This document summarizes census data from the annual trauma census in 2012. It provides an overview of 53,454 total ED visits, with 73% classified as green, 20% yellow, and 6% red. 1% of patients were brought in deceased. Of the 923 trauma surgery patients admitted under the red category, 918 were admitted and 5 were transferred out. A total of 1299 patients underwent surgery for injuries sustained from trauma. The top three causes of injury were RTI (55%), falls (25%), and assaults (16%). Most injuries were due to blunt force (90%) rather than stab wounds or gunshot wounds. The document also summarizes patient demographics, types of injuries sustained, surgical interventions performed,

1. ANNUAL CENSUS 2012

2. Overview of ED
TOTAL ED VISITS - 53454
Red
6%(3136)
Yellow
20%(10950)
Green
73%
(38964)
Brought death
1%(404)

3. DISTRIBUTION OF RED AREA PATIENTS
TRAUMA SURGERY PTS. (N=923)
ADMITTED TRANSFER OUT DISCHARGED
918 NIL 05

4. Admissions &
Interventions
Surgery Admissions (N=1299 )
Area No. admitted Transfer-
out
Red 918 Nil
Yellow 381 5
Green Nil Nil
ED Interventions (N=22496)
Procedure No.
Suturing 22188
ICDT insertion 265
Cricothyroidotomy 15
Venous cut-down 4
SPC 24

5. DEMOGRAPHIC
PROFILE
TOTAL 1299 %
MALE 1062 81%
FEMALE 237 19%
116
203
279
326
189
117
49
20
0
50
100
150
200
250
300
350

6. MODE OF INJURIES
55%(709)
25%(320)
16%(210)
3%(42)
1%(18)
RTI
FFH
ASSAULT
RAILWAYTRACT
SUICIDAL
1138 115 46
BLUNT 90% STAB/ LV (9%) GSW(1%)

7. MODE OF RTIs
21
2
333
32
82
27
212
0
50
100
150
200
250
300
350
RTI
RIDER
(n-270)
PILLON
(n-63)
HELMET 167 29
WITHOUT
HELMET-41%
103 34

8. Anatomical Distribution
103 121
390
433
779
196
88
16
0
100
200
300
400
500
600
700
800
900
Head & Neck Face/ MF Thorax Abdomen Extremity& soft
tissue
Vascular Pelvis Other
NO. OF INJURIES - 2126

9. Abdominal Trauma
Part involved NO.
Solid Organ(Liver
&Spleen)
Single Organ 247
Multiple
Organs
33
Hollow Viscera 154
Genito-urinary 78
Pancreatico-duodenal 19

10. LIVER TRAUMA -150
MANAGEMENT
OM 29
OM + EMB. 9
EMBOLIZATION 6
NOM 87
Laparotomy for
other injuries
19
0
5
10
15
20
25
30
35
40
45
50
I II III IV V
16%(24)
24%(36)
31%(47)
21%(32)
8%(11)
LIVER GRADE
MORTALITY (12.7%) 19
H.SHOCK/COAGULOPAT
HY
11
SEPSIS 08

11. SPLENIC TRAUMA - 130
MANAGEMENT
SPLENECTOMY 35
EMBOLOZATION 15
NOM 80
SPLENORAPHY 0
0
5
10
15
20
25
30
35
40
I II III IV V
5%(7)
22%(28)
28%(37)
23%(30)
22%(28)
SPLEEN GRADE

12. HOLLOW VISCUS TRAUMA
154
HOLLOW VISCUS
PROCEDURES
Esophagus Primary Repair 2
Cervical
esophagostomy
3
Stomach Repair 7
Jejunum Repair +FJ 20
RA + FJ 25
Ileum Repair 12
RA 13
Ileostomy 9
Colon+rectum Repair 10
RA 9
End colostomy 10
Loop colostomy 8
Stoma closure
(routine - OT )
Ileostomy reversal
Colostomy reversal
12
17
Small
bowel
56%(86)
Large
bowel
25%(38)
Esophagu
s
3%(5)
Stomach
4%(7)
Mesentic
tear
12% (18)
Region wise

13. PANCREATICODUODENAL TRAUMA-19
3
0 0
8
5 3
0
2
4
6
8
10
12
OPERATIVE
NON OPERATIVE
OPERATIVE
DISTAL PANCREATECTOMY 06
DISTAL PANCREATECTOMY WITH SPLENECTOMY 02
DEBRIDMENT + NECROSECTOMY 02
WHIPPLES’ PROCEDURE 00
TRIPLE TUBE DRAINAGE 05
UNCINATE PROCESS EXCISION +RESECTION OF D4 PART OF
DUODENUM
01
MORTALITY = 03

14. Pancreatic Transections at Neck
27 yr Male- Blunt trauma Abdomen

15. GENITOURINARY TRAUMA
(79)
MANAGEMENT
KIDNEY Nephrectomy 5
NOM 26
NOM + PCN 5
AE 0
URETER DJ stenting 1
REPAIR&DJ 1
BLADDER NOM 3
REPAIR&SPC 17
URETHRA NOM 2
SPC 13
OTHERS Orchidectomy 2
penile repair partial 3
Hysterectomy 1
46%(36)
3%(2)
26%(20)
19%(15)
6%(5)
KIDNEY
URETER
BLADDER
URETHRA
OTHERS

16. LAPROSCOPIC AND ENDOSCOPIC
PROCEDURES 19
Diagnostic lap 8
Lap foreign body removal(needle) 1
Lap small bowel perf. repair 1
Lap diaphragm repair 2
Lap. ventral hernioplasty 2
Upper GI
endoscopy
diagnostic
3
PEG 2

17. Thoracic Trauma (n=390)
Non-operative – 358 (91.8%) Operative n=32
With ICDT 335 INDICATION
FOR
THORACOTOMY
Massive
Hemothorax
06
Resuscitative
thoracotomy
05
Decortication 05
Pneumonectomy 03
Lobectomy 01
Bronchial repair 01
Thoracoplasty 02
F.B removal 03
With out ICDT 23 VATS 06
Epidural 93
FOB 12
Descending thoracic aorta stenting (open access) 1
Diaphragmatic repair(4-abdominal approach and 2-
laproscopic)
06

18. Cardiac injuries 7
Site of injuryMechanisms of injury
Blunt 3
Penetrating Stab 2
GSW 2
• LV + RV = 1
• RV+RA = 1
• RV =2
• RA = 1
• RV cardiac contusion
bleeding from LIMA = 1
• LV=1
Mortality -3

19. PERIPHERAL VASCULAR TRAUMA
112
TIME SINCE INJURY <6HRS >6 HRS
UPPER
LIMB
(n=77)
CASES 49 26
AMPUTATION 00 02
LOWER
LIMB
(n=47)
CASES 22 15
AMPUTATION 01 09
SUCCESS RATE 89.9%

20. MAJOR VASCULAR INJURY
(16)
VESSEL
INVOLVED
NO MANAGEMENT
SUB CLAVIAN 03 REPAIR , STENTING , NOM
IVC 02 REPAIR
IJV 02 LIGATION
EXT. ILIAC VEIN 02 REPAIR, LIGATION
SUP GLUTEAL A 01 LIGATION
A V FISTULA(EIA-
EIV)
01 ENDO VASCULAR STENTING
EXT. ILIAC ARTERY 01 REPAIR
IIA 01 LIGATION
AORTA 03 NOM -2 , STENTING

21. IVC RENT
25 year male stab injury right lower hypochondrium

22. NECK INJURIES 25
• ZONE I –(n- 01)
• ZONE II – (n-22)
• ZONE III –(n- 02)
OPERATIVE =16
SUB MANDIBULAR GLAND EXCISION 01
TRACHEAL REPAIR + TRACHEOSTOMY 02
LIGATION OF INT JUG VEIN 02
F.B REMOVAL 02
NON THERAPEUTIC EXPLORATION 03
CERVICAL OESOPHAGOSTOMY 02
PRIMARY REPAIR OF HYPOPHARYNX 02
TRACHEAL REPAIR +CERVICAL
ESOPHAGOSTOMY
01
HEMI THYROIDECTOMY 01
NOM =08
BRONCHOSCOPY+GLUE 01

23. 60Y male fall from 4th floor water pipe impalement

25. EXTRAHEPATIC BILIARY SYSTEM
5
CBD injury (blunt) 1 ERCP stent
GB perforation
GB Penetrating 2 Cholecystectomy
Blunt 1 Cholecystectomy
Incidental GB stones 1 cholecystectomy

26. MAXILLO FACIAL INJURIES
(92)
ORIF
61%
CONSERVATIVE
26%
INTRA DENTAL
WIRING
13%
ORIF
CONSERVATIVE
INTRA DENTAL WIRING

27. PROCEDURES FOR EXTREMITY
INJURIES
AK
33%(35)
BK
16%(17)AEB
9%(10)
BEB
4%(4)
DISARTICU
LATION
8%(9)
REVISION
30%(32)
FASIOTOMIES
57
AMPUTATIONS
107

28. PLASTIC PROCEDURES- 864
• STSG - 518
• DEBRIDEMENT – 147
• STSG + D - 74
• VAC - 151
FLAPS. 69
ABDOMINAL 9
ROTATION 15
GASTRONEMUS 11
GROIN 4
SURAL 10
FREE 3
CROSS LEG FLAP 7
CROSS FINGER FLAP 4
SCALP FLAP 2
TRAM 2
GRACILLIS FLAP 2
RECONSTRUCTION SURGERY 31
V-Y PLASTY 5
CONTRACTURE RELEASE 12
LOBULOPLASTY 8
RHINOPLASTY 2
OCULOPLASTY 1
LIP REPAIR 2
ECTROPION REPAIR 1

29. NERVE AND TENDON
REPAIR -24
MEDIAN NERVE 04
ULNAR NERVE 09
RADIAL NERVE 03
TENDON REPAIR 07
FACIAL NERVE 01
REIMPLANTATION 12CASES
(THREE CASES WERE
SUCCESSFUL- thumb ,distal
foot and hand at the level of
wrist)

30. Operative Procedures
Total 1919
Type of Ax No.
GA 1307
Spinal 481
LA 29
REGIONAL 102

31. Surgery mortality 141
32 33
76
0
10
20
30
40
50
60
70
80
<6Hrs 6-24Hrs LATE
ED
1%(2)
OT
14%(19)
ICU
85%
(120)

32. Overview ED mortality
Mortality (N= 510)
ED Death (0.2%of total)
(3.44% of red area)
Brought Dead
Surger
y
NeuroS
x
medicine
2 103 1 404

33. Early mortality( < 6Hrs )
32
HS
88%(28)
Severe Head
injury
6%(2)
Cardiac Injury
6%(2)
MEAN ISS – 48.61

34. EARLY MORTALITY (6-24HRs)
Mean ISS – 29.62
HS & sequelae
94% (31)
Severe Head
injury
6% (2)

35. LATE MORTALITY >24Hrs
Sepsis & sequelae
31% (24)
VAP to ARDS
8% (6)
Brain
injury
9% (7)
ARF
8% (6)
DIC
12% (9)
ARDS
7% (5)
sepsis
25% (19)
HS Sequelae
51%(39)

36. 0
15
30
45
60
75
1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101 105 109 113 117 121 125 129 133 137 141
EXPIRED INDIVIDUAL
INJURY SEVERITY SCORE (ISS)
MEDIAN = 27

37. We have dealt 12 multiple casualties.
DATE MECHANISM NO OF VICTIMS
2/2/2012 RTA(GRAMIN SEWA NOSE TO
TAIL WITH A BUS)
6
6/3/2012 RTA(nose to tail between two
RTV)
9
28/3/2012 RTA(turn over of tempo) 11
11/4/2012 RTA(nose to tail of RTV with
bus)
13
25/4/2012 RTA(tempo turnover) 9
7/6/2012 RTA(side to side collision of
2cars and then one car run over
4 pedestrian)
8
7/6/2012 RTA(side on collision of car
with an auto)
5
7/7/2012 RTA(truck hit a fixed
object(pole))
5
6/8/2012 RTA(bus hit a tree) 38
10/10/2012 RTA(bus hit a tree) 11
14/10/2012 RTA(minibus turnover) 6
25/11/2012 RTA(head on collision of two
truck)
5
2/12/2012 ASSAULT 14

38. Summary
• Change in trend in solid organ injury –liver more common than
spleen compared to previous years
• Increase in non-operative management of solid organ injuries
• Increase in limb salvage rate from 74.4 to 89.9%
• Introduction of Upper GI endoscopy and Uretheroplasty
• Decrease in overall mortality

39. Thank you