M. A. Boeck1, S. South2, E. Foianini3, L. Jauregui4, O. Morales Guitierrez3, G. Toledo5, J. Camacho Mansilla6, P. Mercado7, A. Haider8, M. Swaroop2 1New York Presbyterian Hospital-Columbia,Department Of Surgery,New York, NY, USA 2Feinberg School Of Medicine – Northwestern University,Division Of Trauma/Critical Care,Chicago, IL, USA 3Clinical Foianini,Santa Cruz De La Sierra, SANTA CRUZ, Bolivia 4Hospital De Niños Mario Ortiz Suarez,Santa Cruz De La Sierra, SANTA CRUZ, Bolivia 5Hospital San Juan De Dios,Santa Cruz De La Sierra, SANTA CRUZ, Bolivia 6Hospital Japones,Santa Cruz De La Sierra, SANTA CRUZ, Bolivia 7Hospital Municipal Plan 3000,Santa Cruz De La Sierra, SANTA CRUZ, Bolivia 8Center For Surgery And Public Health,Brigham And Women’s Hospital,Boston, MA, USA
Introduction: The critical first hour post-injury, when patient care impacts survival most, is considered the “Golden Hour” in trauma. In Bolivia and other lower-resource settings, access to trauma care is difficult due to the absence of an integrated trauma system. This study sought to assess time to hospital presentation after injury and associated factors using hospital-based trauma registries from Santa Cruz, Bolivia.
Methods: Injured patients presenting to one of five participating hospital emergency rooms (ER) were entered into a trauma registry. Data were assessed from October 2015 to February 2017. Inclusion criteria required the date and time of both the injury event and hospital presentation, and that the injury preceded hospital arrival.
Results: Of the N=6,449 registered trauma patients, N=5,113 were included for analysis. Median time to hospital presentation was 2.0 hours (IQR 0.83, 9.7). Most injuries occurred at home (37.1%) or in the street (30.5%). Median patient age presenting to the hospital ≤1 hour from the injury event was 24 years (10, 39) vs. 26 years (13, 43) for those arriving >1 hour, with a majority of men in both groups (≤1 hour: 62.1% vs. >1 hour: 64.2%). Patients who arrived >1 hour since the injury were more likely to be referred/transferred than those who arrived sooner (26.5% vs. 8.1%, p<0.001). Only the second-level, public hospital located in the city’s periphery reported a slight majority of patients arriving ≤1 hour (51.7%). Transport factors affecting time of arrival are shown in Table 1, which indicates potentially quicker hospital arrival by private car or taxi versus ambulance or public transport. Vital signs and Glasgow Coma Scale scores on hospital arrival did not clinically significantly differ between the two patient groups. A majority of patients in both groups were discharged home from the ER, however a greater proportion of patients presenting >1 hour from their injury were admitted to the hospital versus those presenting ≤1 hour (23.3% vs. 14.5%, p<0.001).
Conclusion: One-third of trauma patients reached the hospital within an hour of injury, usually by private car or taxi, suggesting a moderate level of access to timely care in this sprawling urban area in Bolivia. Ambulance transport and certain hospitals were associated with later arrival. It is imperative to identify, isolate, and mitigate elements that impede prompt medical attention, and monitor the effect of corrective interventions on patient outcomes for effective trauma system development.
