Trauma outcome improves following the advanced trauma life support program in a developing country

ABSTRACT

Trauma outcome variables before and after the institution of the Advanced Trauma Life Support (ATLS) program were compared for the largest hospital in Trinidad and Tobago from July 1981 through December 1985 (pre-ATLS) and from January 1986 to June 1990 (post-ATLS). A total of 199 physicians were ATLS trained by June 19990. Outcome data were analysed for all dead or severely injured patients (ISS greater than and equal to 16; n=413 pre-ATLAS and n=400 post ATLS). Trauma mortality decreased post ATLS (134 ICU mortality vs. 279 of 413) throughout the hospital, including the ICU (13.6 percent post-ATLS ICU mortality vs. 55.2 percent pre-ATLS). The odds of dying from trauma increased with age (1.02 for each year), ISS score (1.24 for each ISS increment), and blunt injury, both pre-ATLS and post-ATLS. Post-ATLS mortality was associated with a higher ISS (31.6 vs 28.8). Although there was a higher percentage of blunt injury pre-ATLS (84.0 percent) versus post-ATLS (68.3 percent), the mortality rates for both blunt and penetrating injuries were higher in the pre-ATLS group (19.7 percent pre-ATLS vs 6.3 percent post ATLS for penetrating and 76.6 percent pre-ATLS versus 46.2 percent post-ATLS for blunt). For each ISS category, mortalilty was greater in the pre-ATLS group (ISS greater than and equal to 24 pre-ATLS mortality 47;9 percent vs. 16.7 percent post-Atls; ISS 25-40 pre-ATLS mortality 91.0 percent vs. 71.0 percent post-ATLS). The overall ration of observed to expected mortality based on the MTOS data base was lower for the post-ATLS period (pre-ATLS ratio 3.16; post-ATLS ratio 1.94). Multiple logistic regression analysis indicated that although post-ATLS mortality was affected by the lower incidence of blunt injury and a lower overall ISS score, the ATLS program was a significant factor in determing the observed decrease in mortality. Postinjury functional status among survivors was improved post-ATLS (minor disabiltiy 88.3 percent post-ATLS vs. 22.4 percent pre-ATLS and major disability 1.9 percent post-ATLS vs. 6.7 percent pre-ATLS). Our data demonstrate that the ATLS program significantly improved trauma patient outcome in a developing country, thus supporting the concept of international promulgation of this program for physicians(AU)