The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town

Möller, A; Hunter, Luke; Kurland, Lisa; Lahri, Saʼad; Hoving, D.J. van

doi:10.1016/j.afjem.2018.01.001

Cited by 27 publications

(37 citation statements)

References 26 publications

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“… 8 In most countries of study, trauma patients were transported from injury scene using non-ambulatory means that included private and public vehicles. 24 30 39 43 Private vehicle evacuation was the most common transport option. 9 10 24 44 For example, in Ethiopia, only 20.3% of the sampled trauma patients arrived in the trauma management facilities through ambulance services, 43 whereas in Kenya, less than 10% accessed ambulances.…”

Section: Resultsmentioning

confidence: 99%

“…The study reported high mortality (61%) among patients transported through EMS compared with non-EMS (38.9%). 24 …”

Section: Resultsmentioning

confidence: 99%

“…24 Furthermore, the same study found prehospital transport time not to be a significant correlate of post-trauma mortality. 24 In Malawi, transport by non-ambulance means such as private vehicles was also found to confer significant survival benefits as a result of prompt evacuation to a treatment facility and reduction of delays to life-saving interventions. 22 None of the studies examined possible differences in post-trauma mortality based on ambulance ownership, public and private ambulance transport.…”

Section: Prehospital Transport Modementioning

confidence: 91%

“…The study reported high mortality (61%) among patients transported through EMS compared with non-EMS (38.9%). 24 Among the reviewed articles, prehospital time (time taken to evacuate a patient from the scene of injury to a specialized trauma facility after injury) is more than the recommended one 'golden hour'. 40 45 In Ghana, the median transport time to a tertiary (specialized) trauma facility was 82 minutes, 22 more minutes than the recommended 60 minutes.…”

Section: Prehospital Transport Modementioning

confidence: 99%

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Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

Koome

Atela

Thuita

et al. 2020

Trauma Surg Acute Care Open

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BackgroundAfrica accounts forabout 90% of the global trauma burden. Mapping evidence on health systemfactors associated with post-trauma mortality is essential in definingpre-hospital care research priorities and mitigation of the burden. The studyaimed to map and synthesize existing evidence and research gaps on healthsystem factors associated with post-trauma mortality at the pre-hospital carelevel in Africa.MethodsA scoping review of published studies and grey literature was conducted. The search strategy utilized electronic databases comprising of Medline, Google Scholar, Pub-Med, Hinari and Cochrane Library. Screening and extraction of eligible studies was done independently and in duplicate.ResultsA total of 782 study titles and or abstracts were screened. Of these, 32 underwent full text review. Out of the 32, 17 met the inclusion criteria for final review. The majority of studies were literature reviews (24%) and retrospective studies (23%). Retrospective and qualitative studies comprised 6% of the included studies, systematic reviews (6%), cross-sectional studies (17%), Delphi studies (6%), panel reviews (6%) and qualitative studies (12%), systematic reviews (6%), cross-sectional studies (17%), Delphi studies (6%), panel reviews (6%) and qualitative studies (12%). Reported post-trauma mortality ranged from 13% in Ghana to 40% in Nigeria. Reported preventable mortality is as high as 70% in South Africa, 60% in Ghana and 40% in Nigeria. Transport mode is the most studied health system factor (reported in 76% of the papers). Only two studies (12%) included access to pre-hospital care interventions aspects, nine studies (53%) included care providers aspects and three studies (18%) included aspects of referral pathways. The types of transport mode and referral pathway are the only factors significantly associated with post-trauma mortality, though the findings were mixed. None of the included studies reported significant associations between pre-hospital care interventions, care providers and post-trauma mortality.DiscussionAlthough research on health system factors and its influence on post-trauma mortality at the pre-hospital care level in Africa are limited, anecdotal evidence suggests that access to pre-hospital care interventions, the level of provider skills and referral pathways are important determinants of mortality outcomes. The strength of their influence will require well designed studies that could incorporate mixed method approaches. Moreover, similar reviews incorporating other LMICs are also warranted. Key Words: Health System Factors, Emergency Medical Services [EMS], Pre-hospital Care, Post-Trauma mortality, Africa.

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Section: Resultsmentioning

confidence: 99%

“…The study reported high mortality (61%) among patients transported through EMS compared with non-EMS (38.9%). 24 …”

Section: Resultsmentioning

confidence: 99%

Section: Prehospital Transport Modementioning

confidence: 91%

Section: Prehospital Transport Modementioning

confidence: 99%

See 2 more Smart Citations

Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

Koome

Atela

Thuita

et al. 2020

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

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“…rauma is one of the major causes of death in people aged under 46 years in the United States (Rees et al 2015), Japan (Nagata et al 2018), and South Africa (Moller et al 2018). The quality of care for patients with trauma affects their survival rate (Dijkink et al 2018).…”

Section: Introductionmentioning

confidence: 99%

Prehospital Trauma Management: Evaluation of a New Designed Smartphone Application

Balajelini

Ghezeljeh

2018

JCCNC

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Background: Regarding the undeniable role of nurses in caring for patients with trauma, a suitable method is required for the education of nursing students to meet their needs. In this study, first we designed an educational smartphone application for pre-hospital trauma management and then nursing students evaluated its usefulness. Methods: This applied study has a cross-sectional design and conducted to develop a mobile application. A total of 41 undergraduate nursing students participated in this study. They were selected through the census method from Iran University of Medical Sciences in 2018. The educational content of the application was developed based on the available standard skills required for prehospital trauma management. The study sample first received routine education. Then they used the application to handle and manage care for traumatic patients for one month. The students' satisfaction with the application was measured using a software called application satisfaction questionnaire. The obtained data were analyzed by descriptive statistics in SPSS V. 21. Results: After designing the application, 97.6% of the students reported that the classification of data in the application was appropriate. From their point of view (92.7%), the application also provided the required information for the appropriate patient's care in trauma situations. All students reported that the application, its links to web pages, movies, texts, and images were easy to use. About 95% of the students reported that graphic components, colors, and moving between pages were easy. Most were satisfied with the application and recommended its use to other undergraduate nursing students. The majority of them (80.5%) used the application consistently and suggested (80.5%) that the same application should be prepared for other courses. Conclusion: The application was reported to be easy to use for trauma management and students were generally satisfied. Therefore, it can be used to facilitate the educational process and help students learn at any time and place.

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Police Transportation Following Vehicular Trauma and Risk of Mortality in a Resource‐Limited Setting

Purcell

Mulima

Nip³

et al. 2020

World j. surg.

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Background In resource-limited settings, prehospital trauma care and transportation from the scene to a hospital is not well developed. Critically injured patients present to the hospital via privately owned vehicles (PV), public transportation, or the police. We aimed to determine the mortality following road traffic injury based on the mode of transportation to our trauma center. Methods We performed a retrospective analysis of the Kamuzu Central Hospital (KCH) Trauma Registry from January 2011 to May 2018. Patients with road traffic injuries, presenting from the scene, were included. Those brought in dead or discharged from casualty were excluded. Bivariate analysis was performed over mortality. A Poisson multivariate regression determined the relative risk of mortality by prehospital transportation. Results 2853 patients were included; 7.8% (n = 223) died. Patients were transported by PV (n = 1963, 68.8%), minibus (n = 497, 17.4%), and police (268, 9.4%). No patients were transported by ambulance. Patients transported by police (1 h, IQR 0-2) and PV (1 h, IQR 0-2), arrived earlier than those transported by minibus (2 h, IQR 0-27), p \ 0.001. There was no difference in injury severity between the transportation cohorts. Compared to PV, patients transported by police (RR 1.56, 95% CI 1.13-2.17, p = 0.008) have an increased risk of mortality after controlling for injury severity. There was no difference in mortality in patients presenting by minibus (RR 0.83, 95% CI 0.55-1.24, p = 0.4). Conclusion Patients transported to KCH via police have a higher risk of mortality than those transported via private vehicle after controlling for injury severity. Training police in basic life support may be an initial target of intervention in reducing trauma mortality. Overall, the creation of a functional prehospital ambulance system with a cadre of paramedics is necessary for both trauma and non-trauma patients alike. This can only be achieved by training all stakeholders, the police, public transport drivers, and the public at large.

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The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town

Cited by 27 publications

References 26 publications

Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

Prehospital Trauma Management: Evaluation of a New Designed Smartphone Application

Police Transportation Following Vehicular Trauma and Risk of Mortality in a Resource‐Limited Setting

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