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Traumas' Management in a Primary Health Care Level International Journal of Caring Sciences May-August 2018 Volume 11 | Issue 2| Page 927 Original Article Traumas’ Management in a Primary Health Care Level Maria Saridi, PhD Scientific Fellow, Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece Aikaterini Toska, PhD Scientific Fellow, Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece Dimitra Latsou, PhD(c) Statistician, Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece Triseugeni Tsourapa, RN, MSc Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece Kyriakos Souliotis, PhD Associate Professor, Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece Mary Geitona, Professor, PhD Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece Correspondence: Saridi Maria, Sina 33 str. Korinthos. PK.20131, Greece e-mail:[email protected] Abstract Purpose: The aim of this study was the recording of traumas and their management in a primary health care level , health center of Xylokastro, Greece. Material and Method: This research is a cross-sectional observation study. The data were retrieved from the emergency files of the Health Center and included a total 871 patients visited the Center from September 2016 until August 2017. The statistical analysis was carried out using the Pearson's χ2 test or Fisher's exact test. Results : 62.8% of the population visited the health center were males, the mean age was 42.8 years (± 24.8), and 57.5% were coming from an urban area. 51.8% of the patients had been diagnosed with open rupturing wounds, 24.5% with microtrauma, 16.6% were suffered from complicated wounds and 7.1% were diagnosed with friction burns. As far as the cause of trauma, 31.8% of patients visited the health center due to a fall, and 20.9% due to a work accident. The majority of the patients (66.2%) visited the health center did not need referral or transferring to another health care service. However, it was considered necessary the referral to the hospital for patients with complicated wounds. A statistical significant difference it was found between the age of patients , the cause and diagnosis of traumas. Conclusions : Despite the fact that the effective provision of emergency services is a key goal of the primary health care, however, it is imperative to be recognized that trauma is a preventive public health problem, and therefore the development of prevention strategies, is vital in order the mortality and disability of patients to be reduced. Keywords: trauma, primary health, wound, prevention, emergency Introduction group ages worldwide, causing many lost years of life (Mock et al., 2004, Mock et al., 2005). Traumas are an important issue of public health, since are the main cause of mortality in young According to World Health Organization (WHO), more than 5 millions of people are dying www.internationaljournalofcaringsciences.org International Journal of Caring Sciences May-August 2018 Volume 11 | Issue 2| Page 928 every year as a result of traumas, representing the hospitalization, is higher in rural areas (Boland et 9% of all deaths globally and almost 1,7 times al., 2005; Coben et al., 2009; Jiang et al., 2007; the number of lethal incidents caused by HIV / Mitchell &Chong 2010). These areas have also AIDS, tuberculosis, and malaria. For every higher levels of mortality rates compared to death, it is estimated that there are decuple urban areas (Bakke et al., 2013; Fatovich hospital stays, thousands of visits in emergency &Jacobs 2009; Kristiansen et al., 2012; departments, and millions of medical Kristiansen et al., 2014; Lagace et al., 2007). appointments. A great percentage of people who The aim of this study was the recording of survive of traumas, undergone temporary or traumas and their management in a primary permanent disabilities. Among individuals of 15- health care level and more specifically, in the 29 years old, the main cause of death are traumas health center of Xylokastro. caused from road accidents, whereas, in elderlies the falls are the most frequent cause of traumas Methods connected with death (WHO, 2014 ). The present study is an observational study The financial aspect of the burden is also an conducted from September 2016 to August 2017, important issue, since the therapy and in health center of Xylokastro which is a rehabilitation of wounded, represent a great decentralized primary care unit of the general percentage of many national budgets for the hospital of Corinth, in Greece. Xylokastro is a health. Almost 2% of the gross domestic product seaside city and belongs to region of Corinth. It in high income countries is disposed for traumas is the seat of the municipality of Xylokastro – caused by road accidents, whereas for the low Evrostini, where, according to the 2011 census and medium income countries, this percentage is they live 17.365 permanent residents. Every 5%. summer the city receives thousands of visitors as is one of the most important tourist destinations The main goals of trauma care, is the survival of in the Peloponnese. wounded patients, the reduction of morbidity and the improvement of quality of life after the The health center of Xylokastro is responsible for injury. There are important factors in trauma primary healthcare provided in the region and physiology that affect the outcome of the main cooperates with 10 regional primary care clinics, trauma (the real accident its self), of the servicing approximately 21.155 population of secondary trauma (interventions, therapy, responsibility, in the area of the Municipalities of incidents and complications followed the first Xylokastro and Evrostini. This health center is injury) as well as of the individual biological operating 24 hours a day, providing services of response to trauma (comorbidity) (Bouillon, general medicine, dentistry, microbiological 2014). laboratory as well as emergency department. According to available statistical data of 2011, The pre-hospital medical services of emergent the health center provided health care services in care of traumas, can be divided into basic and 9.198 emergent incidents whereas in 2012 had life support services. The basics ones include managed 8.794 emergent incidents. medical care provided initially by the health professionals in order the vital functions to be The population was surveyed, were patients ensured until the transporting of patients to visited the health care center in order to receive another appropriate medical care. The health care due to an accident. The data was specialized support includes the use of methods retrieved from the record of emergencies, were such as medication and intubation, usually transported to a special form, and especially provided by a specialized medical staff as designed for the study. This form contained anesthesiologists. (Ryynanen et al., 2010). patients’ demographic data, as well as data related to the trauma such as cause, diagnosis, The recognition of the severe wounded management methods and necessity of individuals, the transport to an appropriate level transporting for a further specialized care. The of care and the therapeutic interventions, are criterion for inclusion in this study was trauma. considered the most important factors in pre- However, incidents with missing data related the hospital care of (American College of Surgeons injury, as diagnosis, causes and management, 2014; Kristiansen et al., 2010). It is estimated were excluded from the study. that the frequency of severe traumas which needs www.internationaljournalofcaringsciences.org International Journal of Caring Sciences May-August 2018 Volume 11 | Issue 2| Page 929 Statistical analysis specifically, 34.1% of person who had visited the center because of a fall, was belonged to the age The collected data were statistically analyzed group over 71 years old, followed by the age with the statistical program S.P.S.S. 21 group of 1 – 10 years old (23.5%) with a (Statistical Package for Social Sciences). The significant statistical difference compared to the descriptive statistics are presented in percentage other age groups (p = 0.001 and p = 0.001 distribution, mean and standard deviations on respectively). The majority of the sample population’s characteristics, diagnosis of (27.5%) which needed health care services due to incident, cause of trauma, way of management, work accidence was belonged to the age group of need for further management or transporting. 51 to 60 years old and 23.4% to the ages of 31 to Furthermore, statistical differences were 40 years old. The road accidence incidence was performed using Pearson’s χ2 test or Fisher's higher in younger age groups and specific in exact test (where it was necessary). The those of 21-30 years old (25.5%) and 31-40 years significance level was set to 0.05. old (21.8%) compared to the other age groups (p Results = 0.001). The overall population visited the health center Additionally, the beating cases were mainly was consisted of 871 individuals. The majority of concerning the 33.3% of age groups 11-20 and the sample was males (62.8%). The mean age 41-50 years old, whereas the cases of a dog’s was 42.8 years old (±24.8) with the age of one bite, was concerning the ages of 1-10 (21.1%) year old to be the lower, and the age of 105 to be and 61-70 years old (21.1%) without being the higher age. 57.5% of the sample was coming observed a significant statistical difference from an urban area (Table 1 ). Months with a between specific causes of injury and age group. higher number of visitors compared with the Statistically significant difference was found other months, were August (11.5%), following between patients who were diagnosed with by July (10.8%) and June (9%). complicated trauma and were referred to another As far as the diagnosis of trauma, 51.8% of the health care structure and those who were patients had been diagnosed with open rupturing diagnosed with other type of trauma (p ≤ 0.001).
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