Disparities in outcome of trauma

There are notable disparities in mortality rates for injured patients around the world. For example, one study looked at the mortality rates for all seriously injured adults (injury severity score of 9 or more) in three cities, in countries at different economic levels. The mortality rate (including both pre-hospital and inhospital deaths) rose from 35% in a high-income setting to 55% in a middle-income setting, to 63% in a low-income setting (/). Considering only patients who survive to reach the hospital, a similar study demonstrated a six-fold increase in mortality for patients with injuries of moderate severity (injury severity score of 15-24). Such mortality increased from 6% in a hospital in a high-income country to 36% in a rural area of a low-income country (2).

In addition to an excess mortality, there is a tremendous burden of disability from extremity injuries in many developing countries (2, 3). By comparison, head and spinal cord injuries contribute a greater percentage of disability in high-income countries (4). Much of the disability from extremity injuries in developing countries should be eminently preventable through inexpensive improvements in orthopaedic care and rehabilitation.

In part, the improved survival and functional outcome among injured patients in developed countries comes from high-cost equipment and technology. Unfortunately, much of this may be unaffordable to the average injured person in the world for the foreseeable future. However, much of the improvement in patient outcome in higher-income countries has come from improvements in the organization of trauma care services (5—9). Improvement in the organization of trauma services should be achievable in almost every setting and may represent a cost-effective way of improving patient outcomes. This is the basis of the Essential Trauma Care Project. Before going into further detail about the plans for the project itself, it is useful to briefly examine some of the difficulties facing trauma care in developing countries that might be improved upon in an inexpensive fashion through improvements in organization and planning.

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