TRAUMA OUTCOME IMPROVES FOLLOWING THE ADVANCED TRAUMA LIFE-SUPPORT PROGRAM IN A DEVELOPING-COUNTRY

Trauma outcome variables before and after the institution of the Advan ced Trauma Life Support (ATLS) program were compared for the largest h ospital in Trinidad and Tobago from July 1981 through December 1985 (p re-ATLS) and from January 1986 to June 1990 (post-ATLS). A total of 19 9 physicians were ATLS trained by June 1990. Outcome data were analyze d for all dead or severely injured patients (ISS greater-than-or-equal -to 16; n = 413 pre-ATLS and n = 400 post-ATLS). Trauma mortality decr eased post-ATLS (134 of 400 vs. 279 of 413) throughout the hospital, i ncluding the ICU (13.6% post-ATLS ICU mortality vs. 55.2% pre-ATLS). T he 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-AT LS 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 inju ry pre-ATLS (84.0%) versus post-ATLS (68.3%), the mortality rates for both blunt and penetrating injuries were higher in the pre-ATLS group (19.7% pre-ATLS vs. 6.3% post-ATLS for penetrating and 76.6% pre-ATLS versus 46.2% post-ATLS for blunt). For each ISS category, mortality wa s greater in the pre-ATLS group (ISS greater-than-or-equal-to 24 pre-A TLS mortality 47.9% vs. 16.7% post-ATLS; ISS 25-40 pre-ATLS mortality 91.0% vs. 71.0% post-ATLS). The overall ratio of observed to expected mortality based on the MTOS data base was lower for the post-ATLS peri od (pre-ATLS ratio 3.16; post-ATLS ratio 1.94). Multiple logistic regr ession analysis indicated that although post-ATLS mortality was affect ed by the lower incidence of blunt injury and a lower overall ISS scor e, the ATLS program was a significant factor in determining the observ ed decrease in mortality. Postinjury functional status among survivors was improved post-ATLS (minor disability 88.3% post-ATLS vs. 22.4% pr e-ATLS and major disability 1.9% post-ATLS vs. 6.7% pre-ATLS). Our dat a demonstrate that the ATLS program significantly improved trauma pati ent outcome in a developing country, thus supporting the concept of in ternational promulgation of this program for physicians.