Trauma care systems in urban Latin America : the priorities should be prehospital and emergency room management.
Western Trauma Association. Annual meeting. Big Sky MT USA, 1995/02/25.
Trauma is a significant cause of premature death in developing nations, but financial resources to deal with it are extremely limited.
To determine which segments of a developing nation's trauma system would be most amenable to improvements, we compared management and outcome of all seriously injured patients treated over 1 year by the trauma systems associated with an urban hospital in Latin America, Regional Trauma Center 21 (n=545) in Monterrey, Mexico, and a level I trauma center in the United States, Harborview Medical Center (n=533) in Seattle, Wash.
Mortality was higher in Monterrey (55%) than in Seattle (34%, p<0.001), because of a preponderance of prehospital and emergency room (ER) deaths.
In Monterrey, 40% of seriously injured patients died in the field and 11% in the ER, compared with 21% in the field and 6% in the ER in Seattle (p<0.001).
There were significant differences in prehospital care between the two trauma systems.
Scene and transport times were<30 minutes for 47% of Monterrey cases vs. 75% in Seattle (p<0.001).
The observed mortality patterns indicate that priorities for trauma system improvement in urban Latin America should focus on more rapid prehospital transport and improved en route and ER resuscitation.
Such improvements would likely decrease overall mortality, and be less expensive than enhancing expensive intensive care capabilities and other hospital-based technologies.
Mots-clés Pascal : Traumatisme, Homme, Etude comparative, Evaluation, Qualité, Système santé, Mexique, Amérique Centrale, Amérique, Pays en développement, Etats Unis, Amérique du Nord, SAMU, Urgence
Mots-clés Pascal anglais : Trauma, Human, Comparative study, Evaluation, Quality, Health system, Mexico, Central America, America, Developing countries, United States, North America, Emergency medical care unit, Emergency
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0000377
Code Inist : 002B27B14C. Création : 01/03/1996.