Khan Salma, Zafar Hasnain, Zafar Syed Nabeel, Haroon Naveed
Department of Surgery, Memon Medical Institute, Karachi, Pakistan,
World J Surg. 2014 Feb;38(2):281-6. doi: 10.1007/s00268-013-2308-y.
Outcomes of surgical emergencies are associated with promptness of the appropriate surgical intervention. However, delayed presentation of surgical patients is common in most developing countries. Delays commonly occur due to transfer of patients between facilities. The aim of the present study was to assess the effect of delays in treatment caused by inter-facility transfers of patients presenting with surgical emergencies as measured by objective and subjective parameters.
We prospectively collected data on all patients presenting with an acute surgical emergency at Aga Khan University Hospital (AKUH). Information regarding demographics, social class, reason and number of transfers, and distance traveled were collected. Patients were categorized into two groups, those transferred to AKUH from another facility (transferred) and direct arrivals (non-transfers). Differences between presenting physiological parameters, vital statistics, and management were tested between the two groups by the chi square and t tests.
Ninety-nine patients were included, 49 (49.5 %) patients having been transferred from another facility. The most common reason for transfer was "lack of satisfactory surgical care." There were significant differences in presenting pulse, oxygen saturation, respiratory rate, fluid for resuscitation, glasgow coma scale, and revised trauma score (all p values <0.001) between transferred and non-transferred patients. In 56 patients there was a further delay in admission, and the most common reason was bed availability, followed by financial constraints. Three patients were shifted out of the hospital due to lack of ventilator, and 14 patients left against medical advice due to financial limitations. One patient died.
Inter-facility transfer of patients with surgical emergencies is common. These patients arrive with deranged physiology which requires complex and prolonged hospital care. Patients who cannot afford treatment are most vulnerable to transfers and delays.
外科急症的治疗结果与适当手术干预的及时性相关。然而，在大多数发展中国家，外科患者延迟就诊的情况很常见。延迟通常是由于患者在不同医疗机构之间的转运所致。本研究的目的是通过客观和主观参数评估因医疗机构间转运而导致的手术急症患者治疗延迟的影响。
我们前瞻性地收集了阿迦汗大学医院（AKUH）所有急性外科急症患者的数据。收集了有关人口统计学、社会阶层、转运原因和次数以及行程距离的信息。患者分为两组，即从其他医疗机构转至AKUH的患者（转院患者）和直接前来就诊的患者（非转院患者）。通过卡方检验和t检验比较两组患者就诊时的生理参数、生命体征和治疗情况的差异。
共纳入99例患者，其中49例（49.5%）是从其他医疗机构转来的。最常见的转院原因是“缺乏令人满意的外科治疗”。转院患者和非转院患者在就诊时的脉搏、血氧饱和度、呼吸频率、复苏液体量、格拉斯哥昏迷量表评分和修订创伤评分方面存在显著差异（所有p值均<0.001）。56例患者入院进一步延迟，最常见的原因是床位可用性，其次是经济限制。3例患者因缺乏呼吸机而转出医院，14例患者因经济限制自行出院。1例患者死亡。
外科急症患者在医疗机构间的转运很常见。这些患者就诊时生理功能紊乱，需要复杂且长期的住院治疗。无力支付治疗费用的患者最容易受到转运和延迟的影响。
