title: Hospital-based trauma quality improvement initiatives: first step toward improving trauma outcomes in the developing world.
abstract: BACKGROUND
  Injuries remain a leading cause of death in the developing world. Whereas new investments are welcome, quality improvement (QI) at the currently available trauma care facilities is essential. The objective of this study was to determine the effect and long-term sustainability of trauma QI initiatives on in-hospital mortality and complications at a large tertiary hospital in a developing country.
  
  
  METHODS
  In 2002, a specialized trauma team was formed (members trained using advanced trauma life support), and a western style trauma program established including a registry and quality assurance program. Patients from 1998 onward were entered in to this registry, enabling a preimplementation and postimplementation study. Adults (>15 years) with blunt or penetrating trauma were analyzed. The main outcomes of interest were (1) in-hospital mortality and (2) occurrence of any complication. Multiple logistic regression was performed to assess the impact of formalized trauma care on outcomes, controlling for covariates reaching significance in the bivariate analyses.
  
  
  RESULTS
  A total of 1,227 patient records were analyzed. Patient demographics and injury characteristics are described in Table 1. Overall in-hospital mortality rate was 6.4%, and the complication rate was 11.1%. On multivariate analysis, patients admitted during the trauma service years were 4.9 times less likely to die (95% confidence interval, 1.77-13.57) and 2.60 times (odds ratio; 95% confidence interval, 1.29-5.21) less likely to have a complication compared with those treated in the pretrauma service years.
  
  
  CONCLUSIONS
  Despite significant delays in hospital transit and lack of prehospital trauma care, hospital level implementation of trauma QI program greatly decreases mortality and complication rates in the developing world.
  
  
  METHODS
  Care management study, level IV.
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Zain G
authors.initials: ZG
authors.lastname: Hashmi
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.forename: Mehreen
authors.initials: M
authors.lastname: Kisat
authors.forename: Asad
authors.initials: A
authors.lastname: Moosa
authors.forename: Farjad
authors.initials: F
authors.lastname: Siddiqui
authors.forename: Amyn
authors.initials: A
authors.lastname: Pardhan
authors.forename: Asad
authors.initials: A
authors.lastname: Latif
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D016208:Databases, Factual; D003906:Developing Countries; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010154:Pakistan; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D011787:Quality of Health Care; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult