A Year of Trauma at the Emergency Department of National Referral Hospital in Bhutan: An Observational Study

Background: Trauma and related injuries are one of the top ten causes of disability in the world. With the lack of proper baseline data, this study was conducted to improve the understanding of types, modes and outcomes related to trauma visiting the emergency department of national referral hospital in Bhutan. Methods An observational study of all the trauma cases admitted to the Emergency Department over a one year period detailing the mechanism of injury, types of injuries sustained and patient outcomes was carried out. Case record form was used for data collection and Epidata analysis was done for descriptive analysis. Results A total of 820 participants were included during the study period. The sample consisted of 71.6% males and 28.4% females. The median age was 32 years with more than half of the patients (51.4%) belonging to the age range from 26 to 60 years. The top three occupations that experienced trauma were farmers (23.2%), followed by office workers (20.7%) and students (16.9%). Pre-hospital transport was primarily by ambulance (66%) followed by private vehicle (33%). Accidental injury accounted for 91.9% of the injured patients, followed by interpersonal assault (4.8%) and self-harm 3.3%. Fall injuries accounted for 46.2% of the trauma among the study participants, followed by occupational injury (19.1%) and motor vehicle collision injury (19.0%). Extremity injuries were the most common anatomical site comprising of nearly half of all trauma. Majority were admitted to the orthopedic ward 68.2% (n = 391) followed by the surgical ward (n = 91 15.8%). Around sixty five percent (64.9%) were admitted to general ward, 28% of the patients were discharged from ER, 5% were admitted to the ICU and ED mortality was 1.3%. Conclusion This study provides a clinical trauma profile at the national referral hospital in Bhutan where injury-related presentations are common. It highlights the importance of emergency department in managing and evaluation of trauma cases. It also shows the need of further studies to better understand the country’s trauma distribution and development of a robust trauma surveillance system to better provide effective prehospital care and standardized timely hospital care.