Transfer delay and in-hospital mortality of trauma patients in Pakistan
Afrasyab Khan1, Hasnain Zafar, Syed Nadir Naeem
1Section of General Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan.
Insights
Delays in trauma patient transfer to hospitals in developing countries did not significantly impact in-hospital mortality. This suggests that severely injured patients may not survive long enough to reach care.
Area of Science:
- Trauma care
- Emergency medicine
- Public health in developing countries
Background:
- Trauma remains a significant cause of death and disability in developing nations.
- Lack of organized emergency medical services leads to critical delays in patient transfer.
- These delays can exacerbate complications and worsen patient outcomes.
Purpose of the Study:
- To evaluate the impact of hospital transfer and pre-hospital delays on trauma patient outcomes.
- To analyze the relationship between time to treatment and survival rates in trauma patients.
- To assess mortality and morbidity associated with delayed emergency care in a low-resource setting.
Main Methods:
- Retrospective analysis of 978 trauma patients admitted to Aga Khan University Hospital (AKUH), Karachi, Pakistan (1998-2005).
- Data collected from a dedicated Trauma Registry, focusing on time from injury to emergency room (ER) arrival.
- Statistical analysis to compare outcomes between patients arriving within one hour versus those with longer delays.
Main Results:
- Only 30.9% of patients arrived at the ER within the critical first hour.
- The average time from injury to ER arrival was 4.7 hours.
- No statistically significant difference in in-hospital mortality was observed between early (<1h) and delayed (>1h) arrivals (OR=0.9, 95% CI: 0.6, 1.5).
Conclusions:
- In settings lacking emergency response systems, delayed transfer to tertiary care does not significantly alter in-hospital trauma mortality.
- The findings may indicate a self-selection bias, where only patients with less severe injuries survive the prolonged transfer times.
- Further research is needed to optimize pre-hospital trauma care and reduce delays in developing countries.
Background:
Mortality and morbidity in trauma remain a major problem in developing countries. Organized emergency response systems for transfer of trauma patients to hospitals are absent and the consequent delays could cause significant complications.
Aims:
This study assessed the outcomes as a result of hospital transfer and delays in trauma patients.
Methods:
The study was based on trauma patients presenting to the Aga Khan University Hospital (AKUH), Karachi, Pakistan from 1998 to 2005, meeting the trauma team activation criteria. Data were collected and entered in a Trauma Registry. The study focused on analyzing the outcomes of injury to delay in definitive treatment and survival.
Results:
Out of 978 patients, only 303 (30.9%) patients reached the emergency room (ER) within an hour. The mean time from injury occurrence to arrival in the ER was 4.7h. There was no significant difference in mortality between all patients presenting early and those with more than 1h delay (OR=0.9, 95% CI: 0.6, 1.5).
Conclusions:
Transfer and delay in admission to a tertiary care center does not affect in-hospital mortality of trauma patients in a setting with no emergency response system. This may be due to self selection of patients who survive long enough to reach the hospital.
