Priorities for improving hospital-based trauma care in an African city

Background. This study sought to identify potential cost-effective methods to improve trauma care in hospitals in the developing world. Methods. Injured patients admitted to an urban hospital in Ghana over a 1-y ear period were analyzed prospectively for mechanism of injury, mode of tra nsport to the hospital, injury severity, region of principal injury, operat ions performed, and mortality. In addition, time from injury until arrival at the hospital and time from arrival at the hospital until emergency surge ry were evaluated. Results: Mortality was 9.4%. Most deaths (65%) occurred within 24 hours of admission. Sixty percent of emergency operations were performed over 6 hour s after arrival. Tube thoracostomy was performed on only 13 patients (0.6%) . Only 58% of patients received intravenous crystalloid and only 3.6% recei ved 1 or more units of blood. Conclusion. We identified several specific interventions as potential low-c ost measures to improve hospital-based trauma care in this setting, includi ng shorter times to emergency surgery and improvements in initial resuscita tion. In addition to addressing each of these aspects of trauma care indivi dually, quality improvement programs may represent a feasible and sustainab le method to improve trauma care in hospitals in the developing world.