title: Transfer delay and in-hospital mortality of trauma patients in Pakistan.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Section of General Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan.
authors.forename: Afrasyab
authors.initials: A
authors.lastname: Khan
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
authors.forename: Syed Nadir
authors.initials: SN
authors.lastname: Naeem
authors.forename: Syed Ahsan
authors.initials: SA
authors.lastname: Raza
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003695:Delivery of Health Care; D003906:Developing Countries; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000639:trends; D005260:Female; D005392:First Aid / Q000706:statistics & numerical data; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D066298:In Vitro Techniques; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D010154:Pakistan; D011336:Probability; D012042:Registries; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013997:Time Factors; D014187:Transportation of Patients / Q000639:trends; D014505:Urban Population; D055815:Young Adult