Indian female assault patients 40 times more susceptible to death than US females

By Rajiv Shah
A new study in a top US medical journal has raised the alarm that "while both males and females in India had higher odds of mortality than their US counterparts, Indian female assault patients had a 40 times higher odds of death than US females", wondering whether "this difference in mortality attributable to potential delay between injury time and medical attention, along with limited prehospital care services and access to affordable surgical care."
Claimed to be the first ever study drawing a comparison between two countries -- one rich and another poor -- the authors say, their findings confirm "previous literature citing increased mortality after trauma in lower-income countries", adding, "Additionally, our matched analysis revealed significant differences in outcomes based on gender..."
Titled "Comparative analysis of gender differences in outcomes after trauma in India and the USA: case for standardised coding of injury mechanisms in trauma registries", by researchers Mohini Dasari, Siddarth D David, Elizabeth Miller, Juan Carlos Puyana, Nobhojit Roy, belonging to well-known US, Indian and Swedish institutes, the study has been published in the prestigious journal "BMJ Global Health".
"In terms of social variables", the study says, the data suggest, "Domestic violence contributes to a significant percentage of female trauma patients presenting in high-income and low-income countries", underlining, "Multiple strong sources of evidence suggest that only one in four women in India seek care services related to experiencing intimate partner violence."
The Indian data in the study has been taken from top hospitals in Kolkata, Mumbai and Delhi, while the US data has been taken from trauma centres in Pittsburgh, Pennsylvania. Both the data are for the period from 2013 to 2015, and and analyse 7505 Indian and 9448 US patients.
Calling this evidence of "intentional injury and gender-based violence", the data in the study show that in-hospital deaths among India females is to the tune 28.2% as against just 2.5% among US females. As for the males, it is 26.2% in India and in US 3.3%. The higher percentage of deaths take place, the study adds, despite "significantly higher rates of surgical management of patients with trauma in India compared to the US."
While the data further show that 28.5% of Indian patients undergo "surgical management", compared to just 5.2% in the US, the authors of the study believes that this could be because in India, "many motor vehicle collision (MVC) and assault cases, because of the medico-legal nature of case, are transferred to public hospitals."
The study further explains, "Since the Indian cohort is based on public trauma centres, there could be a larger number of surgeries occurring given that these centres provide more tertiary level care to those who cannot afford private care or are referred up to such larger-volume hospitals for cases requiring operative management."
It adds, "Given the limited use of resources such as interventional radiology in such public hospitals in India, all these cases represent surgical procedures occurring in the operating room versus bedside procedures."
Additionally, the study finds discrepancy between India and the US in the Injury Severity Score (ISS), a term used to assess trauma severity. Despite mild ISS values in India, there is "significantly higher mortality", it says, adding, this could be because "Indian public hospitals have limited resources and radiological interventions such as CT, ultrasound and X-rays are not done routinely for patients with trauma unless in cases of severe injury."