Introduction
Until now, injuries are the third leading cause of death
in Thailand. In the United States, it is the leading cause of
death in persons under age 441. During 1 year, every tenth
individual of the German population will have an injury
caused by an accident2. Mortality is easily tubulated and
indicative of the problem, but is not the only consideration.
Each year, millions sustain non-lethal injuries requiring
hospital care, which yields a one-third cost of total budget
in district hospital. Accurate data are needed to evaluate
the severity of trauma patients, therapeutic management
and referral system in individual district hospital of universal
health care policy (30 bath policy).
Orthopedic condition is the common problem (78%)
of trauma patients3. Some require orthopedic management
such as closed reduction of fracture or dislocation,
debridement and internal fixation. All of these patients in
district hospital were referred to the center hospital because
no orthopedist in district hospital in spite of it is the basic
requirement procedure in Thai medical council program.
This report reviews the patient demographics, severity of
injury, orthopedic injuries profiles of trauma patients and
decision management of orthopedic patients in responsible
area of Wisetchaichan hospital.
Patients and Methods
Data were obtained from the trauma registry and
administrative database at emergency room in
Wisetchaichan hospital, Uang-tong, Thailand. Between
January 2003 and December 2004, 1,268 patients were
designated as a trauma patient in emergency department
of our hospital. We collected data on all patients, by
medical records and trauma registry reviews,
retrospectively after discharge. This administrative
database included patientsí demographics, causes of
accident, diagnosis and treatments. Three hundred and
ninety-two patients were excluded from the study on the
basis of incomplete medical records, leaving 876 patients,
who made up the study population.
Data from the patients who had the orthopedic injuries
were analyzed especially in management and referral
aspects. Appropriate orthopedic management defined as
a good decision with strong indication for treatment or
refers. Inappropriate orthopedic management was the
conditions that the doctor made the wrong decision of the
treatment or referred the patient who required only basic
orthopedic management for general practitioners