Dr. Muhammad Rizwan

Critical Care Fellow

AGA KHAN HOSPITAL

DEPARTMENT OF ANAESTHESIOLOGY

Karachi, Pakistan

“Trauma work load of surgical intensive care unit

(SICU) at a university hospital in Pakistan - A six

month retrospective study”

TITLE OF THE STUDY

I N T R O D U C T I O N

Trauma is a worldwide public health problem.

It is the fourth leading cause of death in the western worldespecially in young population up to the age of forty.

Severe trauma, although small in number may need urgentlifesaving interventions.

Damage control surgical interventions & life sustainingorgan support in the intensive care unit consumesignificant resources and cause a huge economic burden tothe patient, healthcare system & society.

Introduction Continue

The 48 bedded state-of-the-art Emergency Department at Aga

Khan University hospital is a WHO Collaborating Center for

Trauma that handles around 60,000 patients annually.

The surgical ICU at the Aga Khan University has a capacity of

7 beds & major trauma victims requiring close monitoring or

organ support, with or without surgical interventions

constitute 30% of the admissions.

R A T I O N A L E

• Impact of trauma on our constraint resources in terms of

time, critical therapeutic interventions, advanced radiological

interventions, laboratory work load & blood product

utilization has not been previously documented in Pakistan.

• The results of this study will highlight the resources that are

required to safely & efficiently manage critically ill trauma

patients that can be utilized to plan future trauma

management facilities & improve the care of major trauma

patients in our country.

O B J E C T I V E

1. To identify trauma work load of SICU and to demonstrate

the resources utilized by the trauma admissions.

2. To compare the characteristics & outcome of trauma & non-

trauma patients.

M A T E R I A L & M E T H O D S

Settings:

SICU of Aga Khan University Hospital Karachi, Pakistan

Duration of the study: 6 months

Study Design: Retrospective study

S A M P L E S E L E C T I O N

Inclusion Criteria:

All adult admissions to SICU from 1st Jan 2014 till 30thJune 2014

Exclusion Criteria:

Age < 16 years

D A T A C O L L E C T I O N

• After Ethical Review Committee (ERC) approval, patientswere enrolled according to the inclusion & exclusion criteriadescribed above.

• Medical record numbers (MRN) of patients admitted duringthe study period were taken from the “admission recordregister” kept in the custody of the ICU head nurse.

• The variables collected from this register were age, gender,type of trauma, source of admission, length of stay in SICUand outcome.

Data Collection

Continue

Radiological investigations and interventions, laboratory

investigations, were collected from the Health information

management system (HIMS).

Blood and blood products utilized by patient were retrieved

from the blood-bank record.

D A T A A N A L Y S I S P R O C E D U R E

Statistical analyses performed using statistical software SPSS

version -16 (SPSS, Chicago, III).

Frequency & percentages were computed for qualitative

observations & analyzed by chi-square test. Mean & SD were

estimated for quantitative observations & analyzed by t-test. For

data which was not normally distributed Mann-Whitney U test

was used.

A ‘P’ value ≤ 0.05 was considered significant.

R E S U L T S

141 SICU admissions were reviewed. 22.7% (32/141) trauma

patients were identified during the 6 month study period.

Average age of the trauma cases was 35.81±13.11 years.

Male to female ratio was 7:1 in trauma cases.

Results cont…

Overall mortality of SICU was 39.7% and of the trauma

patients it was 31.3%.

Median length of stay was 5 (8) days [Median (IQR)].

TYPE OF TRAUMA

(n=32)

43,8% 43,8%

6,3%

3,1% 3,1%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

RTA Gunshot Blast Burn Fall

SOURCES OF ADMISSION (n=32)

OR= Operating Room SCU = Special care unit

ER= Emergency room Other = Referred Cases

71,9%

9,4% 9,4%

6,3%

3,1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

OR Ward ER SCU Others

Non-Operative

25%

Emergency

Operative

72%

Elective

Operative

3%

TYPE OF ADMISSION OF TRAUMA CASES

(n=32)

Variables

Trauma Non-Trauma

P-Valuen=32 n=109

Age (Years) 35.81±13.11 49.04±18.67 0.0005

Gender [M/F]

28/4 72/37

0.01987.5%/12.5% 66.1%/33.9%

Length of stay (days) 19.34±14.09 17.43±18.15 0.58

Outcome [Alive/Death]

22/10 63/46

0.2668.8%/31.3% 57.8%/42.2%

THERAPEUTIC INTERVENTIONS IN

PATIENTS ADMITTED TO SICU WITH

TRAUMA (n=32)

CVC= Central Venous Pressure

CRRT= Continuous Renal

Replacement Therapy

NIV= Non Invasive Ventilation

MV = Mechanical Ventilation

CVC= Central Venous

Catheterization

0% 20% 40% 60% 80% 100%

NIV

CRRT

Tracheostomy

Blood

Transfusion

CVC

Enteral Feeding

Intubation

MV

3,1%

6,3%

43,8%

65,6%

75,0%

84,4%

87,5%

96,9%

Blood product

utilization

Number of

Patients

% Meidan

Pack cells 19 59% 11

FFP 11 34% 22

Plateles 12 38% 14.5

Cryoprecipitates 2 6% 57

1 2 3 4

CT 31 9 9 9 4

MRI 5 4 1 - -

US 19 11 8 - -

TotalRadiology

Number of Radiology / Patients

Max-Min

79-1

105-10

48-2

100-14

BLOOD PRODUCT UTILIZATION AND

RADIOLOGY IN TRAUMA PATIENTS (N=32)

Mean SD Minimum Maximum

CBC 17.03 13.87 3 60

BUN 16.56 14.85 2 58

Creatinie 18.69 17.17 2 70

Electrolytes 21.44 18.14 3 72

PT 11.75 12.81 1 51

APTT 11.41 12.80 1 51

LFT 1.31 2.28 0 8

ABGs 18.13 18.78 1 77

Lactic.Acid 2.09 2.41 0 8

Procalcitonin .00 .00 0 0

Blood.CS 4.28 4.62 0 16

Tracheal.CS 1.06 2.14 0 8

Urine.CS 1.81 1.75 0 7

LABORATORY INVESTIGATION IN

TRAUMA PATIENTS (n=32)

C O N C L U S I O N

• T r a u m a c o n s t i t u t e s a s i g n i f i c a n t w o r k l o a d

( 2 2 . 7 % ) f o r S I C U o f A g a K h a n U n i v e r s i t y ,

P a k i s t a n

• T r a u m a v i c t i m s a r e p r e d o m i n a n t l y y o u n g m a l e s

i n w h o m g u n s h o t i n j u r i e s a r e a s c o m m o n a s r o a d

t r a f f i c a c c i d e n t s

• B l o o d p r o d u c t s , r a d i o l o g i c a l a n d l a b o r a t o r y

i n v e s t i g a t i o n s a r e t h e m a j o r c o n t r i b u t e r s o f

r e s o u r c e s u t i l i z e d .

REFERENCES:

• 1) Chaira O, Cimbanissi S. Organized trauma care: does volume matter and do trauma centers save lives? Curr Opin Crit Care 2003; 9:510-4

• 2) Grossman MD. Introduction to trauma care. In Peitzman AB, Rhodes M, Schwab CW, Yealy DM, eds. The Trauma Manual. Philadelphia, Lippincott–Raven, 1998, pp 1–5

• 3) Mitchell VT, Scarlett MD. Trauma Admissions to the ICU of The University Hospital of the West Indies, Kingston, Jamaica. ITACCS. 2001;86-89

Thank you