Abebe Yonas, Dida Tolesa, Yisma Engida, Silvestri David M
Department of Emergency and Critical Care Nursing, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Emerg Med. 2018 Feb 13;18(1):7. doi: 10.1186/s12873-018-0158-5.
Africa accounts for one sixth of global road traffic deaths-most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined.
This is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months. Emergency Department triage records were used to abstract clinical and arrival characteristics, including acuity. The outcome of interest was ambulance arrival. Secondary outcomes of interest were inter-facility referral and referral communication. Descriptive and multivariable statistics were computed to identify factors independently associated with outcomes.
Over half of patients arrived with either high (13.1%) or moderate (42.2%) acuity. Over half (59.0%) arrived by ambulance, and nearly two thirds (65.9%) were referred. Among referred patients, inter-facility communication was poor (57.7%). Patients with high acuity were most likely to be referred (aOR 2.20, 95%CI 1.16-4.17), but were not more likely to receive ambulance transport (aOR 1.56, 95%CI 0.86-2.84) or inter-facility referral communication (aOR 0.98, 95%CI 0.49-1.94) than those with low acuity. Nearly half (40.2%) of all patients were referred by ambulance despite having low acuity.
Despite ambulance expansion in Addis Ababa, ambulance use among RTC patients remains heavily concentrated among those with low-acuity. Inter-facility referral appears a primary contributor to low-acuity ambulance use. In other contexts, similar routine ambulance monitoring may help identify low-value utilization. Regional guidelines may help direct ambulance use where most valuable, and warrant further evaluation.
非洲的道路交通死亡人数占全球的六分之一，其中大多数发生在院前阶段。相对于其他院前运输方式，救护车运输成本较高，但在时间敏感、高 acuity 场景中具有优势。包括埃塞俄比亚在内的许多国家正在扩大救护车车队，但使用救护车的患者的临床特征仍不明确。
这是一项对埃塞俄比亚亚的斯亚贝巴一家单一创伤转诊中心在 7 个月内收治的 662 例道路交通碰撞（RTC）患者进行的横断面研究。急诊科分诊记录用于提取临床和到达特征，包括 acuity。感兴趣的结局是救护车到达情况。感兴趣的次要结局是机构间转诊和转诊沟通。计算描述性和多变量统计数据以确定与结局独立相关的因素。
超过一半的患者以高（13.1%）或中（42.2%） acuity 到达。超过一半（59.0%）的患者乘坐救护车到达，近三分之二（65.9%）的患者被转诊。在被转诊的患者中，机构间沟通较差（57.7%）。高 acuity 患者最有可能被转诊（调整后比值比 2.20，95%置信区间 1.16 - 4.17），但与低 acuity 患者相比，接受救护车运输（调整后比值比 1.56，95%置信区间 0.86 - 2.84）或机构间转诊沟通（调整后比值比 0.98，95%置信区间 0.49 - 1.94）的可能性并不更高。尽管 acuity 较低，但所有患者中有近一半（40.2%）通过救护车被转诊。
尽管亚的斯亚贝巴的救护车数量有所增加，但 RTC 患者中救护车的使用仍主要集中在低 acuity 患者中。机构间转诊似乎是低 acuity 患者使用救护车的主要原因。在其他情况下，类似的常规救护车监测可能有助于识别低价值利用情况。区域指南可能有助于指导在最有价值的地方使用救护车，并值得进一步评估。
