A Preliminary Trial of the Introduction of Computerized Decision Support to Assist Resuscitation of the Severely Injured in a Level 1 Trauma Centre in India

Injury from motor vehicle accidents remains a leading cause of death in India with increasing number of fatalities. Timely delivery of lifesaving interventions is critical for survival and in restoring physical functioning. As a part of the Australia India Trauma Systems Collaboration, the Trauma Reception and Resuscitation (TRR (c))-computerized decision support system was implemented in a Level 1 Trauma Centre in India in order to determine whether this system would reduce the time in performing lifesaving interventions and improve vital sign data capture and documentation. This prospective cohort study at the Jai Prakash Narayan Apex Center, All India Institute of Medical Science, New Delhi, recruited a total of 106 participants into two groups: TRR (c) (76) and controls (30). During the first 30 min of resuscitation, the TRR (c) group recorded greater sets of vital signs in compared to the controls for medical records. More importantly, the real-time documentation of the vital signs for the TRR (c) group ensured accuracy for medical records. For lifesaving interventions, oxygen was administered in the TRR (c) group only if SpO(2) < 93%, whereas oxygen was administered as standard of care in the controls. There was no statistical difference in the mean times to endotracheal intubation, intercostal catheter insertion or performance of emergency chest x-ray between the control and TRR (c) groups. Importantly however, these 3 comparable interventions were performed consistently within a smaller timeframe for patients receiving care with TRR (c) decision prompts. There was a greater variability in the time taken to perform lifesaving interventions in the control group in comparison to the clinicians assisted with computerized decision prompts. This preliminary study was not powered to measure difference in mortality and patient recruitment was limited to 8 am-5 pm when trained staff could attend to operating the TRR (c) system.