Pre-Hospital Factors that Lead to Increased Mortality and Morbidity in Trauma Patients in Developing Countries: A Systematic Review

Abstract

Trauma is a growing global concern and the WHO estimates that injuries account for one-sixth of the global adult disease burden. Furthermore, there is a disproportionate number of trauma related deaths that occur lower middle-income countries compared to higher income countries. Studies show that deficiencies in care in preventable related deaths include pre-hospital delays, delays in treatment and inadequate resuscitation. Additionally, most trauma related deaths occur in the prehospital setting and it is in the lower to middle income countries where structured emergency medical services are lacking. This review seeks to identify and categorize the contributing prehospital factors that lead to increased mortality and morbidity in trauma patients in developing countries. A systematic review was performed using primary journal articles (written in English) that report pre-hospital interventions and morbidity and mortality outcomes in trauma patients in developing countries. PubMed/MEDLINE and other literature databases were used to locate these primary journal articles by utilizing combinations of search terms “developing countries (MeSH),” “Emergency Medical Services (MeSH),” “pre-hospital emergency response,” and “third world countries.” Our analysis found that patients who experienced a prehospital delay had an 86% increase in mortality. Regarding prehospital care, which was not a well-defined factor across all three papers, one papers found that patients who did not experience adequate prehospital care had a 226% increase in mortality while the other papers only included frequency rates of interventions and corresponding data on mortality. Regarding intubation, one study showed that prehospital intubation was associated with increased mortality compared to emergency department intubation. This study adds to the scarce literature how a lack of prehospital infrastructure is associated with an increased likelihood of mortality. It also highlights the importance and necessity of an increase in quality primary research conducted in developing countries. Only prehospital delay had enough papers with data and thus was the only factor we were able to perform a meta-analysis. Our analysis found that patients who experienced a prehospital delay had an 86% increase in mortality.