The Chennai consensus on in-hospital trauma care for India

Dear Editor,

India is paying the price with a growing volume of injuries, as collateral damage for rapid urban development and sociodemographic transition.[1] For the injured, the current decade of action for road safety (2011–2020), advocates for a “post-crash response” with appropriate care of individuals who have sustained trauma requires prehospital care, in-hospital care, and postdischarge rehabilitation. In the high-income countries (HICs), the 30-day fatality criteria (dying within 30 days of injury)[2] as recommended by the Global Road Safety report, is used to compare countries and their commitment to road safety.[2] In-hospital trauma mortality is proportionally higher in India as compared to hospitalized trauma patients in HICs.[3] In a collaborative effort, leading experts from trauma units of five urban university hospitals came together with a mission of reviewing trauma care and trauma outcomes in India. We would like to share the consensus statement of this meeting under the Towards Improved Trauma Care Outcome (TITCO)-India consortium, in March 2015 at Madras Medical College, Chennai. The key consensus decisions for improving hospital-based care of trauma victims were as follows:

• In keeping with the United Nations’ decade of action 2011–2021, the consortium reemphasized its role in one of the five pillars of the UN Global Plan for road safety, which is to improve postinjury response and hospital care through research and development

• The focus on in-hospital care is based on the learning from countries such as Israel, Australia, and the USA that decline in overall road accident mortality is partially due to the decline in in-hospital mortality. Further, trauma care given as a part of the university hospital will be preferable to standalone trauma centers for a low–middle-income country like India

• Comprehensive trauma registries, like the one maintained by TITCO-India, are known to improve care of the injured. Trauma registries also ground further research on the local factors affecting mortality. The five participating universities will encourage other universities to join this consortium to form a national trauma registry using grant applications or local university funds

• Organizational restructuring of trauma care in university hospitals is required. The trauma nurse coordinator and the senior triage nurse have been identified as the key catalysts for change. Training and investing in nurses (based on the Apex Trauma center model) pays richer dividends than expecting rotating residents and interns to record and document vital signs in a trauma victim. This is the model followed in most mature trauma systems

• The WHO trauma intake form and minimum data set will form the standard case note for all arriving trauma patients in each participating center. The WHO trauma care checklist will be followed in all trauma patient-receiving areas and implemented through the trauma nurse coordinator. Minimum infrastructure made available as per the WHO essential trauma care guidelines

• The next phase of intervention of trauma research will be to intensify the clinical monitoring of the trauma patient. A nonclinical researcher/data collector will record the oxygen saturation, systolic blood pressure, heart rate and Glasgow Coma Scale using standardized equipment and technique. Separate new funding and ethics clearance will be taken for this intervention from each site institutional ethics committee (IECs)

• The consortium members agree that efforts to improve trauma care, referred to as trauma quality improvement programs have been consistently shown to improve the process of care, decrease mortality, and decrease costs. Consortium members will implement these efforts systematically in their hospitals. This will be in the form of “multidisciplinary” meetings discussing preventable deaths, where concrete steps (usually administrative, rather than surgical) can be taken for improving trauma care within the local context

• The consortium will continue to work with other partners, like the traffic police and social organizations to advocate for injury prevention, through social awareness and four known behavioral risk factors, namely alcohol use, helmet use, seat belt use, and speeding

• Trauma due to burns has a different mechanism of injury and outcomes, but is an important cause in the Indian setting. The consortium will maintain a separate burns registry.

Financial support and sponsorship

This work was financially supported by Karolinska Institutet, Tata Institute of Social Sciences, Swedish Health Board, Laerdal foundation.

Conflicts of interest

There are no conflicts of interest.