Trauma mortality patterns in three nations at different economic levels: Implications for global trauma system development
Trauma mortality patterns in three nations at different economic levels: Implications for global trauma system development
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DOI：
10.1097/00005373-199805000-00011
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发表时间：
1998-05-01
影响因子：
--
通讯作者：
Maier, RV
中科院分区：
文献类型：
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作者：
Mock, CN;Jurkovich, GJ;Maier, RV
背景资料：在美国，有组织的创伤护理系统已经降低了创伤死亡率，而在发展中国家，创伤系统的设计还没有得到很好的解决。我们试图确定发展中国家创伤系统中最需要改进的领域。（伤害严重程度评分大于或等于9或死亡），未转移，成年人在不同经济水平国家的三个城市接受治疗超过1年：（1）加纳库马西：低收入，人均国民生产总值310美元，没有紧急医疗服务;（2）墨西哥蒙特雷：中等收入，国民生产总值3 900美元，基本的紧急医疗服务;和（3）华盛顿的西雅图：高收入，国民生产总值25 000美元，先进的紧急医疗服务。每个城市都有一家主要的创伤医院，从中获得医院数据。这些医院每张病床的年度预算如下：库马西4 100美元;蒙特雷68 000美元;西雅图606 000美元。院前死亡的数据，从生命统计登记处在蒙特雷和西雅图，并通过流行病学调查在库马西。结果：平均年龄（34岁）和损伤机制（79%钝）是相似的，在所有地点。死亡率随着经济水平的提高而下降：库马西（63%的重伤者死亡）、蒙特雷（55%）和西雅图（35%）。这一下降主要是由于院前死亡人数减少。在库马西，51%的重伤者死于战场;在蒙特雷，40%;在西雅图，21%。平均院前时间逐渐下降：库马西（102 +/- 126分钟）>蒙特雷（73 +/- 38分钟）>西雅图（31 +/- 10分钟）。在急诊室死亡的创伤患者的百分比是较高的蒙特雷（11%）比任何库马西（3%）或西雅图（6%）。结论：大多数死亡发生在院前设置，表明在所有经济水平的国家伤害预防的重要性。在低收入和中等收入的发展中国家，改善创伤护理的额外努力应该集中在院前和急诊室护理上。改善急诊室护理在已经建立基本EMS的中等收入国家尤为重要。
Background: Whereas organized trauma care systems have decreased trauma mortality ire the United States, trauma system design has not been well addressed in developing nations. We sought to determine areas in greatest need of improvement in the trauma systems of developing nations.Methods: We compared outcome of all seriously injured (Injury Severity Score greater than or equal to 9 or dead), nontransferred, adults managed over 1 year in three cities in nations at different economic levels: (1) Kumasi, Ghana: low income, gross national product (GNP) per capita of $310, no emergency medical ser,ice (EMS); (2) Monterrey, Mexico: middle income, GNP $3,900, basic EMS; and (3) Seattle, Washington: high income, GNP $25,000, advanced EMS. Each city had one main trauma hospital, from which hospital data were obtained. Annual budgets tin US$) per bed for these hospitals were as follows: Kumasi, $4,100; Monterrey, $68,000; and Seattle, $606,000. Data on prehospital deaths were obtained from vital statistics registries in Monterrey and Seattle, and by an epidemiologic survey in Kumasi.Results: Mean age (34 years) and injury mechanisms (79% blunt) were similar in all locations. Mortality declined with increased economic level: Kumasi (63% of an seriously injured persons died), Monterrey (55%), and Seattle (35%). This decline was primarily due to decreases in prehospital deaths. In Kumasi, 51% of all seriously injured persons died in the field; in Monterrey, 40%; and in Seattle, 21%. Mean prehospital time declined progressively: Kumasi (102 +/- 126 minutes) > Monterrey (73 +/- 38 minutes) > Seattle (31 +/- 10 minutes). Percent of trauma patients dying in the emergency room was higher for Monterrey (11%) than for either Kumasi (3%) or Seattle (6%).Conclusions: The majority of deaths occur in the prehospital setting, indicating the importance of injury prevention in nations at all economic levels. Additional efforts for trauma care improvement in both low-income and middle-income developing nations should focus on prehospital and emergency room care. Improved emergency room care is especially important in middle-income nations which have already established a basic EMS.