Influence of Spatial and Temporal Distance of the Hospital on Survival of Patients with Dangerous Injuries Sustained in Traffic Accidents
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Abstract
Background: Effective care of any trauma is a priority in all health care systems. If a patient gets adequate treatment within "golden hour" from the injury the prognosis is better, but not as the only factor. The objective was focused on the influence of time and spacial distance of the hospital from the accident as determinant factors of survival, all in the aim Public Health System of Montenegro reorganisation for better accessibility for traumatized persons from 2011-2020.
Methods: Among 334 subjects, three groups were defined according to the type of injury: bleeding, ashpyxiations, and cranio-cerebral injuries. In every group lethal and non-lethal subjects were analyzed.
Results: Cut-off values are given by ROC curves following proximity and transportation time to hospital specific for injury sustained, as well as for nearest hospital, showed significant differences for proximity of any hospital for bleeding and asphyxiation injuries, and for proximity of any hospital and transportation time to the hospital specific for the sustained cranio-cerebral injury.
Conclusion: Most of the seriously injured patients with bleeding or asphyxiation could be taken care of in any hospital while for cranio-cerebral injuries the specific hospital is crucial. How it is very often about, different organ systems are usualy injured in single patient, so the forming of easily available trauma centers net is the best solution for Montenegro, which is necessary for better survival rates.
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2. Babu BV, Viswanathan K, Ramesh A, et al (2019). An Interventional Study on Com-prehensive Emergency Care and Trauma Registry for Road Traffic Injuries in In-dia: A Protocol. Adv J Emerg Med, 3(4): e50.
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5. Khorasani-Zavareh D, Mohammadi R, Bohm K (2018). Factors influencing pre-hospital care time intervals in Iran: a qualitative study. J Inj Violence Res, 10(2): 83-90.
6. Sánchez-Mangas R, García-Ferrrer A, de Juan A, et al (2010). The probability of death in road traffic accidents. How important is a quick medical response? Accid Anal Prev, 42(4): 1048-56.
7. Newgard CD, Schmicker RH, Hedges JR, et al (2010). Resuscitation Outcomes Consortium Investigators. Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort. Ann Emerg Med, 55(3): 235-246.e4.
8. Lerner EB, Moscati RM (2001). The golden hour: scientific fact or medical "urban legend"? Acad Emerg Med, 8(7): 758-60.
9. Harrington DT, Connolly M, Biffl WL, et al (2005). Transfer times to definitive care facilities are too long: a consequence of an immature trauma system. Ann Surg, 241(6): 961-6; discussion 966-8.
10. Gomes E, Araújo R, Carneiro A, et al (2010). The importance of pre-trauma centre treatment of life-threatening events on the mortality of patients transferred with severe trauma. Resuscitation, 81(4): 440-5.
11. Dinh MM, Bein K, Roncal S, et al (2013). Redefining the golden hour for severe head injury in an urban setting: the effect of prehospital arrival times on patient outcomes. Injury, 44(5): 606-10.
12. Orhon R, Eren SH, Karadayi S, et al (2014). Comparison of trauma scores for pre-dicting mortality and morbidity on trau-ma patients. Ulus Travma Acil Cerrahi Derg, 20(4): 258-64.
13. World Health Organization (2015). Global status report on road safety 2015. World Health Organization, Geneva.
14. Eftekhari A, Dehghani Tafti A, Khorasani-Zavareh D, et al (2019). Root causes of preventable prehospital deaths in road traffic injuries: a systematic review. Trauma Monthly, 24(4): 1–8.
15. Ramadani N, Zhjeqi V, Berisha M, et al (2017). Public health profile of road traf-fic accidents in Kosovo 2010–2015. Mac-edonian J Med Sci, 5(7): 1036–1041.
16. Soori H, Khorasani-Zavareh D (2019). Road traffic injuries measures in the Eastern Mediterranean Region: findings from the Global Status Report on Road Safety-2015. J Inj Violence Res 11(2): 149–158.
17. Alharbi RJ, Lewis V, Mosley I, et al (2020). Current trauma care system in Saudi Ara-bia: A scoping literature review. Accid Anal Prev, 144: 105653.
18. Aljerian N, Alhaidar S, Alothman A, et al (2018). Association between the mode of transport and in-hospital medical compli-cations in trauma patients: findings from a level-I trauma center in Saudi Arabia. Ann Saudi Med, 38(1): 8-14.
19. TŅien K, Bredal IS, Skogstad L, et al (2011). Health related quality of life in trauma pa-tients. Data from a one-year follow up study compared with the general popula-tion. Scand J Trauma Resusc Emerg Med, 19(1): 22.
20. Bhoi S, Singh A, Sinha TP, et al (2018). Magnitude and Spectrum of Injuries Sus-tained in Road Traffic Accidents Among Two Wheeler Riders and Correlation with Helmet Use. J Emerg Trauma Shock, 11(3): 160-164.
21. Fagerlind H, Harvey L, Candefjord S, et al (2019). Does injury pattern among major road trauma patients influence prehospi-tal transport decisions regardless of the distance to the nearest trauma centre? – a retrospective study. Scand J Trauma Resusc Emerg Med, 27(1): 18.
22. Devos S, Van Belleghem G, Pien K, et al (2017). Variations in hospital costs after traffic injuries: The importance of socio-demographic aspects and comorbidities. Injury, 48(10): 2132-2139.
23. Wiratama BS, Chen PL, Chao CJ, et al (2021). Effect of Distance to Trauma Centre, Trauma Centre Level, and Trau-ma Centre Region on Fatal Injuries among Motorcyclists in Taiwan. Int J En-viron Res Public Health, 18(6): 2998.
24. Wright CA, Houseknecht E (2006). A National Evaluation of the Effect of Trauma-Center Care on Mortality. J Trauma Nurs, 13: 150.
25. Feero S, Hedges IJR, Simmons E, et al (1995). Does Out-of-Hospital EMS Time Affect Trauma Survival? Am J Emerg Med, 13: 133–135.
26. Ahuja R, Tiwari G, Bhalla K (2019). Going to the nearest hospital vs. designated trauma centre for road traffic crashes: es-timating the time difference in Delhi, In-dia. Int J Inj Contr Saf Promot, 26(3): 271-282.
27. Coates TJ, Davies G (2002). Prehospital care for road traffic casualities. BMJ, 325(7358): 279.
28. Fagerlind H, Harvey L, Candefjord S, et al (2019). Does injury pattern among major road trauma patients influence prehospi-tal transport decisions regardless of the distance to the nearest trauma centre? - a retrospective study. Scand J Trauma Resusc Emerg Med, 27(1): 18.
29. Newgard CD, Sears GK, Rea TD, et al.(2008). The Resuscitation Outcomes Consortium Epistry-Trauma: Design, Development, and Implementation of a North American Epidemiologic Pre-hospital Trauma Registry. Resuscitation, 78(2): 170-178.
30. Stiell IG, Nesbitt LP, Pickett W, et al.(2008). The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ, 178(9): 1141–1152.
31. Polytrauma Guideline Update Group (2018). Level 3 guideline on the treatment of pa-tients with severe/multiple injuries: AWMF Register-Nr. 012/019. Eur J Trauma Emerg Surg, 44(Suppl 1): 3-271.
2. Babu BV, Viswanathan K, Ramesh A, et al (2019). An Interventional Study on Com-prehensive Emergency Care and Trauma Registry for Road Traffic Injuries in In-dia: A Protocol. Adv J Emerg Med, 3(4): e50.
3. World Health Organization (2018). Global status report on road safety 2018: summary. World Health Organization, Geneva.
4. Bayiga Zziwa E, Muhumuza C, Muni KM, et al (2019). Road traffic injuries in Uganda: pre-hospital care time intervals from crash scene to hospital and related fac-tors by the Uganda Police. Int J Inj Contr Saf Promot, 26(2): 170-175.
5. Khorasani-Zavareh D, Mohammadi R, Bohm K (2018). Factors influencing pre-hospital care time intervals in Iran: a qualitative study. J Inj Violence Res, 10(2): 83-90.
6. Sánchez-Mangas R, García-Ferrrer A, de Juan A, et al (2010). The probability of death in road traffic accidents. How important is a quick medical response? Accid Anal Prev, 42(4): 1048-56.
7. Newgard CD, Schmicker RH, Hedges JR, et al (2010). Resuscitation Outcomes Consortium Investigators. Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort. Ann Emerg Med, 55(3): 235-246.e4.
8. Lerner EB, Moscati RM (2001). The golden hour: scientific fact or medical "urban legend"? Acad Emerg Med, 8(7): 758-60.
9. Harrington DT, Connolly M, Biffl WL, et al (2005). Transfer times to definitive care facilities are too long: a consequence of an immature trauma system. Ann Surg, 241(6): 961-6; discussion 966-8.
10. Gomes E, Araújo R, Carneiro A, et al (2010). The importance of pre-trauma centre treatment of life-threatening events on the mortality of patients transferred with severe trauma. Resuscitation, 81(4): 440-5.
11. Dinh MM, Bein K, Roncal S, et al (2013). Redefining the golden hour for severe head injury in an urban setting: the effect of prehospital arrival times on patient outcomes. Injury, 44(5): 606-10.
12. Orhon R, Eren SH, Karadayi S, et al (2014). Comparison of trauma scores for pre-dicting mortality and morbidity on trau-ma patients. Ulus Travma Acil Cerrahi Derg, 20(4): 258-64.
13. World Health Organization (2015). Global status report on road safety 2015. World Health Organization, Geneva.
14. Eftekhari A, Dehghani Tafti A, Khorasani-Zavareh D, et al (2019). Root causes of preventable prehospital deaths in road traffic injuries: a systematic review. Trauma Monthly, 24(4): 1–8.
15. Ramadani N, Zhjeqi V, Berisha M, et al (2017). Public health profile of road traf-fic accidents in Kosovo 2010–2015. Mac-edonian J Med Sci, 5(7): 1036–1041.
16. Soori H, Khorasani-Zavareh D (2019). Road traffic injuries measures in the Eastern Mediterranean Region: findings from the Global Status Report on Road Safety-2015. J Inj Violence Res 11(2): 149–158.
17. Alharbi RJ, Lewis V, Mosley I, et al (2020). Current trauma care system in Saudi Ara-bia: A scoping literature review. Accid Anal Prev, 144: 105653.
18. Aljerian N, Alhaidar S, Alothman A, et al (2018). Association between the mode of transport and in-hospital medical compli-cations in trauma patients: findings from a level-I trauma center in Saudi Arabia. Ann Saudi Med, 38(1): 8-14.
19. TŅien K, Bredal IS, Skogstad L, et al (2011). Health related quality of life in trauma pa-tients. Data from a one-year follow up study compared with the general popula-tion. Scand J Trauma Resusc Emerg Med, 19(1): 22.
20. Bhoi S, Singh A, Sinha TP, et al (2018). Magnitude and Spectrum of Injuries Sus-tained in Road Traffic Accidents Among Two Wheeler Riders and Correlation with Helmet Use. J Emerg Trauma Shock, 11(3): 160-164.
21. Fagerlind H, Harvey L, Candefjord S, et al (2019). Does injury pattern among major road trauma patients influence prehospi-tal transport decisions regardless of the distance to the nearest trauma centre? – a retrospective study. Scand J Trauma Resusc Emerg Med, 27(1): 18.
22. Devos S, Van Belleghem G, Pien K, et al (2017). Variations in hospital costs after traffic injuries: The importance of socio-demographic aspects and comorbidities. Injury, 48(10): 2132-2139.
23. Wiratama BS, Chen PL, Chao CJ, et al (2021). Effect of Distance to Trauma Centre, Trauma Centre Level, and Trau-ma Centre Region on Fatal Injuries among Motorcyclists in Taiwan. Int J En-viron Res Public Health, 18(6): 2998.
24. Wright CA, Houseknecht E (2006). A National Evaluation of the Effect of Trauma-Center Care on Mortality. J Trauma Nurs, 13: 150.
25. Feero S, Hedges IJR, Simmons E, et al (1995). Does Out-of-Hospital EMS Time Affect Trauma Survival? Am J Emerg Med, 13: 133–135.
26. Ahuja R, Tiwari G, Bhalla K (2019). Going to the nearest hospital vs. designated trauma centre for road traffic crashes: es-timating the time difference in Delhi, In-dia. Int J Inj Contr Saf Promot, 26(3): 271-282.
27. Coates TJ, Davies G (2002). Prehospital care for road traffic casualities. BMJ, 325(7358): 279.
28. Fagerlind H, Harvey L, Candefjord S, et al (2019). Does injury pattern among major road trauma patients influence prehospi-tal transport decisions regardless of the distance to the nearest trauma centre? - a retrospective study. Scand J Trauma Resusc Emerg Med, 27(1): 18.
29. Newgard CD, Sears GK, Rea TD, et al.(2008). The Resuscitation Outcomes Consortium Epistry-Trauma: Design, Development, and Implementation of a North American Epidemiologic Pre-hospital Trauma Registry. Resuscitation, 78(2): 170-178.
30. Stiell IG, Nesbitt LP, Pickett W, et al.(2008). The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ, 178(9): 1141–1152.
31. Polytrauma Guideline Update Group (2018). Level 3 guideline on the treatment of pa-tients with severe/multiple injuries: AWMF Register-Nr. 012/019. Eur J Trauma Emerg Surg, 44(Suppl 1): 3-271.
| Files | ||
| Issue | Vol 51 No 10 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i10.10987 | |
| Keywords | ||
| Trauma center Golden hour Injuries Emergency Traffic accidents Health care system | ||
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How to Cite
1.
Pelicic D, Ristic B, Radojevic N, Djonovic N, Radevic S. Influence of Spatial and Temporal Distance of the Hospital on Survival of Patients with Dangerous Injuries Sustained in Traffic Accidents. Iran J Public Health. 2022;51(10):2289-2297.
