Priorities for improving hospital-based trauma care in an African city.
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.


CONCLUSIONS
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.
London
J A
JA
Department of Surgery, University of California, Davis, Sacramento, California, USA.
Mock
C N
CN
Quansah
R E
RE
Abantanga
F A
FA
Jurkovich
G J
GJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006292:Health Priorities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000191:economics / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D013997:Time Factors; D014187:Transportation of Patients; D014193:Trauma Centers / Q000592:standards*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality / Q000628:therapy