title: Temporal distribution of trauma deaths: quality of trauma care in a developing country.
abstract: BACKGROUND
  Examination of the epidemiology and timing of trauma deaths has been deemed a useful method to evaluate the quality of trauma care.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the quality of trauma care in a regional trauma system and in a university hospital in Brazil by comparing the timing of deaths in the studied prehospital and in-hospital settings to those published for trauma systems in other areas.
  
  
  METHODS
  We analyzed the National Health Minister's System of Deaths Information for the prehospital mortality and we retrospectively collected the demographics, timelines, and trauma severity scores of all in-hospital patients who died after admission through the Emergency Unit of Hospital das Clinicas de Ribeirao Preto between 2000 and 2001.
  
  
  RESULTS
  During the study period, there were 787 trauma fatalities in the city: 448 (56.9%) died in the prehospital setting and 339 (43.1%) died after being admitted to a medical facility. In 2 years, 238 trauma deaths occurred in the studied hospital, and we found a complete clinical set of data for 224 of these patients. The majority of deaths in the prehospital setting were caused by penetrating injuries (66.7%), whereas in-hospital mortality was mainly because of blunt traumas (59.1%). The largest number of in-hospital deaths occurred beyond 72 hours of stay (107 patients-47%).
  
  
  CONCLUSIONS
  The region studied showed some deficiencies in prehospital and in-hospitals settings, in particular in the critical care and short-term follow-up of trauma patients when compared with the literature. Particularly, the late mortality may be related to training and human resources deficiency. Based on the timeline of trauma deaths, we can suggest that the studied region needs improvements in the prehospital trauma system and in hospital critical care.
authors.affiliation: Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Cesar Augusto
authors.initials: CA
authors.lastname: Masella
authors.forename: Vitor Ferreira
authors.initials: VF
authors.lastname: Pinho
authors.forename: Afonso Dinis
authors.initials: AD
authors.lastname: Costa Passos
authors.forename: Fernando A C
authors.initials: FA
authors.lastname: Spencer Netto
authors.forename: Sandro
authors.initials: S
authors.lastname: Rizoli
authors.forename: Sandro
authors.initials: S
authors.lastname: Scarpelini
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D003906:Developing Countries; D004632:Emergency Medical Services; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012041:Regional Medical Programs; D012189:Retrospective Studies; D013997:Time Factors; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*