Scholarly Article
BRIDGING THE GOLDEN HOUR GAP: A MULTICENTRE STUDY OF FACTORS INFLUENCING OUTCOMES IN ORTHOPAEDIC TRAUMA PATIENTS
Amulya K, Ketavath Motilal, Vyas Vijaya Kumar
2026-07-26 · International Journal of Clinical and Biomedical Research · Sumathi Publications
Abstract
Background: Trauma is a leading cause of death and disability worldwide, and orthopaedic injuries contribute substantially to morbidity, particularly in low- and middle-income countries such as India. Delays in prehospital transport and in reaching definitive treatment adversely affect outcomes. This multicentre study examined the influence of Golden Hour arrival, injury severity, transportation, triage, and treatment strategy on outcomes in orthopaedic trauma patients. Methods: A multicentre observational study was designed across three tertiary care trauma centres in South India. Two hundred and fourteen adults with acute orthopaedic trauma presenting within 24 hours of injury were assessed. Demographic characteristics, injury mechanism, fracture pattern, injury severity scores, prehospital care, transportation, triage category, treatment protocol, and clinical outcomes were recorded. The primary outcome was functional recovery at six months; secondary outcomes were mortality, complications, intensive care admission, length of stay, and neurological recovery. Analyses were performed in IBM SPSS Statistics v29.0, with p < 0.05 considered significant. Results: Mean age was 42.8 ± 17.4 years and 69.6% were male. Road traffic accidents accounted for 58.9% of injuries, and lower-limb fractures were the commonest pattern (43.0%). Patients reaching the trauma centre within the Golden Hour had significantly better outcomes than those presenting later (p < 0.001), with delayed presentation associated with unfavourable outcome (odds ratio 3.84, 95% CI 2.12-6.95). Higher Injury Severity Scores and Red Triage status were associated with poorer prognosis. Early Total Care was the commonest treatment strategy (43.9%). Overall, 72.9% achieved good-to-excellent recovery. Mean hospital stay was 9.6 ± 4.8 days; intensive care admission occurred in 17.8%, surgical site infection in 5.6%, implant failure in 1.9%, and mortality in 3.7%. Conclusions: Early access to definitive trauma care, standardised triage, and protocol-based orthopaedic management are associated with improved outcomes. Strengthening prehospital emergency services, trauma referral networks, designated trauma centres, and adherence to evidence-based protocols may reduce preventable morbidity and mortality in India
Keywords
Orthopaedic trauma, Golden Hour, Road traffic accidents, Trauma systems, Advanced Trauma Life Support, Damage Control Orthopaedics, Early Total Care, Injury Severity Score, Prehospital care, India.
Citation Details
International Journal of Clinical and Biomedical Research, Vol. 11, No. 3, pp. 90-98