Peer Review Audit of Trauma Deaths in a Developing Country

Jat, Afzal Ali; Khan, Muhammad Rizwan; Zafar, Hasnain; Raja, Asad Jamil; Hoda, Qamar; Rehmani, Rifat; Lakdawala, Riaz Hussain; Bashir, Saad H.

doi:10.1016/s1015-9584(09)60247-5

Cited by 45 publications

(39 citation statements)

References 23 publications

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“…For patients with acute traumatic injuries developing countries, timely transfer to definitive care is likely to be a critical predictor of outcomes. 8 …”

Section: Introductionmentioning

confidence: 99%

Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa

Boschini

Lu-Myers

Msiska

et al. 2016

Injury

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Introduction Traumatic injuries account for the greatest portion of global surgical burden particularly in low-and middle-income countries (LMICs). To assess effectiveness of a developing trauma system, we hypothesize that there are survival differences between direct and indirect transfer of trauma patients to a tertiary hospital in sub Saharan Africa. Methods Retrospective analysis of 51,361 trauma patients within the Kamuzu Central Hospital (KCH) trauma registry from 2008 to 2012 was performed. Analysis of patient characteristics and logistic regression modeling for in-hospital mortality was performed. The primary study outcome is in hospital mortality in the direct and indirect transfer groups. RESULTS There were 50,059 trauma patients were included in this study. 6,578 patients transferred from referring facilities and 43,481 patients transported from the scene. The indirect and direct transfer cohorts were similar in age and sex. The mechanism of injury for transferred patients was 78.1% blunt, 14.5% penetrating, and 7.4% other, whereas for the scene group it was 70.7% blunt, 24.0% penetrating, and 5.2% other. Median times to presentation were 13(4–30) and 3(1–14) hours for transferred and scene patients, respectively. Mortality rate was 4.2% and 1.6% for indirect and direct transfer cohorts, respectively. A total of 8816 patients were admitted of which 3636 and 5963 were in the transfer and scene cohort, respectively. After logistic regression analysis, the adjusted in-hospital mortality odds ratio was 2.09 (1.24–3.54);p=0.006 for indirect transfer versus direct transfer cohort, after controlling for significant covariates. Conclusions Direct transfer of trauma patients from the scene to the tertiary care center is associated with a survival benefit. Our findings suggest that trauma education and efforts directed at regionalization of trauma care, strengthening pre-hospital care and timely transfer from district hospitals could mitigate trauma-related mortality in a resource-poor setting.

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“…For patients with acute traumatic injuries developing countries, timely transfer to definitive care is likely to be a critical predictor of outcomes. 8 …”

Section: Introductionmentioning

confidence: 99%

Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa

Boschini

Lu-Myers

Msiska

et al. 2016

Injury

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“…These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant.…”

mentioning

confidence: 99%

“…These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].…”

mentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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“…The patients were brought to the hospital either by bystanders or in rudimentary patient transport vehicles containing a simple stretcher and a siren. These patient transport vehicles had no trained emergency medical technicians (EMTs) or emergency equipment, and no system of communication with hospitals 14 15…”

Section: Emergency Services In Pakistanmentioning

confidence: 99%

Establishing a successful pre-hospital emergency service in a developing country: experience from Rescue 1122 service in Pakistan

Waseem¹,

Naseer²,

Razzak

2010

Emergency Medicine Journal

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As in many other developing countries, emergency medical services, especially pre-hospital emergency care, has long been neglected in Pakistan. Consequently, patients are brought to the emergency departments by relatives or bystanders in private cars, taxis or any other readily available mode of transportation. Ambulances, where they exist, have barely a stretcher and arrangements for oxygen supply. Modern emergency services are considered too costly for many countries. A model of pre-hospital emergency services, called Rescue 1122 and established in Punjab province of Pakistan, is presented. The system is supported by government funding and provides a quality service. The article describes the process of establishment of the service, the organisational structure, the scope of services and the role it is currently playing in the healthcare of the region it serves.

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Peer Review Audit of Trauma Deaths in a Developing Country

Cited by 45 publications

References 23 publications

Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa

Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa

Critical Care Issues in the Early Management of Severe Trauma

Establishing a successful pre-hospital emergency service in a developing country: experience from Rescue 1122 service in Pakistan

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