Trauma mortality patterns in three nations at different economic levels: Implications for global trauma system development

被引:304
作者
Mock, CN
Jurkovich, GJ
nii-Amon-Kotei, D
Arreola-Risa, C
Maier, RV
机构
[1] Univ Washington, Harborview Med Ctr, Dept Surg, Seattle, WA 98104 USA
[2] Univ Sci & Technol, Dept Surg, Kumasi, Ghana
[3] Reg Trauma Ctr 21, Monterrey, NL, Mexico
[4] Santa Engracia Med Ctr, Monterrey, NL, Mexico
关键词
injury; trauma; trauma system; developing nation; less developed country; prehospital; Africa; Latin America;
D O I
10.1097/00005373-199805000-00011
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Whereas organized trauma care systems have decreased trauma mortality ire the United States, trauma system design has not been well addressed in developing nations. We sought to determine areas in greatest need of improvement in the trauma systems of developing nations. Methods: We compared outcome of all seriously injured (Injury Severity Score greater than or equal to 9 or dead), nontransferred, adults managed over 1 year in three cities in nations at different economic levels: (1) Kumasi, Ghana: low income, gross national product (GNP) per capita of $310, no emergency medical ser,ice (EMS); (2) Monterrey, Mexico: middle income, GNP $3,900, basic EMS; and (3) Seattle, Washington: high income, GNP $25,000, advanced EMS. Each city had one main trauma hospital, from which hospital data were obtained. Annual budgets tin US$) per bed for these hospitals were as follows: Kumasi, $4,100; Monterrey, $68,000; and Seattle, $606,000. Data on prehospital deaths were obtained from vital statistics registries in Monterrey and Seattle, and by an epidemiologic survey in Kumasi. Results: Mean age (34 years) and injury mechanisms (79% blunt) were similar in all locations. Mortality declined with increased economic level: Kumasi (63% of an seriously injured persons died), Monterrey (55%), and Seattle (35%). This decline was primarily due to decreases in prehospital deaths. In Kumasi, 51% of all seriously injured persons died in the field; in Monterrey, 40%; and in Seattle, 21%. Mean prehospital time declined progressively: Kumasi (102 +/- 126 minutes) > Monterrey (73 +/- 38 minutes) > Seattle (31 +/- 10 minutes). Percent of trauma patients dying in the emergency room was higher for Monterrey (11%) than for either Kumasi (3%) or Seattle (6%). Conclusions: The majority of deaths occur in the prehospital setting, indicating the importance of injury prevention in nations at all economic levels. Additional efforts for trauma care improvement in both low-income and middle-income developing nations should focus on prehospital and emergency room care. Improved emergency room care is especially important in middle-income nations which have already established a basic EMS.
引用
收藏
页码:804 / 814
页数:11
相关论文
共 28 条
[1]   ADVANCED TRAUMA LIFE-SUPPORT PROGRAM INCREASES EMERGENCY ROOM APPLICATION OF TRAUMA RESUSCITATIVE PROCEDURES IN A DEVELOPING-COUNTRY [J].
ALI, J ;
ADAM, R ;
STEDMAN, M ;
HOWARD, M ;
WILLIAMS, JI .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1994, 36 (03) :391-394
[2]   TRAUMA OUTCOME IMPROVES FOLLOWING THE ADVANCED TRAUMA LIFE-SUPPORT PROGRAM IN A DEVELOPING-COUNTRY [J].
ALI, J ;
ADAM, R ;
BUTLER, AK ;
CHANG, H ;
HOWARD, M ;
GONSALVES, D ;
PITTMILLER, P ;
STEDMAN, M ;
WINN, J ;
WILLIAMS, JI .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1993, 34 (06) :890-899
[3]  
Altman DG, 1990, PRACTICAL STAT MED R
[4]  
*AM COLL SURG COMM, 1993, ADV TRAUM LIF SUPP P
[5]  
[Anonymous], ABBR INJ SCAL 1990 R
[6]  
ARREOLARISA C, 1995, J TRAUMA, V39, P457
[7]   EPIDEMIOLOGY OF TRAUMA DEATHS [J].
BAKER, CC ;
OPPENHEIMER, L ;
STEPHENS, B ;
LEWIS, FR ;
TRUNKEY, DD .
AMERICAN JOURNAL OF SURGERY, 1980, 140 (01) :144-150
[8]  
Baker S.B., 1992, The injury fact book
[9]  
BENNETT S, 1991, World Health Statistics Quarterly, V44, P98
[10]  
Collins J. G., 1990, VITAL HLTH STAT, V10