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We analyzed one feasible timeline of critical surgery within the first hour of admission as a possible intervention, which could be applied in existing trauma systems in Low and middle-income countries (LMIC), and may improve trauma care outcomes. Retrospective analysis of a prospectively maintained data registry under project named TITCO (Towards Improved Trauma Care Outcome) was done at a level one trauma center in India from October 2013 to September 2015. All admitted patients who underwent critical surgery within the first hour of admission were analyzed. These patients were divided in two groups depending upon primary presentation or referred from other facility. Statistical analysis was done between these two groups to compare outcome. Sixty-one (57.6%) patients were directly admitted, whereas forty-five (42.4%) were transferred from other hospitals. The median time from injury to presentation for primary patients was 50 min with interquartile range (IQR) of 40. In referred patient median time gap between the injury to our center (not referring center) was 230 min with IQR of 350. This difference was statistically significant. Both the groups were comparable in terms of injury severity measured by ISS. Major outcome indicators in the form of median ICU and total stay, as well as mortality, were not significantly different. We propose that critical surgery within the first hour of presentation might be a useful hospital-based key performance indicator even in the existing trauma systems in LMIC to improve the outcome of injured patients.

Background: Nurses are the backbone of health care systems worldwide. In India, the assessment ofexisting knowledge of nursing workforce and the utilization of skills is not evaluated and properly used toensure good quality in health care.Methods : Using the Delphi technique a survey was developed and sent to nurses. Self- rating methods (ona likert scale) were used in order to operationalize the personal skills.Results: Almost half (48%) of the participants have a Bachelor degree. Out of this 27.2% qualified for ahigher education (e.g. Master in related subject). Most nurses (56% in sample were females) are permanentemployed working as staff nurse or nursing officers in the public sector. Among the participants. 20% havesufficient teaching experience between 1 to 3 years. Self-rating of skills was high in almost all topics.Conclusion: Having attained higher education most of the participants remain working as staff nurses.The good self-rating of participants underlines their ability to take over much higher positions andresponsibilities. Moreover, teaching experience is hardly acknowledged by institutions since teaching staffis usually recruited from outside. The study suggests that a majority of the population has an interest to workin rural area .Better work conditions are needed in order to gain workforce in this areas.Skills should be effectively utilized in areas of administration, management, research and education, with aproper distribution to rural and urban areas in order to ensure a good health care system in India.

Background Low- and middle-income countries (LMICs) contribute to 90% of injuries occurring in the world. The liver is one of the commonest organs injured in abdominal trauma. This study aims to highlight the demographic and management profile of liver injury patients, presenting to four urban Indian university hospitals in India. Methods This is a retrospective registry-based study. Data of patients with liver injury either isolated or concomitant with other injuries was used using the ICD-10 code S36.1 for liver injury. The severity of injury was graded based on the World Society of Emergency Surgery (WSES) grading for liver injuries. Results A total of 368 liver injury patients were analysed. Eighty-nine percent were males, with road traffic injuries being the commonest mechanism. As per WSES liver injury grade, there were 127 (34.5%) grade I, 96 (26.1%) grade II, 70 (19.0%) grade III and 66 (17.9%) grade IV injuries. The overall mortality was 16.6%. Two hundred sixty-two patients (71.2%) were managed non-operatively (NOM), and 106 (38.8%) were operated. 90.1% of those managed non-operatively survived. Conclusion In this multicentre cohort of liver injury patients from urban university hospitals in India, the commonest profile of patient was a young male, with a blunt injury to the abdomen due to a road traffic accident. Success rate of non-operative management of liver injury is comparable to other countries.

Introduction: Trauma systems vary in performance during different time periods and may affect the patient outcomes, especially in resource-limited settings. The present study was undertaken to study the pattern, epidemiological profile, processes of care variations of trauma victims presenting during-hours and after-hours in a level 1 trauma Center of a lower middle-income country. Methodology: Retrospective analyses of prospectively collected data registry at a single tertiary care center. Data collected from 2013 to 2015 were analyzed. Patients with a history of trauma and admission to the center or death between arrival and admission were included. Isolated limb injury and patients dead on arrival were excluded. Results: Of 4692, 1789 (38.1%) patients arrived and were admitted during-hours and 2903 (61.9%) after-hours. The overall in-hospital mortality was 14.9% in the cohort. Moreover, it was 16.10% during after-hours in comparison to 13.0% during-hours. The Revised Trauma Score was statistically different during-hours and after-hours suggesting patients with greater physiological derangement after-hours. The Kaplan–Meier survival curves for 7 days were comparable in two groups with the log-rank test of 078. The proportion of initial radiological investigations (chest X-ray, focused assessment sonography in trauma [FAST], and computerized tomography [CT] scans) was ranged from 84.9% for CT scans in the cohort to 99.3% for FAST. Conclusions: Processes of care do not differ significantly for the patients admitted at a level 1 trauma center irrespective of time of the day. Although survival probability for the initial 7 days of follow-up is comparable between two groups; however, for 30 and 90 days of follow-up they are significantly different between during-hours and after-hours, likely due to injury severity.

Objective We evaluated the transferability of prediction models between trauma care contexts in India and the United States and explored updating methods to adjust such models for new contexts. Study Design and Settings Using a combination of prospective cohort and registry data from 3,728 patients of Towards Improved Trauma Care Outcomes in India (TITCO) and from 18,756 patients of the US National Trauma Data Bank (NTDB), we derived models in one context and validated them in the other, assessing them for discrimination and calibration using systolic blood pressure, heart rate, and Glasgow coma scale as candidate predictors. Results Early mortality was 8% in the TITCO and 1–2% in the NTDB samples. Both models discriminated well, but the TITCO model overestimated the risk of mortality in NTDB patients, and the NTDB model underestimated the risk in TITCO patients. Conclusion Transferability was good in terms of discrimination but poor in terms of calibration. It was possible to improve this miscalibration by updating the models' intercept. This updating method could be used in samples with as few as 25 events.