Reducing Prehospital Time: Systematic Review

Research has shown that a significant contributor to trauma deaths in LMICs is prehospital deaths which occur following a crash but before the patient can be admitted to hospital. It is estimated that the proportion of trauma patients who die before reaching hospital in LICs is more than twice as high as in HICs [1]. For example, a study by Mock et al. [2] compared trauma mortality patterns across regions in three different countries (USA, Mexico, and Ghana) and found that in Kumasi, Ghana, prehospital deaths occurred in 51% of all seriously
injured patients, whereas in Seattle, USA, 21% of patients died before reaching hospital. The study also found prehospital times to increase as country income level decreased: the average prehospital time was 31 minutes in Seattle, 73 minutes in Monterrey, Mexico, and 102 minutes in Kumasi, Ghana. The summarised results from this study are presented in Table 1. This study highlights the adverse effects of prolonged prehospital times that occur in LMICs due to lack of available transportation and long distances from hospitals.
The results from the studies included in the systematic review were fairly consistent. Most studies found a significant association between prehospital time and mortality, and the results that were significant all found that longer prehospital times increased risk of death, regardless of the time interval used in the analysis. The average odds ratios across the studies ranged from 1.5 to 4.6, meaning trauma patients were 1.5 to 4.6 times more likely to die as a result of
their injuries if they experienced delays to hospital compared to those who were not delayed.