Men, foreign nationals suffer more from polytrauma injuries in Singapore

Polytrauma patients with musculoskeletal injuries are significantly at risk of morbidity and mortality, according to a Singapore study. These individuals are usually economically productive men injured in road traffic accidents and falls from height, as well as foreign nationals with high-risk jobs.

“We have suggested some measures to reduce polytrauma in motorcyclists, such as improved defensive driving, appropriate attire, and other road safety measures,” the researchers said. Additionally, “[w]e found that the bill size in foreign workers was significantly higher than what they are insured for; we suggest that insurance requirements for this vulnerable group of patients be adjusted in view of this.”

A total of 560 polytrauma patients (injury severity score [ISS] >17, mean age 44 years, 79.3 percent male) who suffered musculoskeletal injuries (ISS >2) from 2011 to 2015 in the National University Hospital, Singapore, were assessed in this retrospective cohort study.

Of the patients, 39.3 percent were foreign migrant workers. Majority of road traffic accidents involved motorcyclists (63 percent). Hospital stay was 18.8 days on average, while intensive care unit stay (ICU) showed a mean duration of 5.7 days. Mortality rate among patients stood at 19.8 percent. [Singapore Med J 2022;doi:10.11622/smedj.2022081]

The most common fractures encountered at the institution were femur and tibia fractures. Nearly half of the patients (46.4 percent) needed surgical treatment.

Risk factors predictive of mortality included a Glasgow Coma Scale (GCS) score <12 and need for blood transfusion. Lower limb injuries, road traffic accidents, GCS score <8 and need for transfusion were associated with extended hospital stay (p<0.05), while reduced GCS score, need for blood transfusion, and upper limb musculoskeletal injuries were predictive of longer ICU stay.

Of note, foreign workers had significantly higher inpatient costs, which substantially exceeded the minimum insurance coverage currently required.

“We found a preponderance of male patients in our study (3.8 times more male than female patients), which was consistent with the findings in other studies,” the researchers said. [Injury 2013;44:1015-1021; Am J Surg 2005;189:571-576; Injury 2001;32:613-617]

“This was also similar to other studies that reported the epidemiology of polytrauma in Singapore,” they added. [J Emerg Trauma Shock 2014;7:174-179; Ann Acad Med Singap 1991;20:190-195; Ann Acad Med Singap 2010;39:920-927]

Foreign workers

A significant proportion of patients in this study were made up of foreign nationals working in Singapore (n=220; 39.3 percent). This was potentially driven by the larger number of foreign patients involved in high-risk occupations such as construction.

Of these patients, 124 were involved in road traffic accidents, while 67 were involved in falls from a height. All patients who fell from a height were industrial accidents.

“Unfortunately, it was not possible for us to determine whether the injuries sustained in road traffic accidents were industry related or nonindustry related, as this was not recorded,” the researchers said.

Polytrauma patients was defined as one with an abbreviated injury scale score of ≥2 in at least two body regions. Musculoskeletal trauma is “extremely common” in these patients and is the number one reason for surgical treatment. Often, these individuals have poor functional outcomes after treatment, according to the researchers. [ANZ J Surg 2010;80:119-121; Injury 2012;43:196-199]