Inter‐facility Transfer of Surgical Emergencies in a Developing Country: Effects on Management and Surgical Outcomes

Khan, Salma; Zafar, Hasnain; Zafar, Syed Nabeel; Haroon, Naveed

doi:10.1007/s00268-013-2308-y

Cited by 19 publications

(24 citation statements)

References 38 publications

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“…However, all three participating hospitals had high transfer rates which indicate that our model may be generalised to this type of setting while it must be studied in detail for less specialised hospitals. Similar transfer rates have been reported from other university hospitals in the region [40].…”

Section: Discussionsupporting

confidence: 87%

Predicting Early Mortality in Adult Trauma Patients Admitted to Three Public University Hospitals in Urban India: A Prospective Multicentre Cohort Study

et al. 2014

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BackgroundIn India alone, more than one million people die yearly due to trauma. Identification of patients at risk of early mortality is crucial to guide clinical management and explain prognosis. Prediction models can support clinical judgement, but existing models have methodological limitations. The aim of this study was to derive a vital sign based prediction model for early mortality among adult trauma patients admitted to three public university hospitals in urban India.MethodsWe conducted a prospective cohort study of adult trauma patients admitted to three urban university hospitals in India between October 2013 and January 2014. The outcome measure was mortality within 24 hours. We used logistic regression with restricted cubic splines to derive our model. We assessed model performance in terms of discrimination, calibration, and optimism.ResultsA total of 1629 patients were included. Median age was 35, 80% were males. Mortality between admission and 24 hours was 6%. Our final model included systolic blood pressure, heart rate, and Glasgow coma scale. Our model displayed good discrimination, with an area under the receiver operating characteristics curve (AUROCC) of 0.85. Predicted mortality corresponded well with observed mortality, indicating good calibration.ConclusionThis study showed that routinely recorded systolic blood pressure, heart rate, and Glasgow coma scale predicted early hospital mortality in trauma patients admitted to three public university hospitals in urban India. Our model needs to be externally validated before it can be applied in the clinical setting.

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Section: Discussionsupporting

confidence: 87%

Predicting Early Mortality in Adult Trauma Patients Admitted to Three Public University Hospitals in Urban India: A Prospective Multicentre Cohort Study

et al. 2014

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“…In the present study, patients in LMICs were more likely to experience significant in-hospital delays. Consistent with previous studies 22,23 , this was associated with end stoma formation. It should be noted in the present data, however, that in-hospital delay (48 h or more) was not associated with an increased risk of death in the mixed-effects model.…”

Section: Discussionsupporting

confidence: 92%

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

Collaborative

2019

BJS Open

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BackgroundEnd colostomy rates following colorectal resection vary across institutions in high‐income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left‐sided colorectal resection.MethodsThis study comprised an analysis of GlobalSurg‐1 and ‐2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left‐sided colorectal resection within discrete 2‐week windows. Countries were grouped into high‐, middle‐ and low‐income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.ResultsIn total, 1635 patients from 242 hospitals in 57 countries undergoing left‐sided colorectal resection were included: 113 (6·9 per cent) from low‐HDI, 254 (15·5 per cent) from middle‐HDI and 1268 (77·6 per cent) from high‐HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low‐ compared with middle‐ and high‐HDI settings. The association with colostomy use in low‐HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001).ConclusionGlobal differences existed in the proportion of patients receiving end stomas after left‐sided colorectal resection based on income, which went beyond case mix alone.

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“…By comparison, secondary triage is an evaluation regarding the ultimate location of definitive care, made subsequent to primary survey and stabilization [3,4]. A judicious approach to triage decisions is critical because overtriage can be a resource-depleting problem at either the primary or secondary level [5][6][7][8]. National guidelines exist for primary triage, which recommend maintaining measurable primary overtriage rates to level I trauma centers in order to minimize missed injury [9].…”

mentioning

confidence: 99%

Secondary Overtriage in Pediatric Trauma: Can Unnecessary Patient Transfers Be Avoided?

Goldstein

Arendonk

Aboagye

et al. 2015

Journal of Pediatric Surgery

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Inter‐facility Transfer of Surgical Emergencies in a Developing Country: Effects on Management and Surgical Outcomes

Abstract: Inter-facility transfer of patients with surgical emergencies is common. These patients arrive with deranged physiology which requires complex and prolonged hospital care. Patients who cannot afford treatment are most vulnerable to transfers and delays.

Cited by 19 publications

References 38 publications

Predicting Early Mortality in Adult Trauma Patients Admitted to Three Public University Hospitals in Urban India: A Prospective Multicentre Cohort Study

Predicting Early Mortality in Adult Trauma Patients Admitted to Three Public University Hospitals in Urban India: A Prospective Multicentre Cohort Study

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

Secondary Overtriage in Pediatric Trauma: Can Unnecessary Patient Transfers Be Avoided?

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