title: Time intervals in the treatment of fractured femurs as indicators of the quality of trauma systems.
abstract: OBJECTIVE
  To investigate the use of time intervals in the treatment of fractured femurs as indicators of the quality of trauma systems.
  
  
  METHODS
  Time intervals from injury to admission, admission to surgery and surgery to discharge for patients with isolated femur fractures in four low- and middle-income countries were compared with the corresponding values from one German hospital, an Israeli hospital and the National Trauma Data Bank of the United States of America by means of Student's t-tests. The correlations between the time intervals recorded in a country and that country's expenditure on health and gross domestic product (GDP) were also evaluated using Pearson's product moment correlation coefficient.
  
  
  RESULTS
  Relative to patients from high-income countries, those from low- and middle-income countries were significantly more likely to be male and to have been treated by open femoral nailing, and their intervals from injury to admission, admission to surgery and surgery to discharge were significantly longer. Strong negative correlations were detected between the interval from injury to admission and government expenditure on health, and between the interval from admission to surgery and the per capita values for total expenditure on health, government expenditure on health and GDP. Strong positive correlations were detected between the interval from surgery to discharge and general government expenditure on health.
  
  
  CONCLUSIONS
  The time intervals for the treatment of femur fractures are relatively long in low- and middle-income countries, can easily be measured, and are highly correlated with accessible and quantifiable country data on health and economics.
authors.affiliation: San Francisco General Hospital, University of California in San Francisco, 2550 Twenty-third Street, Building 9, 2nd Floor, San Francisco, CA 94110, United States of America (USA).
authors.forename: Amir
authors.initials: A
authors.lastname: Matityahu
authors.affiliation: University of Florida, Gainesville, USA .
authors.forename: Iain
authors.initials: I
authors.lastname: Elliott
authors.affiliation: Orthopaedic Trauma Institute, University of California, San Francisco, USA .
authors.forename: Meir
authors.initials: M
authors.lastname: Marmor
authors.affiliation: Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, USA .
authors.forename: Amber
authors.initials: A
authors.lastname: Caldwell
authors.affiliation: University of Florida, Gainesville, USA .
authors.forename: Richard
authors.initials: R
authors.lastname: Coughlin
authors.affiliation: School of Public Health, University of California, Berkeley, USA .
authors.forename: Richard A
authors.initials: RA
authors.lastname: Gosselin
mesh_terms: D000328:Adult; D003431:Cross-Cultural Comparison; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D005264:Femoral Fractures / Q000601:surgery / Q000628:therapy*; D005380:Financing, Government / Q000706:statistics & numerical data; D005594:Fracture Fixation, Intramedullary / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D040841:Resource Allocation; D012189:Retrospective Studies; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013997:Time Factors; D014143:Traction / Q000009:adverse effects / Q000191:economics / Q000379:methods; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014481:United States; D055815:Young Adult