Direct Transfer to a Tertiary Care Hospital After Traumatic Injury is Associated with a Survival Benefit 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:
03 2022
03 2022
Historique:
accepted:
20
11
2021
pubmed:
7
1
2022
medline:
19
2
2022
entrez:
6
1
2022
Statut:
ppublish
Résumé
Trauma is a leading cause of morbidity and mortality worldwide, and patients in low- and middle-income countries are disproportionately affected. Organized trauma systems, including appropriate transfer to a higher level of care, improve trauma outcomes. We sought to evaluate the relationship between transfer status and trauma mortality in Malawi. We performed a retrospective analysis of trauma patients admitted to Kamuzu Central Hospital (KCH), a trauma center in Lilongwe, Malawi, between January 1, 2013, and May 30, 2018. Transfer status was categorized as direct if a patient arrives at KCH from the injury scene and indirect if a patient comes to KCH from another health care facility. We used logistic regression modeling to evaluate the relationship between transfer status and in-hospital mortality. A total of 8369 patients were included in the study. The mean age was 34.6 years (SD 15.8), and 81% of patients were male. The most common mechanism of injury was motor vehicle collision. Injury severity did not significantly differ between the two groups. Crude mortality was 4.8% for indirect and 2.6% for direct transfers. After adjusting for relevant covariates, odds ratio of mortality was 2.12 (1.49-3.02, p < 0.001) for indirect versus direct transfers. Trauma patients indirectly transferred to a trauma center have nearly double the risk of mortality compared to direct transfers. Trauma outcome improvement efforts must focus on strengthening prehospital care, improving district hospital capacity, and developing protocols for early assessment, treatment, and transfer of trauma patients to a trauma center.
Identifiants
pubmed: 34989834
doi: 10.1007/s00268-021-06415-7
pii: 10.1007/s00268-021-06415-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
504-511Informations de copyright
© 2021. The Author(s) under exclusive licence to Société Internationale de Chirurgie.
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