Citation

Lin N, Nwanna-Nzewunwa O, Carvalho M, Wange A, Ajiko MM, Juillard C, Dicker RA. World J. Surg. 2019; ePub(ePub): ePub.

Affiliation

Division of Surgical Critical Care, Department of Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA. rdicker@mednet.ucla.edu.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00268-019-05095-8

PMID

31388707

Abstract

INTRODUCTION: Over 90% of injury-related deaths occur in low- and middle-income countries. Relating spatial distribution of injury burden and trauma care capacity is crucial for effective resource allocation. Our study assesses trauma burden and emergency and essential surgical care (EESC) quality in Teso Sub-region Eastern Uganda through a spatial analysis of trauma burden in relation to surgical capacity at the district level.

METHODS: In this study, we surveyed trauma patients presenting at Soroti Regional Referral Hospital (SRRH) and assessed EESC capacity of district hospitals. We used geospatial techniques to relate trauma burden and capacity and characterized delay using the three-delay framework.

RESULTS: We surveyed 131 trauma patients presenting to SRRH for trauma-related injuries from June 1 to July 15, 2017. Almost all trauma incidents (n = 129, 98.4%) occurred within a 2-h ideal drive time to SRRH. From time of injury to receiving care, median time totaled to approximately 9.25 h. District hospital exhibited decreased EESC capacity (personnel, infrastructure, procedures, equipment, and supplies (PIPES) score range 2.2-5.5, mean 4.2) compared to SRRH (PIPES score 8.1).

CONCLUSION: Trauma patients face delays in each step of the care-seeking process from deciding to seek care, arriving at care site, and receiving treatment. Synergistic effects of a poor prehospital care, EESC deficiencies on district and regional levels, cost of seeking care contribute to delays that likely result in increased morbidity and mortality. Improved resource allocation, training at the district level, and strengthening system-level organization of emergency medical services could avert preventable death and disability.

Language: en