Lack of Prioritization Causes Extended Time to Assessment of Severely Injured Trauma Patients in a Resource-Scarce Emergency Department

Abstract

Introduction:

The time between injury and medical intervention is crucial in trauma care. Triage is essential to ensure prioritization and timely assessment of injured patients.

Aim:

To investigate how the lack of triage system impacts timely intervention in a sub-Saharan hospital emergency department, and to investigate potential benefits of triage towards efficient management of trauma patients.

Methods:

A prospective study including adult trauma patients admitted to the emergency department at Moi Teaching and Referral Hospital in Eldoret, Kenya, was conducted. Mode of arrival, vital parameters, time before physician’s assessment, and mortality were registered. Retrospectively, Injury Severity Score (ISS) was calculated, and patients were categorized according to the Rapid Emergency Triage and Treatment System (RETTS).

Results:

A total of 571 patients were analyzed, revealing a mean ISS of 12.2 (SD 7.7) and a mean length of stay of 11.6 (SD 18.3) days. 70% of the patients arrived by taxi, private car, or police car; only 17.6% were transported by ambulance. RETTS categorization was compared with ISS using a Kruskal-Wallis test with Dunn’s multiple comparisons post-test. A higher average ISS was found in the red category compared to other categories (H(df) = 24.47(4), p < 0.001). A Spearman correlation test between ISS and time to assessment revealed an r value of −0.041 (p = 0.43).

Discussion:

The results clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. Since there was no difference in time to assessment regardless of ISS, the need for a triage system is apparent. Currently, the implementation and evaluation of a validated triage tool at the emergency department are underway. Moreover, the finding that less than 18% of trauma patients are transported to the emergency department by ambulance illustrates the need to develop prehospital care systems.