TRAUMA BARE SYSTEMS IN URBAN LATIN-AMERICA - THE PRIORITIES SHOULD BEPREHOSPITAL AND EMERGENCY ROOM MANAGEMENT

Trauma is a significant cause of premature death in developing nations , but financial resources to deal with it are extremely limited. To de termine 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 (Injury Severity Score of greater than or equal to 9 or died) treated over 1 year by the trauma systems assoc iated 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. M ortality was higher in Monterrey (55%) than in Seattle (34%, p < 0.001 ), because of a preponderance of prehospital and emergency room (ER) d eaths. In Monterrey, 40% of seriously injured patients died in the fie ld 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 prehospi tal care between the two trauma systems. Scene and transport times wer e <30 minutes for 47% of Monterrey cases vs. 75% in Seattle (p < 0.001 ). For patients with arrival blood pressure <80, prehospital intubatio ns had been performed on 5% of Monterrey patients vs. 79% in Seattle ( p < 0.001) and en route fluid resuscitation administered to 70% of Mon terrey patients vs. 99% in Seattle (p < 0.001). The observed mortality patterns indicate that priorities for trauma system improvement in ur ban Latin America should focus on more rapid prehospital transport and improved en route and ER resuscitation. Such improvements would likel y decrease overall mortality, and be less expensive than enhancing exp ensive intensive care capabilities and other hospital-based technologi es.