Dear Editor,
We read the article by Singh et al., published in your esteemed journal with great interest.[1] We have certain major concerns and suggestions which we want to highlight.
Firstly, as per the study title “Injury pattern of road traffic accident cases attending trauma center.” So, it is not sure why the authors described all causes of trauma instead of focusing only on road traffic accident cases (RTA) cases. Secondly, the methodology mentioned that 100 per day were reported to the trauma center, and the authors took a sample of 410. So, whether the study completed in one week or one month? The sampling technique, as well as the study duration, was not mentioned. A sample size of 410 is very small for a study in a trauma center having 100 footfalls daily.
In the Results section, the injuries described seem to be musculoskeletal only, but other organ injuries frequently seen in RTA cases, such as abdominal injuries and thoracic injuries, are not specified. This is also not per the six anatomical regions defined for trauma patients. The pattern of injuries could have been mentioned as per the abbreviated injury scale based on the anatomical area of involvement.[2] Those with spinal injuries are also not mentioned in the article.[2] There are no data regarding pedestrian injuries, which is indicative of rash driving. The article mentioned that patients with multiple injuries (24.4%) need more clarity. The injury severity score (ISS) was not calculated and mentioned.[3,4] PGI has a level 1 trauma center where chances of survival are higher, so other centers will likely refer the patients. As there was no triaging or ISS calculation, it cannot be said that the patients referred are in the red or green triage category. Patients with ISS >15 (polytrauma) should be sent to a level 1 trauma center for better survival.[4] The authors have not discussed the outcome of trauma patients and their survival. As in the discussion session, the authors stated, “In our study, it was seen that maximum patients coming to ATC were from rural area 76% (313) and 24% (97) from urban areas.” So, the author’s explanation does not seem logical here without mentioning the injury severity of the referred patients.
The statement by authors in the Key message and recommendation section, “In India, we need to strength our primary health care. As maximum trauma cases are from rural areas, why not save patients in golden hour. Instead, just refer, there should be trauma care center in rural area and in urban area also.” We agree with the statement of the need for primary health care but disagree entirely about the term “just refer, there should be trauma care center in rural area and in urban area also.” In India, pre-hospital care needs to be established as trauma patients spend most of their golden in ambulances.
The author’s concluding message “Always wear a Helmet for your family, it’s very difficult for family in your absence.” The effect of helmets is not reflected in their methodology and results, and therefore, they seem to be far-reaching in their conclusion.
Finally, we feel great disappointment going through the manuscript. PGI has a level 1 trauma center, and INI of importance, so readers expect quality data and presentation.
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Conflicts of interest
There are no conflicts of interest.
References
- 1.Singh R, Sachdeva MK, Koushal V, Aggarwal S, Kaman L, Singh A, et al. Injury pattern of road traffic accident cases attending trauma centre of tertiary care hospital of North India. J Family Med Prim Care. 2023;12:2434–9. doi: 10.4103/jfmpc.jfmpc_789_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Greenspan L, McLellan BA, Greig H. Abbreviated injury scale and injury severity score: A scoring chart. J Trauma. 1985;25:60–4. doi: 10.1097/00005373-198501000-00010. [DOI] [PubMed] [Google Scholar]
- 3.Baker SP, O’Neill B, Haddon W, Jr, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96. [PubMed] [Google Scholar]
- 4.Mohanty CR, Jain M, Radhakrishnan RV, Sriramka B. In reply to article “A cross-sectional study of epidemiological factors related to road traffic accidents in a metropolitan city”. J Family Med Prim Care. 2020;9:2136. doi: 10.4103/jfmpc.jfmpc_323_20. [DOI] [PMC free article] [PubMed] [Google Scholar]