Police Transportation Following Vehicular Trauma and Risk of Mortality in a Resource-Limited Setting.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
accepted:
23
10
2020
pubmed:
10
11
2020
medline:
25
6
2021
entrez:
9
11
2020
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 33164113
doi: 10.1007/s00268-020-05853-z
pii: 10.1007/s00268-020-05853-z
pmc: PMC7856211
mid: NIHMS1645010
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
662-667Subventions
Organisme : FIC NIH HHS
ID : D43 TW009340
Pays : United States
Organisme : NIGMS NIH HHS
ID : T32 GM008450
Pays : United States
Organisme : FIC NIH HHS
ID : D43TW009340
Pays : United States
Organisme : FIC NIH HHS
ID : D43TW009340
Pays : United States
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