BACKGROUND: This study sought to identify potential cost-effective methods to improve trauma care in hospitals in the developing world. METHODS: Injured patients admitted to an urban hospital in Ghana over a 1-year period were analyzed prospectively for mechanism of injury, mode of transport to the hospital, injury severity, region of principal injury, operations performed, and mortality. In addition, time from injury until arrival at the hospital and time from arrival at the hospital until emergency surgery were evaluated. RESULTS: Mortality was 9.4%. Most deaths (65%) occurred within 24 hours of admission. Sixty percent of emergency operations were performed over 6 hours after arrival. Tube thoracostomy was performed on only 13 patients (0.6%). Only 58% of patients received intravenous crystalloid and only 3.6% received 1 or more units of blood. CONCLUSION: We identified several specific interventions as potential low-cost measures to improve hospital-based trauma care in this setting, including shorter times to emergency surgery and improvements in initial resuscitation. In addition to addressing each of these aspects of trauma care individually, quality improvement programs may represent a feasible and sustainable method to improve trauma care in hospitals in the developing world.
BACKGROUND: This study sought to identify potential cost-effective methods to improve trauma care in hospitals in the developing world. METHODS: Injured patients admitted to an urban hospital in Ghana over a 1-year period were analyzed prospectively for mechanism of injury, mode of transport to the hospital, injury severity, region of principal injury, operations performed, and mortality. In addition, time from injury until arrival at the hospital and time from arrival at the hospital until emergency surgery were evaluated. RESULTS: Mortality was 9.4%. Most deaths (65%) occurred within 24 hours of admission. Sixty percent of emergency operations were performed over 6 hours after arrival. Tube thoracostomy was performed on only 13 patients (0.6%). Only 58% of patients received intravenous crystalloid and only 3.6% received 1 or more units of blood. CONCLUSION: We identified several specific interventions as potential low-cost measures to improve hospital-based trauma care in this setting, including shorter times to emergency surgery and improvements in initial resuscitation. In addition to addressing each of these aspects of trauma care individually, quality improvement programs may represent a feasible and sustainable method to improve trauma care in hospitals in the developing world.
Authors: John Martel; Rockefeller Oteng; Nee-Kofi Mould-Millman; Sue Anne Bell; Ahmed Zakariah; George Oduro; Terry Kowalenko; Peter Donkor Journal: J Emerg Med Date: 2014-07-25 Impact factor: 1.484
Authors: Sue Anne Bell; Rockefeller Oteng; Richard Redman; Jeremy Lapham; Victoria Bam; Veronica Dzomecku; Jamila Yakubu; Nadia Tagoe; Peter Donkor Journal: Int Emerg Nurs Date: 2014-02-19 Impact factor: 2.142
Authors: Hani Mowafi; Rae Oranmore-Brown; Kathryn L Hopkins; Emily E White; Yacob F Mulla; Phil Seidenberg Journal: World J Surg Date: 2016-12 Impact factor: 3.352
Authors: Patrick M Carter; Jeffery S Desmond; Christopher Akanbobnaab; Rockefeller A Oteng; Sarah D Rominski; William G Barsan; Rebecca M Cunningham Journal: Acad Emerg Med Date: 2012-03 Impact factor: 3.451
Authors: Mark A Brouillette; Scott P Kaiser; Peter Konadu; Raphael A Kumah-Ametepey; Alfred J Aidoo; Richard C Coughlin Journal: World J Surg Date: 2014-04 Impact factor: 3.352