.84
Figure 2.13. Injuries According to Body Region for Major Trauma Cases
60
50
40
30
20
External
Abdomen/Pelvic content
Thorax
Face
0
Extremitis/ Pelvic girdle
10
Head & Neck
Percentage of Major Trauma Cases (%)
70
Body Region
Table 2.13. Injuries According to Body Region for Major Trauma Cases
Body Region
No.
%
Head & Neck
Face
Thorax
Abdomen/Pelvic content
Extremitis/ Pelvic girdle
External
1060
295
245
150
365
24
65.15
18.13
15.06
9.22
22.43
1.48
35
Figure 2.14. Abbreviated Injury Scale (AIS) for All Injuries for Major Trauma
Patients
30
AIS of Major Trauma Patients (%)
25
20
15
10
5
0
1
2
3
4
5
6
Abbreviated Injury Scale (AIS)
Table 2.14. Abbreviated Injury Scale (AIS) for All Injuries for Major Trauma
Patients
AIS
No.
%
1
2
3
4
5
6
TOTAL
928
1002
1045
787
256
3
4021
23.08
24.92
25.99
19.57
6.37
0.07
100
* Included cases with more than one record on “AIS”
36
Figure 2.14a. Abbreviated Injury Scale (AIS) Distribution According to Body
Region for Major Trauma Cases
Figure 2.14a(i). Head and Neck Region
70
65
60
55
Percentage(%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
5
6
AIS Distribution
Figure 2.14a(ii). Face Region
70
65
60
55
Percentage (%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
AIS Distribution
37
5
6
Figure 2.14a(iii). Thorax Region
70
65
60
55
Percentage(%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
5
6
AIS Distribution
Figure 2.14a(iv). Abdomen/Pelvic Content Region
70
65
60
55
Percentage(%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
AIS Distribution
38
5
6
Figure 2.14a(v). Extremitis /Pelvic Girdle Region
70
65
60
55
Percentage(%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
5
6
5
6
AIS Distribution
Figure 2.14a(vi). External Region
70
65
60
55
Percentage(%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
AIS Distribution
39
AIS
1
2
3
4
5
6
TOTAL
Table 2.14a. Distribution According to Body Region for Major Trauma Cases
Abdomen/
Extremitis/
Head and
Face
Thorax
Pelvic
Pelvic
External
Neck
content
girdle
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%
295
14.64
218
63.74
56
19.18
47
27.01
125
24.8
17
65.38
349
17.32
114
33.33
52
17.81
85
48.85
225
44.64
7
26.92
505
25.06
8
2.34
136
46.58
32
18.39
148
29.37
1
3.85
635
31.51
0
0
40
13.7
7
4.02
2
0.4
0
0
231
11.46
2
0.58
7
2.4
3
1.72
3
0.6
0
0
0
0
0
0
1
0.34
0
0
1
0.2
1
3.85
No.
758
832
830
684
246
3
%
22.61
24.81
24.75
20.4
7.34
0.09
2015
3353
100
100
342
100
292
100
174
40
100
504
100
26
100
Total
Figure 2.15. Body Region with Abbreviated Injury Scale (AIS) ≥ 3 for Major
Trauma Cases
80
70
AIS ≥ 3(%)
60
50
40
30
20
10
0
Head & Neck Thorax
Extremitis/
Pelvic girdle
Abdomen/
Pelvic
Face
External
Body Region
Table 2.15. Body Region with Abbreviated Injury Scale (AIS) ≥ 3 for Major
Trauma Cases
Body Region
No.
%
Head & Neck
Face
Thorax
Abdomen/Pelvic content
Extremitis/Pelvic girdle
External
TOTAL
1628
11
206
47
196
3
2091
77.86
0.53
9.85
2.25
9.37
0.14
100
41
Figure 2.16. Injury Severity Score (ISS) for Major Trauma Cases
70
Percentage of Major Trauma Cases (%)
65
60
55
50
45
40
35
30
25
20
15
10
5
0
40
Injury Severity Score (ISS)
Table 2.16. Injury Severity Score (ISS) for Major Trauma Cases
ISS
40
TOTAL
No.
%
165
91
788
160
16
1220
13.52
7.46
64.59
13.11
1.31
100
42
Chapter 3: PROCEDURES AND OPERATIVE MANAGEMENT
60
50
40
30
20
Pelvic Clamp/binding/ext.fixator
Needle Thoracocentesis
Chest Tube Insertation
Mechanical Ventalation
Ultrasound/FAST
0
Endotracheal Intubation
10
CTScan
Percentage of Major Trauma Cases(%)
Figure 3.1. Procedure Done in ED for Major Trauma Cases
Procedure Done in ED
Table 3.1. Procedure Done in ED for Major Trauma Cases
Procedure Done in ED
Endotracheal Intubation
Intubated at Referral Hospital
Intubated at Current Hospital
Not Available
Needles Thoracocentesis
Pelvic Clamp/Binding/ext. Fixator
CT Scan
Brain
Cervical Spine
Abdomen
Pelvis
Thorax
Others, specify
Mechanical Ventilation
Chest Tube Insertation
Ultrasound/FAST
No.
753
400
339
14
11
4
796
738
429
94
18
28
7
144
87
298
43
%
61.72
53.12
45.02
1.86
0.9
0.33
65.25
92.71
53.89
11.81
2.26
3.52
0.88
11.8
7.13
24.43
Figure 3.2. Operative Management for Major Trauma Cases
60
Percentage of Major Trauma Cases (%)
55
50
45
40
35
30
25
20
15
10
5
0
Yes
No
Operation Management
Table 3.2. Operative Management for Major Trauma Cases
Total
Operative Management
No.
%
Yes
564
46.88
No
639
53.12
TOTAL
1203
100
* 17 cases have no information on “Operative Management”
44
Figure 3.3. Operative Procedure for Major Trauma Cases
55
Percentage of Operative Procedure (%)
50
45
40
35
30
25
20
15
10
5
0
Intracranial
Others
Intra-abdominal Pelvic Fixation Spinal Surgery
Intrathoracic
Operative Procedure
Table 3.3. Operative Procedure for Major Trauma Cases
Operative Procedure
Intracranial
Intrathoracic
Intra-abdominal
Spinal Surgery
Pelvic Fixation
Others
TOTAL
No.
334
4
91
5
10
168
613
45
%
54.49
0.65
14.85
0.82
1.63
27.41
100
Figure 3.4. Types of Intracranial Procedure for Major Trauma Cases
Percentage of Intracranial Procedure (%)
30
25
20
15
10
5
Elevation of Depressed Skull Fracture
Intracranial Pressure(ICP) Monitoring
External Ventricular Drain
Others
Decompressive Craniectomy
Evacuation of Hematoma
0
Intracranial Procedure
Table 3.4. Types of Intracranial Procedure for Major Trauma Cases
Intracranial Procedure
No.
%
Evacuation of Hematoma
Decompressive Craniectomy
External Ventricular Drain
Intracranial Pressure(ICP) Monitoring
Elevation of Depressed Skull Fracture
Others
TOTAL
183
173
87
37
7
114
601
30.45
28.79
14.48
6.16
1.16
18.97
100
46
Chapter 4: OUTCOME
Figure 4.1. Total Outcome for Major Trauma Cases
Percentage of Major Trauma Cases (%)
70
60
50
40
30
20
10
0
Survivors
Death
Outcome
Table 4.1. Total Outcome for Major Trauma Cases
Outcome
No.
%
Survivors
Deaths
TOTAL
836
379
1215
68.81
31.19
100
*5 cases have no information in “Outcome”.
47
Figure 4.1a. Outcome for Major Trauma Cases by Centre
Survivors
Death
Percentage of Major Trauma Cases (%)
90
80
70
60
50
40
30
20
10
0
A
B
C
D
E
F
G
H
Centre
Table 4.1a. Outcome for Major Trauma Cases by Centre
Centre
A
B
C
D
E
F
G
H
TOTAL
Survivors
No.
46
210
101
113
45
69
178
74
836
Death
%
68.66
78.36
63.13
70.19
46.39
58.97
70.08
81.32
68.81
No.
21
58
59
48
52
48
76
17
379
*5 cases have no information in “Outcome”.
48
%
31.34
21.64
36.88
29.81
53.61
41.03
29.92
18.68
31.19
Total
67
268
160
161
97
117
254
91
1215
Figure 4.2. Disposition of Survivors at Discharge for Major Trauma Cases
75
70
Percentage of of Survivors (%)
65
60
55
50
45
40
35
30
25
20
15
10
5
Discharge Against Medical Advice
Transfer to Other Hosp.
Transfer to Referring Hosp.
Discharge Home
0
Disposition
Table 4.2. Disposition of Survivors at Discharge for Major Trauma Cases
Disposition of Survivors
No.
579
127
87
33
826
Discharge Home
Transfer to Referring Hospital
Transfer to Other Hospital
Discharge Against Medical Advice
TOTAL
*10 cases from total number of “Survivors” have no information on discharge.
49
Survivors
%
70.1
15.38
10.53
4
100
Figure 4.3. Outcome for Major Trauma Cases by Age Group
Survivors
Death
Percentage of Major Trauma Cases(%)
90
80
70
60
50
40
30
20
10
0
0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
>=85
Age Group
Table 4.3. Outcome for Major Trauma Cases by Age Group
Age
Group
(years)
0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
≥85
TOTAL
Survivors
Death
Total
No.
%
No.
%
No.
%
16
49
288
205
102
87
37
36
14
2
836
69.57
84.48
73.1
73.21
71.83
67.44
48.68
46.15
51.85
25
68.81
7
9
106
75
40
42
39
42
13
6
379
30.43
15.52
26.9
26.79
28.17
32.56
51.32
53.85
48.15
75
31.19
23
58
394
280
142
129
76
78
27
8
1215
1.89
4.77
32.43
23.05
11.69
10.62
6.26
6.42
2.22
0.66
100
50
Figure 4.4. Mechanism of Injury by Outcome for Total Major Trauma Cases
Survivors
Death
Percentage of Major Trauma Cases(%)
80
70
60
50
40
30
20
10
0
Blunt
Penetrating
Burns
Mechanism of Injury
Table 4.4. Outcome for Major Trauma Cases by Mechanism of Injury
Mechanism of Injury
Blunt
Penetrating
Burns
TOTAL
Survivors
No.
%
774
68.44
57
79.17
5
45.45
836
68.86
No.
357
MALAYSIA
National Trauma Database
January 2008 to December 2008
Third Report
MOH/S/CRC/14.10(TR)
National Trauma Database
Ministry of Health Malaysia
NATIONAL TRAUMA DATABASE
JANUARY 2008 TO DECEMBER 2008
THIRD REPORT
Edited by
Sabariah Faizah Jamaluddin
Mahathar Abd Wahab
Fatahul Laham Mohamed
Ismail Mohd Saiboon
Mohd Idzwan Zakaria
Mohd Yusof Abdul Wahab
A publication of the
National Trauma Database
And
Clinical Research Centre, Ministry of Health
July 2010
©National Trauma Database, Malaysia
Published by the
National Trauma Database (NTrD)
Hospital Sungai Buloh
Jalan Hospital
47000 Sungai Buloh
Selangor Darul Ehsan
Malaysia
Tel
Fax
Website
: 603-6145 4333
: 603-6157 2727
: ntrd@acrm.gov.my
: http://www.acrm.org.my/ntrd
Disclaimer
This report has been supplied by NTrD. The interpretation and reporting of these data are
the responsibility of the editors.
Suggested citation
The suggested citation for this report is as follows:
Sabariah Faizah Jamaluddin, Mahathar Abd Wahab, Fatahul Laham Mohamed,
IsmailMohd Saiboon, Mohd Idzwan Zakaria, Mohd Yusof Abdul Wahab (Eds)
NATIONAL TRAUMA DATABASE JANUARY 2008 TO DECEMBER 2008 - THIRD
REPORT, Malaysia 2010.
Electronic version
The electronic version of this report can be downloaded at http://www.acrm.org.my/ntrd
ACKNOWLEDGEMENTS
The National Trauma Database Committee would like to thank all those who have
participated and contributed to our third report, from January 2008 to December 2008.
We would like to especially thank the following:
1.
All centre coordinators, doctors, medical assistants and staff nurses from the
Emergency Departments of the participating hospitals. Without their commitment,
hard work, timely data collection and submission, this report would not be
possible.
2.
The Clinical Research Centre for its technical support, especially Dr Lim Teck
Onn, Dr Goh Pin Pik and Dr Jamaiyah Haniff, for their continuous support and
guidance.
3.
The Ministry of Health, Malaysia for the research grants to set up the registry.
i
INTRODUCTION
The purpose of this report is to provide a descriptive analysis of patients hospitalised with
major trauma in participating Ministry of Health (MOH) hospitals in Malaysia for 2008.
The data source for this report is the National Trauma Database (NTrD). Major trauma
cases were selected based on the following criteria:
i.
ii.
iii.
iv.
v.
Patients who died from injuries after admission.
Patients with Injury Severity Score (ISS) of >(more than) 15.
Patients admitted to Intensive Care Units (ICUs) or High Dependency Wards
(HDWs) for >(more than) 24 hours and who were mechanically ventilated.
Urgent surgery within 24 hours for intra-cranial, intra-thoracic, intraabdominal, or fixation for pelvic or spinal injuries.
All severe head injury patients rated 3-8 on the Glasgow Coma Scale (GCS)
The National Trauma Database 2008 – Third Report provides information about the
profile of persons with major trauma who were admitted to participating hospitals
throughout Malaysia.
The report is presented in Five Chapters:
Chapter 1 provides an overview on the demographics of the patients, including gender,
age group, race, admission time, admission day and admission type.
Chapter 2 discusses the injury details of the patients, such as injury mechanisms, injury
intent, injury causes, injury places, medical reviewers, disposition, ICU admission, and
systolic BP. The patients were also rated on the Glasgow Coma Scale (GCS), Revised
Trauma Score (RTS), Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS).
Chapter 3 describes the operative management carried out on patients, including the
management of operations and procedures.
Chapter 4 provides information on the outcome of the patients, which is then categorised
according to age groups, injury mechanisms, injury causes, injury places, the
mechanisms, causes and places of injury, admission types, systolic BP, GCS, RTS, AIS,
ISS, and ICU admission. The probability of survival is also measured using the Trauma
Revised Injury Severity Score (TRISS) methodology which includes the RTS, ISS,
mechanisms of injury and patient’s age.
Chapter 5 includes the total length of stay in hospital and ICU.
The limitations of the study are:
i.
Under reporting - The reported data came from less than the actual number of
cases.
ii
ii.
Missing data - Missing values not included in the analysis makes the sample
size for some of the time periods shorter than others.
Hopefully the information in this report will be used to implement strategies to strengthen
and improve trauma care in the country.
About NTrD
The National Trauma Database (NTrD) is a service initiated and supported by the
Ministry of Health (MOH) to collect information about trauma incidences in Malaysia,
and to evaluate its risk factors and treatment in the country. Such information will be of
use to the MOH, Non-Governmental Organisations, private healthcare providers and
other interested parties in programme planning and evaluation, leading to trauma
prevention and control.
The NTrD is co-sponsored by the following organisations of the Ministry of Health
Malaysia:
i.
ii.
iii.
iv.
Emergency Medical and Trauma Services
Neurosurgery Services
Surgery Services
Clinical Research Centre
The objectives of the NTrD are to:
1. Determine the frequency, mechanisms of injury and distribution of major trauma in
Malaysia. The statistics and data will be of importance in determining precisely the
private and public resources utilised in its management.
2. Determine the outcome and probability of survival of trauma patients.
3. Evaluate major trauma management practices in the participating hospitals and to come
up with guidelines for improved trauma care.
4. Determine the effectiveness and impact of the introduction of improved practices.
5. Stimulate and facilitate research on major trauma and its management.
The key data sources identified for this database are:
All Emergency Physicians and Neurosurgeons in Malaysia beginning with those
currently working in the MOH, and later extending to those beyond MOH (private
organisation, universities (private and university hospitals) and the Armed Forces),
for data on Major Trauma and Head Injury patients in the country.
iii
METHOD OF DATA COLLECTION
Coverage
In 2008 there were eight participating MOH hospitals. The number of these centres has
increased as with the previous two reports involving the May 2006 to April 2007 cases
and January 2007 to December 2007 cases.
Registration method
One Notification Form, called the Case Report Form (CRF), is employed in data
collection (Refer to Appendix A). The CRF gathers information on patient demography,
admission, injury details, clinical details, diagnostic and operative procedures, in-hospital
outcome and Injury Severity Scores. The CRFs are used as part of the clinical record. The
completed forms are sent to NTrD where the data is analysed, interpreted and presented
in regular reports and disseminated to the users. The participation of Source Data
Providers (SDPs) is entirely voluntary.
The data transferred to NTrD is kept strictly confidential with access only to authorised
individuals working in the NTrD.
Statistical analysis
This report is a descriptive analysis. All data is described in terms of percentages except
continuous data like length of stay (LOS). Missing data was ignored and the analysis
confined to available data. The TRISS methodology is used for the probability of survival
which incorporates ISS, RTS, mechanisms of injury and the patient’s age.
iv
MEMBERS OF THE STEERING COMMITTEE OF THE NTrD
1.
Dr Lim Teck Onn
(Chairman)
2.
Dr Sabariah Faizah
Jamaluddin
(Co-Chairman)
Dr Fatahul Laham
Mohamed
3.
4.
Dr Jamaiyah Bte Haniff
5.
Dr Mahathar
Wahab
6.
Dr Hoo Ling Ping
Bin
Clinical Research Centre,
Ministry of Health
Bte Head of Department
Emergency Department,
Hospital Sungai Buloh
Bin Head of Department
Emergency Department,
Hospital Sultanah Bahiyah
Head of Unit
Clinical Epidemiology Unit,
Clinical Research Centre
Abdul Emergency Physician
Emergency Department,
Kuala Lumpur Hospital
Consultant Biostatistician,
ClinResearch Sdn. Bhd.
SUPPORTING STAFF OF THE NTrD
1.
Role
Clinical Registry Manager (CRM)
2.
3.
4.
5.
6.
7.
Clinical Data Manager
Medical Reviewer
Clinical Epidemiologist
Clinical Economist
Consultant Biostatistician
Biostatistician
8.
9.
10.
11.
Web Application Developer
Desktop Publisher
Database Admin
Network Admin/ Engineer
Team member
Mr Mohd Fadhleen Bin Dom (October
2007 - July 2009)
Ms Lithnes Kalaivani Palniandy (July
2009 – present)
Ms Teo Jau Shya
Ms Anne John Michael
Dr Jamaiyah Bte Haniff
Dr Shanti Varatharajan
Dr Hoo Ling Ping
Ms Lena Yeap
Ms Siti Norhazrina Bte Abd Wahab
Mrs Sayani Bte Sabran
Mrs Azizah Bte Alimat
Ms Lim Jie Ying
Mr Adlan Bin Abdul Rahman
v
LIST OF PARTICIPATING CENTRES
1. Selayang Hospital
Department
Head of Department
Members
: Emergency and Trauma
: Dr Mohamed Alwi Bin Haji Abdul Rahman
: MA Hushaimi Bin Husin
: SN Afidah Bte Ibrahim
Department
Head of Department
Members
: Surgery
: Dr Fijerald Henry
: Dr Geeverughese C. George
: Dr Nor Azira Bte Ismail
2. Kuala Lumpur Hospital
Department
Head of Department
Coordinator
Members
: Emergency and Trauma
: Dato’ Dr Abu Hassan Asaari Bin Abdullah
: Dr Mahathar Bin Ab Wahab
: MA Mohd Ariff Bin Mohd Yusoff
: MA Mudzaffar Shah Bin Abdul Ghaffar
Department
Head of Department
Coordinator
Members
: Neurosurgery
: Mr Mohammed Saffari Bin Mohammed Haspani
: Mr N. Ramesh Narenthiranathan
: Dr Rahmat Bin Harun @ Haron
: MA Mohd Fariz Bin Mohd Zaini
3. Sultanah Bahiyah Hospital
Department
Head of Department
Members
: Emergency and Trauma
: Dr Fatahul Laham Bin Mohamed
: Dr Zaidah Bte M. Arif
: MA M Kamil Bin Din
: SN Hapisiah Bte Abu Kasim
Department
Head of Department
Coordinator
Members
: Surgery
: Mr Mohan Nallusamy
: Dr Wan Khamizar Bin Wan Kazim
: Dr Wan Najmi Bin Wan Daud
: Dr Jasjit Singh Nijhar
: MA Syahrulamri Bin Abdullah
vi
4. Pulau Pinang Hospital
Department
Head of Department
Members
: Emergency and Trauma
: Dr Teo Aik Howe
: MA Raj Kumar a/l Paramasiven
Department
Head of Department
Members
: Neurosurgery
: Mr K Ravindran a/l Kateerayson
: Dr Noor Hazlina Bte Zainuddin
: Dr Regunath a/l Kandasamy
: MA Mohd Imri Bin Ibrahim
5. Sultanah Aminah Hospital
Department
Head of Department
Members
: Emergency and Trauma
: Dr Md Saed Bin Mian
: MA Raschidi Bin Abdul Karim
: MA Radzman Bin Che Rus
: MA Ahmad Salimi Bin Mohd Noor
: MA Norzamzuri Bin Zakaria
Department
Head of Department
Members
: Surgery
: Mr Johari Siregar Bin Adnan
: Mr Noor Azman Bin A Rahman
: MA Rahmad Bin Jaafar
: SN Nurul Saadah Bte Saruan
6. Sungai Buloh Hospital
Department
Head of Department
Members
: Emergency and Trauma
: Dr Sabariah Faizah Jamaluddin
: MA Mazlan Bin Zakariya
: SN Asmalida Bte Md Emran
: MA Nik Mohd Kamil Bin Mat Taib
: MA Fairuz Zaman Bin Bohari
7. Tengku Ampuan Rahimah Hospital
Department
Head of Department
Coordinator
Members
: Emergency and Trauma
: Dr Ahmad Tajuddin Bin Mohamad Nor
: Dr Ranjini Sivaganabalan
: SN Marykutty Mathews
: Ms Mogana Krishnan
: SN Kartini Bte Ahmad
vii
8. UKM Medical Centre
Department
Head of Department
Coordinator
Members
: Emergency and Trauma
: Assoc Prof Dr Ismail Bin Mohd Saiboon
: Dr Muhammad Radhi Ahmad
: MA Abdul Karim Bin Mustafa
: MA Syed Hairul Zamaah Bin Said Abu Bakar
: MA Mohammad Azizi Bin Abu Bakar
: MA Bala Krishnian a/l Muniandy
viii
ABBREVIATIONS
AIS
BP
CRC
CRF
GCS
HDW
ICU
ISS
MOH
NTrD
OP
RTS
SDP
TRISS
Abbreviated Injury Scale
Blood Pressure
Clinical Research Centre
Case Report Form
Glasgow Coma Score
High Dependency Ward
Intensive Care Unit
Injury Severity Score
Ministry of Health
National Trauma Database
Operation Procedure
Revised Trauma Score
Source Data Provider
Trauma Revised Injury Severity Score
GLOSSARY
Disease Register
The on-going systemic collection, analysis and
interpretation of specific disease data essential to the
planning, implementation and evaluation of clinical and
public health practices, closely integrated with
dissemination of these data to those who need to know. The
final link in the chain is the application of these data to the
management, prevention and control of the disease. A
registration system includes a functional capacity for data
collection, analysis and dissemination, linked to clinical and
public health programmes.
Site
The location of a SDP reporting data on registrable patients
to the registry.
Source Data Providers
The individuals or institutions that report the required data
to the registry.
Sponsors
The individuals or institutions that own the registry.
Expert Panel
Individuals who are subject matter experts i.e. Emergency
Physicians and Neurosurgeons. The expert group will keep
abreast of the latest development in this area. They should
be convened to decide on the initial data collection process,
develop the Performa and data content, as well as a guide
for future development. They ensure that the database has a
sound technical as well as scientific basis.
ix
EDITORIAL TEAM
Chief Editor
:
Dr Sabariah Faizah Bte Jamaluddin
Members
:
Dr Mahathar Bin Abd Wahab
Dr Fatahul Laham Bin Mohamed
Assoc Prof Dr Ismail Bin Mohd Saiboon
NTrD
:
Ms Lithnes Kalaivani Palniandy
EXPERT PANEL ON REPORT WRITING
1. Dr Sabariah Faizah Bte Jamaluddin
2. Dr Mahathar Bin Abd Wahab
3. Dr Fatahul Laham Bin Mohamed
4. Assoc Prof Dr Ismail Bin Mohd Saiboon
5. Dr Mohd Idzwan Bin Zakaria
6. Mr Mohd Yusof Bin Abdul Wahab
x
Head
Emergency and Trauma Department,
Sungai Buloh Hospital
Emergency Physician
Emergency and Trauma Department
Kuala Lumpur Hospital
Emergency Physician
Emergency and Trauma Department
Sultanah Bahiyah Hospital
Emergency and Orthopaedic Surgeon
Emergency Medicine Department
University Kebangsaan Malaysia
Medical Centre
Emergency Physician
Emergency and Trauma Department
University Malaya Medical Centre
Consultant Surgeon
Department of Surgery
Tengku Ampuan Rahimah Hospital
CONTENTS
Acknowledgements
i
Introduction
ii
Method of Data Collection
iv
Members of the Steering Committee of the NTrD
v
Supporting Staff of the NTrD
v
List of Participating Centres of NTrD
vi
Abbreviations and Glossary
ix
Editorial Team
x
Expert Panel on Report Writing
x
Contents
xi
Report Summary
1
Listing of Tables
6
Listing of Figures
8
Chapter 1: Demographics
10
Chapter 2: Injury Details
21
Chapter 3: Operation Management
43
Chapter 4: Outcome
47
Chapter 5: Length of Stay
64
Appendix A: Notification Form and Follow- Up Form
72
xi
REPORT SUMMARY
CHAPTER 1: DEMOGRAPHICS
In 2008, a total of 147,607 trauma patients were admitted to the Emergency
Department of the eight participating centres. Out of these, 0.8 % were major
trauma patients. Majority of these cases (59.6 %) were direct admissions. The
highest admission of major trauma patients was from Centre B with a total of
41,617 patients (22.3 %).However, most of these cases from this centre were
referral cases in which most of the referrals were from other hospitals with
specialists. Centre H had the highest number of direct admission cases (100 %).
Majority of the major trauma patients were male (87.7 %), within the age groups
of 15-24 (32.4 %) and 25-34 (23 %). The Malays was the highest group (48.0%)
and 14.7 % of the total admissions were foreigners.
Friday was the busiest day with 15.6 % admissions, followed by Thursday (15.2
%). Most of the admissions occurred in the evening between 1801h and 2400h
(30.1 %).
CHAPTER 2: INJURY DETAILS
About ninety three percent (93.2 %) of major trauma cases were recorded as blunt
injury with about eighty eight percent (88.4 %) of the cases being unintentional.
Road traffic accidents contributed to 74.3 % of cases as compared to other causes
of injury. The most common road traffic accidents, 62 %, involved motorcycle
riders. Most of these cases were initially reviewed by the emergency and surgical
medical officers or trainees, 92.2 % and 79.8 % respectively. About twenty nine
percent (28.7 %) of major trauma cases were admitted to the general wards after
management in emergency departments. A total of 40.4 % cases were admitted to
ICUs.
1
About sixty two percent (61.8 %) of major trauma cases had systolic BP greater
than 120mmHg, while only 6.5 % of cases had systolic BP less than 90mmHg.
Most of the major trauma cases had Glasgow Coma Scale (GCS) of 3 to 8
(51.7%). Most of the intra-cranial injuries recorded were due to traumatic
subdural haemorrhage (43.7 %).
About thirty percent (29.6 %) of patients had low Revised Trauma Score (RTS) of
between 0 to =85
Age Group
Table 1.4. Major Trauma Cases by Age Group
Age group
>0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
≥85
TOTAL
No.
24
58
395
280
143
130
77
78
27
8
1220
14
%
1.97
4.75
32.38
22.95
11.72
10.66
6.31
6.39
2.21
0.66
100
50
45
40
35
30
25
20
15
10
Orang Asli
Not Available
Bumiputra Sabah
Bumiputra Sarawak
Other Malaysian
Foreigner
Indian
0
Chinese
5
Malay
Percentage of Major Trauma Cases (%)
Figure 1.5. Major Trauma Cases by Race
Race
Table 1.5. Major Trauma Cases by Race
Race
No.
%
Malay
Chinese
Indian
Orang Asli
Bumiputra Sabah
Bumiputra Sarawak
Other Malaysian
Foreigner
Not Available
TOTAL
586
255
184
0
4
5
6
179
1
1220
48.03
20.9
15.08
0
0.33
0.41
0.49
14.67
0.08
100
15
Figure 1.6. Time of Admission for Major Trauma Cases
30
Percentage of Major Trauma Cases (%)
28
26
24
22
20
18
16
14
12
10
8
6
4
2
0
0001-0600
0601-1200
1201-1800
1801-2400
Time of Admission
Table 1.6. Time of Admission for Major Trauma Cases
Time of Admission (Hours)
0001-0600
0601-1200
1201-1800
1801-2400
TOTAL
No.
283
264
305
367
1219
*1 case has no information on “Time of Admission”
16
%
23.22
21.66
25.02
30.11
100
Figure 1.7. Day of Admission for Major Trauma Cases
Percentage of Major Trauma Cases (%)
16
14
12
10
8
6
4
2
0
Sunday
Monday
T uesday
Wednesday
T hursday
Friday
Saturday
Day
Table 1.7. Day of Admission for Major Trauma Cases
Admission (Days)
No.
%
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
TOTAL
168
168
164
161
185
190
184
1220
13.77
13.77
13.44
13.2
15.16
15.57
15.08
100
17
Figure 1.8. Type of Admission for Major Trauma Cases
Percentage of Major Trauma Cases (%)
70
60
50
40
30
20
10
0
Direct
T ransferred / Referral
Admission Type
Table 1.8. Type of Admission for Major Trauma Cases
Admission Type
No.
%
Direct
Transferred / Referral
TOTAL
725
491
1216
59.62
40.38
100
*4 cases has no information on “Admission Type”
18
Figure 1.8a. Type of Admission for Major Trauma Cases by Centre
Direct
Transfer
Percentage of Major Trauma Cases (%)
100
80
60
40
20
0
A
B
C
D
E
F
G
H
Centre
Table 1.8a. Type of Admission for Major Trauma Cases by Centre
Centre
A
B
C
D
E
F
G
H
TOTAL
Transferred / Referred
From
No.
%
Direct
No.
%
63
78
112
82
45
81
173
91
725
94.03
28.89
70
50.93
47.37
68.64
68.11
100
59.62
4
192
48
79
50
37
81
0
491
*4 cases has no information on “Admission Type”
19
5.97
71.11
30
49.07
52.63
31.36
31.89
0
40.38
Total
67
270
160
161
95
118
254
91
1216
Figure 1.9. Type of Admission Referred From for Major Trauma Cases
Percentage of Major Trauma Cases (%)
45
40
35
30
25
20
15
10
5
0
Hospital with Specialist
Private Hospital
Hospital without Specialist
Private Clinics
Health Clinics
Source of Referral
Table 1.9. Type of Admission Referred From for Major Trauma Cases
Source of Referral
No.
%
Hospital with Specialist
Hospital without Specialist
Health Clinics
Private Hospital
Private Clinics
TOTAL
212
207
28
32
10
491
43.18
42.16
5.7
6.52
2.04
100
20
Chapter 2: INJURY DETAILS
Figure 2.1. Mechanism of Injury for Major Trauma Cases
Percentage of Major Trauma Cases (%)
90
80
70
60
50
40
30
20
10
0
Blunt
Penetrating
Burns
Mechanism of Injury
Table 2.1. Mechanism of Injury for Major Trauma Cases
Mechanism of Injury
No.
%
Blunt
Penetrating
Burns
TOTAL
1136
72
11
1219
93.19
5.91
0.9
100
* 1 case has no information on “Mechanism of Injury”
21
Figure 2.2. Major Trauma Cases by Injury Intent
Percentage of Major Trauma Cases (%)
80
60
40
20
Child Neglect/ Maltreatment
Domestic Violence
Intentional Self Harm
Intentional Assault
Intent Cannot be Determined
Unintentional
0
Injury Intent
Table 2.2. Major Trauma Cases by Injury Intent
Injury Intent
No.
%
Unintentional
Intentional Self Harm
Domestic Violence
Intent Cannot be Determined
Child Neglect / Maltreatment
Intentional Assault
TOTAL
1079
9
0
73
0
66
1220
88.44
0.74
0
5.98
0
5.41
100
22
70
60
50
40
30
20
Sports injury
Gunshot Wound
Burns
Others
Unknown
Industrial Accident
Stabbing
Fall under 2 metre
Other Assault
0
Fall over 2 metre
10
Road Traffic Accident
Percentage of Major Trauma Cases (%)
Figure 2.3. Major Trauma Cases by Cause of Injury
Cause of Injury
Table 2.3. Major Trauma Cases by Cause of Injury
Cause of Injury
No.
%
Road Traffic Accident
Industrial Accident
Fall over 2 meter
Fall under 2 meter (about one door’s height)
Sports injury
Burns
Stabbing
Gunshot Wound
Other Assault
Others
Unknown
TOTAL
900
20
89
59
1
10
28
8
58
18
20
1211
74.32
1.65
7.35
4.87
0.08
0.83
2.31
0.66
4.79
1.49
1.65
100
* 9 cases have no information on “Cause of Injury”
23
70
60
50
40
30
20
Front Seat Passenger
Back Seat Passenger
Bicyclist
Driver
Motorcycle Pillion
Pedestrian
0
Not Available
10
Motorcycle Rider
Percentage of Major Trauma Cases (%)
Figure 2.3a. Major Trauma Cases by Type of Road Traffic Accident
Type of Road Traffic Accident
Table 2.3a. Major Trauma Cases by Type of Road Traffic Accident
Type of Road Traffic Accident
No.
%
Motorcycle Rider
Motorcycle Pillion
Driver
Front Seat Passenger
Back Seat Passenger
Bicyclist
Pedestrian
Not Available
TOTAL
557
55
52
11
18
24
70
111
898
62.03
6.12
5.79
1.22
2
2.67
7.8
12.36
100
*2 cases have no information on “Type of Road Traffic Accident”
24
80
70
60
50
40
30
20
Sports Recreational Area
School / Kindergarten / Nursery
Unspecified Place
Residential
Other Specified Place
Trade / Service Area
Not Available
Industrial / Construction Area
0
Home
10
Road/Street/Highway
Percentage of Major Trauma Cases (%)
Figure 2.4. Major Trauma Cases by Place of Injury
Place of Injury
Table 2.4. Major Trauma Cases by Place of Injury
Place of Injury
No.
%
Road/Street/ Highway
Home
Industrial / Construction Area
School / Kindergarten / Nursery
Sports Recreational Area
Trade / Service Area
Residential Institution
Other Specified Place
Unspecified Place
Not Available
TOTAL
950
87
77
4
3
17
9
16
4
53
1220
77.87
7.13
6.31
0.33
0.25
1.39
0.74
1.31
0.33
4.34
100
25
Figure 2.5. Category of Initial Reviewing Officer in ED for Major Trauma Cases
Emergency Physician
Surgeon
Percentage of Major Trauma Cases (%)
100
90
80
70
60
50
40
30
20
10
0
Medical Officer / T rainee
Specialist / Consultant
Category of Initial Reviewing Officer
Table 2.5. Category of Initial Reviewing Officer in ED for Major Trauma Cases
Emergency
Surgeon
Physician
Category of Initial Reviewing Officer
No.
%
No.
%
Medical Officer/Trainee
Specialist/Consultant
TOTAL
* Included cases with both category of “Initial Reviewing Officer”
26
1136
92.21
764
79.83
96
7.79
193
20.17
1232
100
957
100
Figure 2.6. Disposition of Major Trauma Cases from ED
Percentage of Major Trauma Cases (%)
30
25
20
15
10
5
0
General Ward
OT
ICU
Mortuary
HDW
Other Hospital
AOR
Disposition from ED
Table 2.6. Disposition of Major Trauma Cases from ED
Disposition From ED
No.
%
ICU
OT
General Ward
Mortuary
AOR
HDW
Other Hospital
Not Available
TOTAL
275
284
348
118
4
100
80
5
1214
22.65
23.39
28.67
9.72
0.33
8.24
6.59
0.41
100
*6 cases have no information on “Disposition from ED”
27
Figure 2.7. ICU Admission for Major Trauma Cases
60
Percentage of Major Trauma Cases (%)
55
50
45
40
35
30
25
20
15
10
5
0
Yes
No
ICU Admission
Table 2.7. ICU Admission for Major Trauma Cases
ICU Admission
No.
%
Yes
No
TOTAL
490
723
1213
40.4
59.6
100
*7 cases have no information on “ICU Admission”.
28
Figure 2.7a. ICU Admissions for Major Trauma Cases by Centre
Yes
No
Percentage of Major Trauma Cases (%)
80
70
60
50
40
30
20
10
0
A
B
C
D
E
F
G
H
ICU Admissions
Table 2.7a. Total ICU Admissions for Major Trauma Cases by Centre
ICU admissions
Centre
A
B
C
D
E
F
G
H
TOTAL
Yes
No.
22
71
71
95
60
39
101
31
490
Total
No
%
32.84
26.1
44.38
59.01
61.86
33.05
40.73
34.44
40.4
No.
45
201
89
66
37
79
147
59
723
*7 cases have no information on “ICU Admission”.
29
%
67.16
73.9
55.63
40.99
38.14
66.95
59.27
65.56
59.6
67
272
160
161
97
118
248
90
1213
Figure 2.8. Major Trauma Cases by Systolic BP
65
Percentage of Major Trauma Cases (%)
60
55
50
45
40
35
30
25
20
15
10
5
0
1-49
50-75
76-89
90-120
>120
Systolic BP
Table 2.8. Major Trauma Cases by Systolic BP
Systolic BP
No.
%
1-49
50-75
76-89
90-120
>120
TOTAL
2
36
40
378
738
1194
0.17
3.02
3.35
31.66
61.81
100
*26 cases have no information on “Systolic BP”.
30
Figure 2.9. Major Trauma Cases by Glasgow Coma Scale (GCS)
55
Percentage of Major Trauma Cases (%)
50
45
40
35
30
25
20
15
10
5
0
13-15
9-12
3-8
GCS
Table 2.9. Major Trauma Cases by Glasgow Coma Scale (GCS)
Glasgow Coma Scale (GCS)
No.
%
13-15
359
29.64
9-12
226
18.66
3-8
626
51.69
TOTAL
1211
100
*9 cases have no information on “GCS”.
31
Percentage of Traumatic Brain Injured Patients (%)
Figure 2.10. Traumatic Brain Injuries for Major Trauma Cases
50
45
40
35
30
25
20
15
10
5
0
Intracranial Injury
Others
Skull and Facial
Bones Fracture
Open Head Wound
Traumatic Brain Injury
Table 2.10. Traumatic Brain Injuries for Major Trauma Cases
Traumatic Brain Injury
No.
%
Open Head Wound
Skull and Facial Bones Fracture
Intracranial Injury
Others
TOTAL
124
324
813
340
1601
7.75
20.24
50.78
21.24
100
* Included cases with more than one type of “Traumatic Brain Injury”.
32
Figure 2.11. Intracranial Injury for Major Trauma Cases
40
35
30
25
20
15
10
Focal brain injury
Intracracnial injury, unspecified
Intracranial injury with prolonged coma
Diffuse brain injury
Epidural haemorrhage
Traumatic cerebral oedema
Traumatic subarachnoid haemorrhage
Traumatic subdural haemorrhage
0
Other intracranial injuries
5
Concussion
Percentage of Intracranial Injury(%)
45
Intracranial Injury
Table 2.11. Intracranial Injury for Major Trauma Cases
Intracranial Injury
No.
Concussion
174
Traumatic cerebral oedema
160
Diffuse brain injury
50
Focal brain injury
8
Epidural hemorrhage
52
Traumatic subdural hemorrhage
395
Traumatic subarachnoid hemorrhage
195
Intracranial injury with prolonged coma
25
Others
173
Intracranial injury, unspecified
14
TOTAL
1246
* Included cases with more than one type of “Intracranial Injury”.
33
%
19.27
17.72
5.54
0.89
5.76
43.74
21.59
2.77
19.16
1.55
100
Figure 2.12. Major Trauma Cases by RTS
Percentage of Major Trauma Cases (%)
30
25
20
15
10
5
0
0-0.99
1-1.99
2-2.99
3-3.99
4-4.99
5-5.99
6-6.99
RTS
Table 2.12. Major Trauma Cases by RTS
RTS
No.
%
0-0.99
1-1.99
2-2.99
3-3.99
4-4.99
5-5.99
6-6.99
7-7.84
TOTAL
165
4
13
20
159
320
208
331
1220
13.52
0.33
1.07
1.64
13.03
26.23
17.05
27.13
100
34
7-7.84
Figure 2.13. Injuries According to Body Region for Major Trauma Cases
60
50
40
30
20
External
Abdomen/Pelvic content
Thorax
Face
0
Extremitis/ Pelvic girdle
10
Head & Neck
Percentage of Major Trauma Cases (%)
70
Body Region
Table 2.13. Injuries According to Body Region for Major Trauma Cases
Body Region
No.
%
Head & Neck
Face
Thorax
Abdomen/Pelvic content
Extremitis/ Pelvic girdle
External
1060
295
245
150
365
24
65.15
18.13
15.06
9.22
22.43
1.48
35
Figure 2.14. Abbreviated Injury Scale (AIS) for All Injuries for Major Trauma
Patients
30
AIS of Major Trauma Patients (%)
25
20
15
10
5
0
1
2
3
4
5
6
Abbreviated Injury Scale (AIS)
Table 2.14. Abbreviated Injury Scale (AIS) for All Injuries for Major Trauma
Patients
AIS
No.
%
1
2
3
4
5
6
TOTAL
928
1002
1045
787
256
3
4021
23.08
24.92
25.99
19.57
6.37
0.07
100
* Included cases with more than one record on “AIS”
36
Figure 2.14a. Abbreviated Injury Scale (AIS) Distribution According to Body
Region for Major Trauma Cases
Figure 2.14a(i). Head and Neck Region
70
65
60
55
Percentage(%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
5
6
AIS Distribution
Figure 2.14a(ii). Face Region
70
65
60
55
Percentage (%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
AIS Distribution
37
5
6
Figure 2.14a(iii). Thorax Region
70
65
60
55
Percentage(%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
5
6
AIS Distribution
Figure 2.14a(iv). Abdomen/Pelvic Content Region
70
65
60
55
Percentage(%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
AIS Distribution
38
5
6
Figure 2.14a(v). Extremitis /Pelvic Girdle Region
70
65
60
55
Percentage(%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
5
6
5
6
AIS Distribution
Figure 2.14a(vi). External Region
70
65
60
55
Percentage(%)
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
AIS Distribution
39
AIS
1
2
3
4
5
6
TOTAL
Table 2.14a. Distribution According to Body Region for Major Trauma Cases
Abdomen/
Extremitis/
Head and
Face
Thorax
Pelvic
Pelvic
External
Neck
content
girdle
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%
295
14.64
218
63.74
56
19.18
47
27.01
125
24.8
17
65.38
349
17.32
114
33.33
52
17.81
85
48.85
225
44.64
7
26.92
505
25.06
8
2.34
136
46.58
32
18.39
148
29.37
1
3.85
635
31.51
0
0
40
13.7
7
4.02
2
0.4
0
0
231
11.46
2
0.58
7
2.4
3
1.72
3
0.6
0
0
0
0
0
0
1
0.34
0
0
1
0.2
1
3.85
No.
758
832
830
684
246
3
%
22.61
24.81
24.75
20.4
7.34
0.09
2015
3353
100
100
342
100
292
100
174
40
100
504
100
26
100
Total
Figure 2.15. Body Region with Abbreviated Injury Scale (AIS) ≥ 3 for Major
Trauma Cases
80
70
AIS ≥ 3(%)
60
50
40
30
20
10
0
Head & Neck Thorax
Extremitis/
Pelvic girdle
Abdomen/
Pelvic
Face
External
Body Region
Table 2.15. Body Region with Abbreviated Injury Scale (AIS) ≥ 3 for Major
Trauma Cases
Body Region
No.
%
Head & Neck
Face
Thorax
Abdomen/Pelvic content
Extremitis/Pelvic girdle
External
TOTAL
1628
11
206
47
196
3
2091
77.86
0.53
9.85
2.25
9.37
0.14
100
41
Figure 2.16. Injury Severity Score (ISS) for Major Trauma Cases
70
Percentage of Major Trauma Cases (%)
65
60
55
50
45
40
35
30
25
20
15
10
5
0
40
Injury Severity Score (ISS)
Table 2.16. Injury Severity Score (ISS) for Major Trauma Cases
ISS
40
TOTAL
No.
%
165
91
788
160
16
1220
13.52
7.46
64.59
13.11
1.31
100
42
Chapter 3: PROCEDURES AND OPERATIVE MANAGEMENT
60
50
40
30
20
Pelvic Clamp/binding/ext.fixator
Needle Thoracocentesis
Chest Tube Insertation
Mechanical Ventalation
Ultrasound/FAST
0
Endotracheal Intubation
10
CTScan
Percentage of Major Trauma Cases(%)
Figure 3.1. Procedure Done in ED for Major Trauma Cases
Procedure Done in ED
Table 3.1. Procedure Done in ED for Major Trauma Cases
Procedure Done in ED
Endotracheal Intubation
Intubated at Referral Hospital
Intubated at Current Hospital
Not Available
Needles Thoracocentesis
Pelvic Clamp/Binding/ext. Fixator
CT Scan
Brain
Cervical Spine
Abdomen
Pelvis
Thorax
Others, specify
Mechanical Ventilation
Chest Tube Insertation
Ultrasound/FAST
No.
753
400
339
14
11
4
796
738
429
94
18
28
7
144
87
298
43
%
61.72
53.12
45.02
1.86
0.9
0.33
65.25
92.71
53.89
11.81
2.26
3.52
0.88
11.8
7.13
24.43
Figure 3.2. Operative Management for Major Trauma Cases
60
Percentage of Major Trauma Cases (%)
55
50
45
40
35
30
25
20
15
10
5
0
Yes
No
Operation Management
Table 3.2. Operative Management for Major Trauma Cases
Total
Operative Management
No.
%
Yes
564
46.88
No
639
53.12
TOTAL
1203
100
* 17 cases have no information on “Operative Management”
44
Figure 3.3. Operative Procedure for Major Trauma Cases
55
Percentage of Operative Procedure (%)
50
45
40
35
30
25
20
15
10
5
0
Intracranial
Others
Intra-abdominal Pelvic Fixation Spinal Surgery
Intrathoracic
Operative Procedure
Table 3.3. Operative Procedure for Major Trauma Cases
Operative Procedure
Intracranial
Intrathoracic
Intra-abdominal
Spinal Surgery
Pelvic Fixation
Others
TOTAL
No.
334
4
91
5
10
168
613
45
%
54.49
0.65
14.85
0.82
1.63
27.41
100
Figure 3.4. Types of Intracranial Procedure for Major Trauma Cases
Percentage of Intracranial Procedure (%)
30
25
20
15
10
5
Elevation of Depressed Skull Fracture
Intracranial Pressure(ICP) Monitoring
External Ventricular Drain
Others
Decompressive Craniectomy
Evacuation of Hematoma
0
Intracranial Procedure
Table 3.4. Types of Intracranial Procedure for Major Trauma Cases
Intracranial Procedure
No.
%
Evacuation of Hematoma
Decompressive Craniectomy
External Ventricular Drain
Intracranial Pressure(ICP) Monitoring
Elevation of Depressed Skull Fracture
Others
TOTAL
183
173
87
37
7
114
601
30.45
28.79
14.48
6.16
1.16
18.97
100
46
Chapter 4: OUTCOME
Figure 4.1. Total Outcome for Major Trauma Cases
Percentage of Major Trauma Cases (%)
70
60
50
40
30
20
10
0
Survivors
Death
Outcome
Table 4.1. Total Outcome for Major Trauma Cases
Outcome
No.
%
Survivors
Deaths
TOTAL
836
379
1215
68.81
31.19
100
*5 cases have no information in “Outcome”.
47
Figure 4.1a. Outcome for Major Trauma Cases by Centre
Survivors
Death
Percentage of Major Trauma Cases (%)
90
80
70
60
50
40
30
20
10
0
A
B
C
D
E
F
G
H
Centre
Table 4.1a. Outcome for Major Trauma Cases by Centre
Centre
A
B
C
D
E
F
G
H
TOTAL
Survivors
No.
46
210
101
113
45
69
178
74
836
Death
%
68.66
78.36
63.13
70.19
46.39
58.97
70.08
81.32
68.81
No.
21
58
59
48
52
48
76
17
379
*5 cases have no information in “Outcome”.
48
%
31.34
21.64
36.88
29.81
53.61
41.03
29.92
18.68
31.19
Total
67
268
160
161
97
117
254
91
1215
Figure 4.2. Disposition of Survivors at Discharge for Major Trauma Cases
75
70
Percentage of of Survivors (%)
65
60
55
50
45
40
35
30
25
20
15
10
5
Discharge Against Medical Advice
Transfer to Other Hosp.
Transfer to Referring Hosp.
Discharge Home
0
Disposition
Table 4.2. Disposition of Survivors at Discharge for Major Trauma Cases
Disposition of Survivors
No.
579
127
87
33
826
Discharge Home
Transfer to Referring Hospital
Transfer to Other Hospital
Discharge Against Medical Advice
TOTAL
*10 cases from total number of “Survivors” have no information on discharge.
49
Survivors
%
70.1
15.38
10.53
4
100
Figure 4.3. Outcome for Major Trauma Cases by Age Group
Survivors
Death
Percentage of Major Trauma Cases(%)
90
80
70
60
50
40
30
20
10
0
0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
>=85
Age Group
Table 4.3. Outcome for Major Trauma Cases by Age Group
Age
Group
(years)
0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
≥85
TOTAL
Survivors
Death
Total
No.
%
No.
%
No.
%
16
49
288
205
102
87
37
36
14
2
836
69.57
84.48
73.1
73.21
71.83
67.44
48.68
46.15
51.85
25
68.81
7
9
106
75
40
42
39
42
13
6
379
30.43
15.52
26.9
26.79
28.17
32.56
51.32
53.85
48.15
75
31.19
23
58
394
280
142
129
76
78
27
8
1215
1.89
4.77
32.43
23.05
11.69
10.62
6.26
6.42
2.22
0.66
100
50
Figure 4.4. Mechanism of Injury by Outcome for Total Major Trauma Cases
Survivors
Death
Percentage of Major Trauma Cases(%)
80
70
60
50
40
30
20
10
0
Blunt
Penetrating
Burns
Mechanism of Injury
Table 4.4. Outcome for Major Trauma Cases by Mechanism of Injury
Mechanism of Injury
Blunt
Penetrating
Burns
TOTAL
Survivors
No.
%
774
68.44
57
79.17
5
45.45
836
68.86
No.
357